Cargando…

Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials

BACKGROUND: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential...

Descripción completa

Detalles Bibliográficos
Autores principales: Santschi, Valérie, Chiolero, Arnaud, Colosimo, April L., Platt, Robert W., Taffé, Patrick, Burnier, Michel, Burnand, Bernard, Paradis, Gilles
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187511/
https://www.ncbi.nlm.nih.gov/pubmed/24721801
http://dx.doi.org/10.1161/JAHA.113.000718
_version_ 1782338186379264000
author Santschi, Valérie
Chiolero, Arnaud
Colosimo, April L.
Platt, Robert W.
Taffé, Patrick
Burnier, Michel
Burnand, Bernard
Paradis, Gilles
author_facet Santschi, Valérie
Chiolero, Arnaud
Colosimo, April L.
Platt, Robert W.
Taffé, Patrick
Burnier, Michel
Burnand, Bernard
Paradis, Gilles
author_sort Santschi, Valérie
collection PubMed
description BACKGROUND: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. METHODS AND RESULTS: Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty‐nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (−7.6 mm Hg, 95% CI: −9.0 to −6.3; I(2)=67%) and diastolic BP (−3.9 mm Hg, 95% CI: −5.1 to −2.8; I(2)=83%). The 95% PI ranged from −13.9 to −1.4 mm Hg for systolic BP and from −9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. CONCLUSIONS: Pharmacist interventions – alone or in collaboration with other healthcare professionals – improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost‐effective, and least time‐consuming intervention should be addressed with further research.
format Online
Article
Text
id pubmed-4187511
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Blackwell Publishing Ltd
record_format MEDLINE/PubMed
spelling pubmed-41875112014-11-03 Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials Santschi, Valérie Chiolero, Arnaud Colosimo, April L. Platt, Robert W. Taffé, Patrick Burnier, Michel Burnand, Bernard Paradis, Gilles J Am Heart Assoc Original Research BACKGROUND: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. METHODS AND RESULTS: Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty‐nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (−7.6 mm Hg, 95% CI: −9.0 to −6.3; I(2)=67%) and diastolic BP (−3.9 mm Hg, 95% CI: −5.1 to −2.8; I(2)=83%). The 95% PI ranged from −13.9 to −1.4 mm Hg for systolic BP and from −9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. CONCLUSIONS: Pharmacist interventions – alone or in collaboration with other healthcare professionals – improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost‐effective, and least time‐consuming intervention should be addressed with further research. Blackwell Publishing Ltd 2014-04-25 /pmc/articles/PMC4187511/ /pubmed/24721801 http://dx.doi.org/10.1161/JAHA.113.000718 Text en © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/3.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Santschi, Valérie
Chiolero, Arnaud
Colosimo, April L.
Platt, Robert W.
Taffé, Patrick
Burnier, Michel
Burnand, Bernard
Paradis, Gilles
Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
title Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
title_full Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
title_fullStr Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
title_full_unstemmed Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
title_short Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials
title_sort improving blood pressure control through pharmacist interventions: a meta‐analysis of randomized controlled trials
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187511/
https://www.ncbi.nlm.nih.gov/pubmed/24721801
http://dx.doi.org/10.1161/JAHA.113.000718
work_keys_str_mv AT santschivalerie improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT chioleroarnaud improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT colosimoaprill improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT plattrobertw improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT taffepatrick improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT burniermichel improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT burnandbernard improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials
AT paradisgilles improvingbloodpressurecontrolthroughpharmacistinterventionsametaanalysisofrandomizedcontrolledtrials