Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials.

TitreImproving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials.
Publication TypeJournal Article
Year of Publication2014
AuthorsSantschi, V, Chiolero, A, Colosimo, AL, Platt, RW, Taffé, P, Burnier, M, Burnand, B, Paradis, G
JournalJournal of the American Heart Association
Volume3
Issue2
Paginatione000718
Date Published04/2014
DOI10.1161/JAHA.113.000718
ISSN2047-9980 (Electronic)
Mots-clésAntihypertensive Agents, Blood Pressure, Community Pharmacy Services, Cooperative Behavior, Health Knowledge, Attitudes, Practice, Humans, Hypertension, Interdisciplinary Communication, Medication Therapy Management, Patient Care Team, Patient Education as Topic, Pharmacists, Professional Role, Randomized Controlled Trials as Topic, Treatment Outcome
Abstract

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.

Notes

Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: epublish PDF : Original Research

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/24721801?dopt=Abstract

WOS ID (UT)

000336798000041

Alternate JournalJ Am Heart Assoc
Citation Key / SERVAL ID3560
Peer reviewRefereed
PubMed ID24721801
PubMed Central IDPMC4187511
Grant List / / Canadian Institutes of Health Research / Canada

                         

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