Skip to main content

The impact of the clinical pharmacist-led interventions in China: A systematic review and Meta-Analysis

Abstract

Background The clinical pharmacist has been an important partner in clinical treatment team. In China, there is no systematic review to evaluate the effectiveness of clinical pharmacy services on patients’ outcomes such as hospitalization days, readmission rate and mortality. Aim of the review To investigate the impact of clinical pharmacist services on patients’ length of hospitalization, readmission and mortality in China. Methods A literature search was performed in PubMed, EMBASE, Cochrane Library, clinicaltrials.gov, and a Chinese database (up to January 2019). Randomized control trials or pre- to post-intervention comparison studies were included to investigate the impact of clinical pharmacist-led interventions on the length of stay, readmission rate and mortality of inpatients. Basic information, intervention and therapeutic area were extracted. Results After screening all articles from the mentioned databases, 14 studies were included for meta- analysis and subgroup analysis. Most studies focused on cardiology and respiratory diseases. Results show that clinical pharmacist services can reduce the length of stay of inpatients (MD: − 3.00, 95% CI − 4.72 to − 1.29, P < 0.01) and the readmission rate (RR 0.44, 95% CI 0.35–0.56, P < 0.01) as well as the mortality of patients during hospitalization (RR 0.57, 95% CI 0.35–0.92, P = 0.02). Conclusions Clinical pharmacist-led interventions could significantly reduce Chinese patients’ length of hospitalization and readmission rate. More studies are needed to confirm the relationship between the clinical pharmacist-led interventions and patients’ mortality.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. Penm J, Li Y, Zhai S, Hu Y, Chaar B, Moles R. The impact of clinical pharmacy services in China on the quality use of medicines: a systematic review in context of China’s current healthcare reform. Health Policy Plan. 2014;29(7):849–72.

    PubMed  Article  Google Scholar 

  2. Rodrigues CR, Harrington AR, Murdock N, Holmes JT, Borzadek EZ, Calabro K, et al. Effect of pharmacy-supported transition-of-care interventions on 30-day readmissions: a systematic review and meta-analysis. Ann Pharmacother. 2017;51(10):1060028017712725.

    Article  Google Scholar 

  3. Thomas R, Huntley AL, Mann M, Huws D, Elwyn G, Paranjothy S, et al. Pharmacist-led interventions to reduce unplanned admissions for older people: a systematic review and meta-analysis of randomised controlled trials. Age Ageing. 2013;43(2):174–87.

    PubMed  Article  Google Scholar 

  4. Wu Y, Yan Q. Review and reflection on the development of clinical pharmacy in China. Chin J Clin Pharmacy. 2014;23(01):1–8. https://doi.org/10.19577/j.cnki.issn10074406.2014.01.001.

    Article  Google Scholar 

  5. Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019;394(10204):1192–204.

    PubMed  Article  Google Scholar 

  6. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

    PubMed  PubMed Central  Article  Google Scholar 

  7. Wells GSB, O’Connell D, Peterson J, Welch V, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [abstract]. In: 3rd symposium on systematic reviews: beyond the basics. 2000 Jul 3–5:UK2000. p. 2015.

  8. Li JL, Fu Y, Qin SB, Liang GK, Liu J, Nie XY, et al. Association between P2RY12 gene polymorphisms and adverse clinical events in coronary artery disease patients treated with clopidogrel: a systematic review and meta-analysis. Gene. 2018;657:69–80.

    CAS  PubMed  Article  Google Scholar 

  9. Shen J, Sun Q, Zhou X, Wei Y, Qi Y, Zhu J, et al. Pharmacist interventions on antibiotic use in inpatients with respiratory tract infections in a Chinese hospital. Int J Clin Pharm. 2011;33(6):929–33.

    PubMed  Article  Google Scholar 

  10. Zhang C, Zhang L, Huang L, Luo R, Wen J. Clinical pharmacists on medical care of pediatric inpatients: a single-center randomized controlled trial. PLoS ONE. 2012;7(1):e30856.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. Xin C, Ge X, Yang X, Lin M, Jiang C, Xia Z. The impact of pharmaceutical care on improving outcomes in patients with type 2 diabetes mellitus from China: a pre- and postintervention study. Int J Clin Pharm. 2014;36(5):963–8.

    PubMed  Article  Google Scholar 

  12. Zhai XB, Tian DD, Liu XY. The role of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a prospective, nonrandomized controlled trial using propensity score methods. Int J Clin Pharmacol Ther. 2015;53(3):220–9.

    CAS  PubMed  Article  Google Scholar 

  13. Xin C, Xia Z, Jiang C, Lin M, Li G. The impact of pharmacist-managed clinic on medication adherence and health-related quality of life in patients with COPD: a randomized controlled study. Patient Prefer Adherence. 2016;10:1197–203.

    PubMed  PubMed Central  Article  Google Scholar 

  14. Limei Y, Fangwei C, Jie Z. Analysis on application of nutritional support on acute pancreatitis before and after the intervention implemented by clinical pharmacists. Eval Anal Drug Hosp China. 2017;17(10):1437–9.

    Google Scholar 

  15. Lili P. Analysis of clinical efficacy in children with asthmatic disease on clinical pharmacy intervention medication. Anti-Infect Pharm. 2015;12(1):037–9.

    Google Scholar 

  16. Heng G, Tiying D, Xiongjie Y, Juan T, Miaomiao G, Lijun D, et al. Establishment and evaluation of integrated pharmaceutical care on COPD patients. Chin J Pharmacoepidemiol. 2018;27(6):414–8.

    Google Scholar 

  17. Zhongjian Z, Wenyan W, Huiyong H, Wenlin S, Cuizhu W, Deqin C. Pharmacist intervention in spontaneous intracerebral hemorrhage. Chin Hosp Pharm J. 2018;38(5):529–32.

    Google Scholar 

  18. Jie J, Xiaying S, Xiaying S, Ling W, Nannan S. Comparative study on effects of pharmaceutical intervention on clinical therapy for pulmonary tuberculosis patients complicated with diabetes mellitus. Chin J Mod Appl Pharm. 2017;34(2):288–92.

    Google Scholar 

  19. Ying Z, Hua-guang W, Li-hong L. Effects of clinical pharmacists participate in the therapy of liver transplantation. Clin Medicat J. 2017;15(2):67–70.

    Google Scholar 

  20. Jin P, Meixia L, Fengyuan C, Zhengrong L, Zonglin Z, Zengcheng S, et al. Effect evaluation of clinical pharmacists participating in clinical pathway management for chronic heart failure. China Pharm. 2017;28(23):3277–81.

    Google Scholar 

  21. Yu-ling H, Wei-jie L, Jia-yong L, Hui-min H, Xing-yi C, Wen-zhu Z. Clinical pharmacists participating in managing patients with chronic heart failure. Cent South Pharm. 2016;14(5):551–4.

    Google Scholar 

  22. Shuang C, Xuefeng J, Rui G, Lin L. Effects evaluation of clinical pharmacists participating in disease management of chronic heart failure. China Pharm. 2016;27(35):5021–3.

    Google Scholar 

  23. Deters MA, Laven A, Castejon A, Doucette WR, Ev LS, Krass I, et al. Effective interventions for diabetes patients by community pharmacists: a meta-analysis of pharmaceutical care components. Ann Pharmacother. 2018;52(2):198–211.

    PubMed  Article  Google Scholar 

  24. Renaudin P, Boyer L, Esteve MA, Bertault-Peres P, Auquier P, Honore S. Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(6):1660–73.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Dawoud DM, Smyth M, Ashe J, Strong T, Wonderling D, Hill J, et al. Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis. Res Soc Adm Pharm RSAP. 2018. https://doi.org/10.1016/j.sapharm.2018.10.006.

    Article  Google Scholar 

  26. Rodrigues CR, Harrington AR, Murdock N, Holmes JT, Borzadek EZ, Calabro K, et al. Effect of pharmacy-supported transition-of-care interventions on 30-day readmissions: a systematic review and meta-analysis. Ann Pharmacother. 2017;51(10):866–89.

    PubMed  Article  Google Scholar 

  27. Viswanathan M, Kahwati LC, Golin CE, Blalock SJ, Coker-Schwimmer E, Posey R, et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Internal Med. 2015;175(1):76–87.

    Article  Google Scholar 

  28. Jokanovic N, Tan EC, Sudhakaran S, Kirkpatrick CM, Dooley MJ, Ryan-Atwood TE, et al. Pharmacist-led medication review in community settings: an overview of systematic reviews. Res Soc Adm Pharm RSAP. 2017;13(4):661–85.

    Article  Google Scholar 

  29. Hatah E, Braund R, Tordoff J, Duffull SB. A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. Br J Clin Pharmacol. 2014;77(1):102–15.

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

We like to thank all the authors whose articles are referenced in our study.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Xiao-yan Nie or Yi-min Cui.

Ethics declarations

Funding

This research was funded by Beijing Municipal Natural Science Foundation, Grant Number 7184223.

Conflicts of interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Qin, Sb., Zhang, Xy., Fu, Y. et al. The impact of the clinical pharmacist-led interventions in China: A systematic review and Meta-Analysis. Int J Clin Pharm 42, 366–377 (2020). https://doi.org/10.1007/s11096-020-00972-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-00972-y

Keywords

  • China
  • Clinical pharmacist
  • Length of stay
  • Mortality
  • Readmission rate