Skip to main content
Log in

Mapping the characteristics of meta-analyses of pharmacy services: a systematic review

  • Review Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background: Suboptimal meta-analyses with misleading conclusions are frequently published in the health areas, and they can compromise decision making in clinical practice. Aim of the review: This systematic review aimed to map the characteristics of published meta-analyses of pharmacy services and their association with the study conclusions. Method: We searched electronic databases (PubMed, Scopus, and Web of Science) to identify published meta-analyses of pharmacy services up to January 2019. Components of meta-analyses were extracted (i.e. studies’ metadata; methods used in the systematic review; description of the statistical model used for the meta-analysis; main results; conflict of interest and funding source). The methodological quality was evaluated using the R-AMSTAR tool. Results: A total of 85 meta-analyses were included, with 2016 as the median publication year. Overall, the methodological quality of meta-analyses of pharmacy services was considered suboptimal. Only one-third of authors registered a protocol; complete search strategy and raw data were provided by 55.3% and 9.4% of studies, respectively. Evidence strength (GRADE) was evaluated in only 19.2% of studies. PRISMA and Cochrane recommendations were stated to be followed in 60% and 27.4% of articles, respectively. Around half of studies performed sensitivity analysis, however, the prediction interval was presented by only one meta-analysis. Studies that favoured the pharmacists’ interventions poorly discussed the methodological quality and heterogeneity of primary trials. Conclusion: Poor conduction and reporting were observed in meta-analyses of pharmacy services, especially in those that favoured the pharmacist’s interventions. Reproducibility and transparency should be rigorously ensured by journal editors and peer-reviewers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Ioannidis JP. Meta-analyses can be credible and useful: a new standard. JAMA Psychiatry. 2017;74(4):311–2.

    Article  PubMed  Google Scholar 

  2. van Wely M. The good, the bad and the ugly: meta-analyses. Hum Reprod. 2014;29(8):1622–6.

    Article  PubMed  Google Scholar 

  3. Lau J, Ioannidis JPA, Schmid CH. Summing up evidence: one answer is not always enough. Lancet. 1998;351(9096):123–7.

    Article  CAS  PubMed  Google Scholar 

  4. Cronin P, Rawson JV, Heilbrun ME, Lee JM, Kelly AM, Sanelli PC, et al. How to critically appraise the clinical literature. Acad Radiol. 2014;21(9):1117–28.

    Article  PubMed  Google Scholar 

  5. Group ECW. Protect us from poor-quality medical research. Hum Reprod. 2018;33(5):770–6.

    Article  Google Scholar 

  6. Ioannidis JP. The mass production of redundant, misleading, and conflicted system. Milbank Memorial Fund. 2016;94(3):485–514.

    Google Scholar 

  7. Macleod MR, Michie S, Roberts I, Dirnagl U, Chalmers I, Ioannidis JPA, et al. Biomedical research: increasing value, reducing waste. Lancet. 2014;383(9912):101–4.

    Article  PubMed  Google Scholar 

  8. Rotta I, Salgado TM, Silva ML, Correr CJ, Fernandez-Llimos F. Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000–2010). Int J Clin Pharm. 2015;37(5):687–97.

    Article  CAS  PubMed  Google Scholar 

  9. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0: Cochrane2011.

  10. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G, Chew L, et al. From systematic reviews to clinical recommendations for evidence-based health care: validation of revised assessment of multiple systematic reviews (r-amstar) for grading of clinical relevance. Open Dent J. 2010;4:84–91.

    PubMed  PubMed Central  Google Scholar 

  12. Mendes AM, Tonin FS, Buzzi MF, Pontarolo R, Fernandez-Llimos F. Mapping pharmacy journals: a lexicographic analysis. Res Social Adm Pharm. 2019;15(12):1464–71.

    Article  PubMed  Google Scholar 

  13. Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffe P, Burnier M, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3(2):e000718.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Page MJ, Shamseer L, Altman DG, Tetzlaff J, Sampson M, Tricco AC, et al. Epidemiology and reporting characteristics of systematic reviews of biomedical research: a cross-sectional study. PLoS Med. 2016;13(5):e1002028.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tonin FS, Steimbach LM, Mendes AM, Borba HH, Pontarolo R, Fernandez-Llimos F. Mapping the characteristics of network meta-analyses on drug therapy: a systematic review. PLoS ONE. 2018;13(4):e0196644.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Ioannidis JP, Greenland S, Hlatky MA, Khoury MJ, Macleod MR, Moher D, et al. Increasing value and reducing waste in research design, conduct, and analysis. Lancet (London, England). 2014;383(9912):166–75.

    Article  Google Scholar 

  17. Bennet D, Bennet A. The depth of knowledge: surface, shallow or deep? VINE. 2008;38(4):406–20.

    Google Scholar 

  18. Minguet F, Salgado TM, Santopadre C, Fernandez-Llimos F. Redefining the pharmacology and pharmacy subject category in the journal citation reports using medical subject headings (MeSH). Int J Clin Pharm. 2017;39(5):989–97.

    Article  CAS  PubMed  Google Scholar 

  19. Salgado TM, Fernandez-Llimos F. Missing pharmacy-specific medical subject headings (MeSH) terms: problems and solutions. RSAP. 2019;15(9):1189–90.

    PubMed  Google Scholar 

  20. Melchiors AC, Correr CJ, Venson R, Pontarolo R. An analysis of quality of systematic reviews on pharmacist health interventions. Int J Clin Pharm. 2012;34(1):32–42.

    Article  PubMed  Google Scholar 

  21. Cebron Lipovec N, Zerovnik S, Kos M. Pharmacy-supported interventions at transitions of care: an umbrella review. Int J Clin Pharm. 2019;41(4):831–52.

    Article  PubMed  Google Scholar 

  22. MacLure K, Paudyal V, Stewart D. Reviewing the literature, how systematic is systematic? Int J Clin Pharm. 2016;38(3):685–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Gagnier JJ, Kellam PJ. Reporting and methodological quality of systematic reviews in the orthopaedic literature. J Bone Joint Surg Am Vol. 2013;95(11):e771–e77777.

    Article  Google Scholar 

  24. Peters JP, Hooft L, Grolman W, Stegeman I. Reporting quality of systematic reviews and meta-analyses of otorhinolaryngologic articles based on the PRISMA statement. PLoS ONE. 2015;10(8):e0136540.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, et al. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ (Clin Res Ed). 2014;348:g3804.

    Google Scholar 

  26. Tam WW, Lo KK, Khalechelvam P. Endorsement of PRISMA statement and quality of systematic reviews and meta-analyses published in nursing journals: a cross-sectional study. BMJ OPEN. 2017;7(2):e013905.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tunis AS, McInnes MD, Hanna R, Esmail K. Association of study quality with completeness of reporting: have completeness of reporting and quality of systematic reviews and meta-analyses in major radiology journals changed since publication of the PRISMA statement? Radiology. 2013;269(2):413–26.

    Article  PubMed  Google Scholar 

  28. Iqbal SA, Wallach JD, Khoury MJ, Schully SD, Ioannidis JP. Reproducible research practices and transparency across the biomedical literature. PLoS Biol. 2016;14(1):e1002333.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. McGowan J, Sampson M. Systematic reviews need systematic searchers. JMLA. 2005;93(1):74–80.

    PubMed  PubMed Central  Google Scholar 

  30. Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):245.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lam MT, De Longhi C, Turnbull J, Lam HR, Besa R. Has embase replaced MEDLINE since coverage expansion? JMLA. 2018;106(2):227–34.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013;50(5):587–92.

    Article  PubMed  Google Scholar 

  33. Wong IC. Randomised controlled trials (RCTs) to evaluate complex healthcare interventions—a case study. PWS. 2004;26(5):247–52.

    PubMed  Google Scholar 

  34. Bonetti AF, Reis WC, Mendes AM, Rotta I, Tonin FS, Fernandez-Llimos F, et al. Impact of pharmacist-led discharge counseling on hospital readmission and emergency department visits: a systematic review and meta-analysis. J Hospital Med. 2019;14:E1–E8.

    Google Scholar 

  35. Delaney A, Bagshaw SM, Ferland A, Laupland K, Manns B, Doig C. The quality of reports of critical care meta-analyses in the cochrane database of systematic reviews: an independent appraisal. Crit Care Med. 2007;35(2):589–94.

    Article  PubMed  Google Scholar 

  36. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ (Clin Res Ed). 2014;348:g1687.

    Google Scholar 

  37. Borenstein M, Higgins JP, Hedges LV, Rothstein HR. Basics of meta-analysis: I(2) is not an absolute measure of heterogeneity. Res Synth Methods. 2017;8(1):5–18.

    Article  PubMed  Google Scholar 

  38. Borestein M, Hedges LV, Higgins JP, Rothstein HR. Prediction intervals. In: Introduction to meta-analysis. Chichester: Wiley; 2009.

    Chapter  Google Scholar 

  39. IntHout J, Ioannidis JP, Rovers MM, Goeman JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016;6(7):e010247.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Purdy S, Little M, Mayes C, Lipworth W. Debates about conflict of interest in medicine: deconstructing a divided discourse. J Bioeth Inq. 2017;14(1):135–49.

    Article  PubMed  Google Scholar 

  41. Minkoff H, Ecker J. When guild interests and professional obligations collide. Obstet Gynecol. 2017;130(2):454–7.

    Article  PubMed  Google Scholar 

  42. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Greenwald AG, Banaji MR. Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychol Rev. 1995;102(1):4–27.

    Article  CAS  PubMed  Google Scholar 

  44. Page MJ, Altman DG, Shamseer L, McKenzie JE, Ahmadzai N, Wolfe D, et al. Reproducible research practices are underused in systematic reviews of biomedical interventions. J Clin Epidemiol. 2018;94:8–18.

    Article  PubMed  Google Scholar 

  45. Charrois TL, Zolezzi M, Koshman SL, Pearson G, Makowsky M, Durec T, et al. A systematic review of the evidence for pharmacist care of patients with dyslipidemia. Pharmacotherapy. 2012;32(3):222–33.

    Article  PubMed  Google Scholar 

  46. 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 Intern Med. 2015;175(1):76–877.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge the Program of Postgraduate in Pharmaceutical Sciences, Federal University of Parana, for allowing us to perform this study. Aline F. Bonetti acknowledges Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES) for her Ph.D. Grant.

Funding

AFB obtained a Doctoral Grant from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Funding Code 001.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fernando Fernandez‐Llimos.

Ethics declarations

Conflicts of interest

The authors declare no conflict of interest other than being pharmacists and pharmacy practice researchers.

Additional information

Publisher's Note

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

Fernando Fernandez‐Llimos and Roberto Pontarolo are principal investigators in this study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 206 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bonetti, A.F., Della Rocca, A.M., Lucchetta, R.C. et al. Mapping the characteristics of meta-analyses of pharmacy services: a systematic review. Int J Clin Pharm 42, 1252–1260 (2020). https://doi.org/10.1007/s11096-020-01058-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-01058-5

Keywords

Navigation