Investigating Sources of Heterogeneity in Randomized Controlled Trials of the Effects of Pharmacist Interventions on Glycemic Control in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies. METHODS: A comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses. RESULTS: The literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression. CONCLUSIONS: Our findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients or with higher baseline HbA1c levels may be the main beneficiaries of pharmacist care. PROTOCOL PROSPERO REGISTRATION NUMBER: CRD42014007457.

Assessment of pharmacist's recommendation of non-prescription medicines in Brazil: a simulated patient study.

BACKGROUND: The number of medicines available without a prescription has increased in Brazil as elsewhere. The Brazilian National Health Surveillance Agency recently passed a resolution emphasizing the role of Brazilian pharmacists in promoting rational use of medicines. However, evidence that Brazilian pharmacists monitor the use of non-prescription medicines in the community promoting rational use of medicines is lacking. OBJECTIVE: To assess practice behavior of pharmacists in Brazil when providing nonprescription medicines in the community pharmacy setting. SETTING: The study was conducted in 25 community pharmacies from a city of Aracaju in Brazil. METHODS: Simulated patients visited a convenience sample of 25 pharmacies twice from March to July 2010. During the visits, simulated patients enacted two standardized scenarios: treatment for a persistent headache and childhood diarrhea accompanied by fever. The interactions with the pharmacists were audiovisually recorded using a hidden micro camera. Recordings were later used to fill out a questionnaire designed to evaluate practice behavior of community pharmacists. MAIN OUTCOME MEASURE: The communication and counseling skills of pharmacists in the recommendation of non-prescription medicines, aiming at the rational use of medicines. RESULTS: Pharmacists in the study spent on average 1.5 min counseling the simulated patient. At least one question was asked to assess signs and symptoms in 50.0 % of the simulated patient visits in the headache scenario and in 56.0 % of visits in the childhood diarrhea scenario. Non-pharmacological treatment was suggested in 25 % of visits in the childhood diarrhea scenario. During the counseling process, no pharmacist advised the simulated patient about possible drug interactions, adverse reactions and what to do if the patient forgot to take the medicine. The pharmacists had low scores in measures of non-verbal communication. The sample of this study presented poor communication skills, compromising the treatment of the patients. CONCLUSION: This study showed that the pharmacists' counseling in the simulated patient assessment was insufficient, indicating a need for substantial improvement in practice behavior.