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Type: Artigo de periódico
Title: Sensitivity of patient outcomes to pharmacist interventions. Part II: Systematic review and meta-analysis in hypertension management
Author: Machado, M
Bajcar, J
Guzzo, GC
Einarson, TR
Abstract: BACKGROUND: Hypertension is a major health concern worldwide due to its deleterious impact. Few studies have quantitatively assessed pharmacists' interventions in hypertensive patients. OBJECTIVES: To identify and quantify outcomes sensitive to pharmacists' interventions. METHODS: Intemational Pharmaceutical Abstracts, MEDLINE, Cochrane Central, and EMBASE were searched from inception through December 2006. Two independent reviewers identified articles; results were compared and resolved through consensus. Data extracted included intervention type, patient numbers, demographics, study characteristics, instruments used, data compared, and outcomes reported. A random effects meta-analysis was used to combine data. Study quality was assessed using the Downs-Black scale. RESULTS: Of 203 potential articles identified, 98 were selected and their abstracts were read. Nine of these were reviewed full-text and 19 more were identified from references, resulting in a total of 28 articles. Research designs included 18 randomized controlled trials, 6 single-arm clinical trials, 3 nonrandomized comparative trials, and 1 database study. Average quality score was 66% +/- 12% (fair). Medication management (82%) and hypertension education (68%) were the interventions most used. Thirty-nine study results (57% of all outcomes evaluated) were sensitive to pharmacists' interventions. Meta-analysis of 2246 patents in 13 studies found that pharmacists' interventions significantly reduced systolic blood pressure (10.7 +/- 11.6 mm Hg; p = 0.002), while controls remained unchanged (3.2 +/- 12.1 mm Hg; p = 0.361). Pharmacists' interventions further reduced systolic blood pressure (6.9 12.1 mm Hg; p = 0.047) over controls. Nonsensitive results included further reduction in diastolic blood pressure (3.6 +/- 3.7 mm Hg; p = 0.06), quality of life (1 of 8 significant), and adherence (5 of 13 significant). CONCLUSIONS: Systolic blood pressure is sensitive to pharmacists' interventions. Other outcomes may also be sensitive; however, more high-quality studies are needed for a comprehensive quantitative assessment.
Subject: hypertension
pharmaceutical care
pharmacist intervention
Country: EUA
Editor: Harvey Whitney Books Co
Rights: fechado
Identifier DOI: 10.1345/aph.1K311
Date Issue: 2007
Appears in Collections:Artigos e Materiais de Revistas Científicas - Unicamp

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