Advertisement

International Journal of Clinical Pharmacy

, Volume 34, Issue 1, pp 32–42 | Cite as

An analysis of quality of systematic reviews on pharmacist health interventions

  • Ana Carolina MelchiorsEmail author
  • Cassyano Januário Correr
  • Rafael Venson
  • Roberto Pontarolo
Review Article

Abstract

Background In the past 20 years, many studies have evaluated the impact of pharmaceutical practices on clinical, humanistic and economic outcomes. However, few studies have critically analysed the primary studies and published reviews regarding pharmaceutical practices. Aim of the Review The aim of this review is to assess the quality of systematic reviews and meta-analysis on pharmacist health interventions published from 1990 to 2009. Method The data sources used were MEDLINE, Cochrane Library, International Pharmaceutical Abstracts, Latin American and Caribbean Health Sciences, Scientific Electronic Library Online, and Scopus. Studies in which interventions were done by a pharmacist or in which the pharmacist was a health team member were included. There were no restrictions based on the type of intervention, country or languages. The data extracted by two independent reviewers were the following: publication journal, language, publication year, search strategy, study design, quality assessment of the included studies, disease, study settings, intervention description, and outcome measures. The methodological quality of systematic reviews was accessed with AMSTAR. Results A total of 151 articles were found from which 31 were included. An increase in the number of publications occurred after 2005. Nineteen reviews evaluated the quality of primary studies, and 6 of these reviews performed meta-analyses. The methodological quality of reviews was considered to be moderate (52.8 ± 22.3% for reviewer #1 and 54.8 ± 16.5% for reviewer #2); of the 31 included reviews, 7, 18 and 6 reviews had high, moderate and poor quality, respectively. Conclusion The quality of published reviews varies from moderate to poor. Improvements in the study design can be achieved by following specific recommendations, such as clearly describing the methods, performing the data extraction in duplicate, researching at least two databases, listing the included and excluded studies, employing tables with the main studies data and evaluating and reporting the scientific quality of the included articles.

Keywords

Meta-analysis Methodological quality Pharmacist Pharmacist interventions Quality assessment Pharmaceutical care Pharmaceutical services Systematic reviews 

Notes

Acknowledgments

The authors gratefully acknowledge the Program of Pharmaceutical Sciences and the Federal University of Paraná for supporting this research.

Funding

None.

Conflicts of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.PubMedGoogle Scholar
  2. 2.
    Fundación Pharmaceutical Care España. Manual de procedimentos en Atención Farmacéutica. Barcelona: PhCE. 1999;ISBN: 84-699-1180-5.Google Scholar
  3. 3.
    Kennie NR, Schuster BG, Einarson TR. Critical analysis of the pharmaceutical care research literature. Ann Pharmacother. 1998;32(1):17–26.PubMedCrossRefGoogle Scholar
  4. 4.
    Rangel Mayoral JF, Luis Fernandez J, Liso Rubio FJ. Current research status in pharmaceutical care. Farm Hosp. 2005;29(5):335–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Roughead EE, Semple SJ, Vitry AI. Pharmaceutical care services: a systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes. Int J Pharm Pract. 2005;13(1):53–70.CrossRefGoogle Scholar
  6. 6.
    Shea B, Dubé C, Moher D. Assessing the quality of reports of systematic reviews: the QUOROM statement compared to other tools. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. London: BMJ Books; 2001. p. 122–39.CrossRefGoogle Scholar
  7. 7.
    Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol. 1991;44(11):1271–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Oxman AD, Guyatt GH, Singer J, Goldsmith CH, Hutchison BG, Milner RA, et al. Agreement among reviewers of review articles. J Clin Epidemiol. 1991;44(1):91–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC. Meta-analyses of randomized controlled trials. N Engl J Med. 1987;316(8):450–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.PubMedCrossRefGoogle Scholar
  11. 11.
    Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62(10):1013–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst. 2006;4:20.PubMedCrossRefGoogle Scholar
  13. 13.
    Shojania KG, Bero LA. Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy. Eff Clin Pract. 2001;4(4):157–62.PubMedGoogle Scholar
  14. 14.
    Kozma CM. Outcomes research and pharmacy practice. Am Pharm. 1995;NS36(7):34–40.Google Scholar
  15. 15.
    Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009] The Cochrane Collaboration;2009. Available from: http:\\www.cochrane-handbook.org.
  16. 16.
    Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS One. 2007;2(12):e1350.PubMedCrossRefGoogle Scholar
  17. 17.
    Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ. 2009;87(5):353–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Dent LA, Harris KJ, Noonan CW. Tobacco interventions delivered by pharmacists: a summary and systematic review. Pharmacotherapy. 2007;27(7):1040–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Finley PR, Crismon ML, Rush AJ. Evaluating the impact of pharmacists in mental health: a systematic review. Pharmacotherapy. 2003;23(12):1634–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Hanlon JT, Lindblad CI, Gray SL. Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults? Am J Geriatr Pharmacother. 2004;2(1):3–13.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Pickard AS, Hung SY. An update on evidence of clinical pharmacy services’ impact on health-related quality of life. Ann Pharmacother. 2006;40(9):1623–34.PubMedCrossRefGoogle Scholar
  23. 23.
    Singhal PK, Raisch DW, Gupchup GV. The impact of pharmaceutical services in community and ambulatory care settings: evidence and recommendations for future research. Ann Pharmacother. 1999;33(12):1336–55.PubMedCrossRefGoogle Scholar
  24. 24.
    Wubben DR, Vivian EM. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review. Pharmacotherapy. 2008;28(4):421–36.PubMedCrossRefGoogle Scholar
  25. 25.
    Blenkinsopp A, Anderson C, Armstrong M. Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease. J Public Health Med. 2003;25(2):144–53.PubMedCrossRefGoogle Scholar
  26. 26.
    Blenkinsopp A, Hassey A. Effectiveness and acceptability of community pharmacy-based interventions in type 2 diabetes: a critical review of intervention design, pharmacist and patient perspectives. Int J Pharm Pract. 2005;13(4):231–40.CrossRefGoogle Scholar
  27. 27.
    Fish A, Watson MC, Bond CM. Practice-based pharmaceutical services: a systematic review. Int J Pharm Pract. 2002;10(4):225–33.CrossRefGoogle Scholar
  28. 28.
    Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol. 2008;65(3):303–16.PubMedCrossRefGoogle Scholar
  29. 29.
    Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev. 2004;(1):CD003698.Google Scholar
  30. 30.
    Zermansky AG, Silcock J. Is medication review by primary-care pharmacists for older people cost effective? A narrative review of the literature, focusing on costs and benefits. PharmacoEconomics. 2009;27(1):11–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Bell S, McLachlan AJ, Aslani P, Whitehead P, Chen TF. Community pharmacy services to optimise the use of medications for mental illness: A systematic review. Aust New Zealand Health Policy. 2005;2(1).Google Scholar
  32. 32.
    Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother. 2009;43(6):1096–106.PubMedCrossRefGoogle Scholar
  33. 33.
    Ellitt GR, Brien JA, Aslani P, Chen TF. Quality patient care and pharmacists’ role in its continuity—a systematic review. Ann Pharmacother. 2009;43(4):677–91.PubMedCrossRefGoogle Scholar
  34. 34.
    Ponniah A, Anderson B, Shakib S, Doecke CJ, Angley M. Pharmacists’ role in the post-discharge management of patients with heart failure: a literature review. J Clin Pharm Ther. 2007;32(4):343–52.PubMedCrossRefGoogle Scholar
  35. 35.
    Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687–94.PubMedCrossRefGoogle Scholar
  36. 36.
    Pickard AS, Johnson JA, Farris KB. The impact of pharmacist interventions on health-related quality of life. Ann Pharmacother. 1999;33(11):1167–72.PubMedCrossRefGoogle Scholar
  37. 37.
    Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging. 2003;20(11):817–32.PubMedCrossRefGoogle Scholar
  38. 38.
    Von Gunten V, Reymond JP, Beney J. Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. Pharm World Sci. 2007;29(3):146–63.CrossRefGoogle Scholar
  39. 39.
    Verrue CLR, Petrovic M, Mehuys E, Remon JP, Vander Stichele R. Pharmacists’ interventions for optimization of medication use in nursing homes: a systematic review. Drugs Aging. 2009;26(1):37–49.PubMedCrossRefGoogle Scholar
  40. 40.
    Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. J Clin Pharm Ther. 2006;31(5):409–19.PubMedCrossRefGoogle Scholar
  41. 41.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569–82.PubMedCrossRefGoogle Scholar
  42. 42.
    Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007;41(11):1770–81.PubMedCrossRefGoogle Scholar
  43. 43.
    Machado M, Nassor N, Bajcar JM, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother. 2008;42(9):1195–207.PubMedCrossRefGoogle Scholar
  44. 44.
    Sanghera N, Chan PY, Khaki ZF, Planner C, Lee KK, Cranswick NE, et al. Interventions of hospital pharmacists in improving drug therapy in children: a systematic literature review. Drug Saf. 2006;29(11):1031–47.PubMedCrossRefGoogle Scholar
  45. 45.
    Van Wijk BLG, Klungel OH, Heerdink ER, De Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother. 2005;39(2):319–28.PubMedCrossRefGoogle Scholar
  46. 46.
    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.PubMedCrossRefGoogle Scholar
  47. 47.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Williams L, Lowenthal DT. Drug therapy in the elderly. South Med J. 1992;85(2):127–31.PubMedCrossRefGoogle Scholar
  49. 49.
    Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7(27):iii–x, 1–173.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Ana Carolina Melchiors
    • 1
    • 2
    Email author
  • Cassyano Januário Correr
    • 3
  • Rafael Venson
    • 4
  • Roberto Pontarolo
    • 3
  1. 1.Health Science Department, Pharmacy Practice Research GroupFederal University of Espírito SantoSão MateusBrazil
  2. 2.Pharmacy DepartmentUniversity Center North of Espírito Santo, Federal University of Espírito SantoSão MateusBrazil
  3. 3.Pharmacy Department, Pharmacy Practice Research GroupFederal University of ParanáParanáBrazil
  4. 4.Department of PharmacyFederal University of ParanáParanáBrazil

Personalised recommendations