The impact of clinical pharmacists in improving Jordanian patients' health outcomes.

OBJECTIVES: To assess the impacts of clinical pharmacists on Jordanian patients' health outcomes. Methods: A systematic review was conducted until July 2016 within EBSCO, Pubmed, Cochrane database, and ISI Web of Knowledge. Published studies evaluating the benefit of clinical pharmacy services on therapeutic, safety, humanistic, and economic outcomes in hospital or community settings in Jordan were targeted. Two reviewers independently extracted and assessed risk of bias using a pre-published validated tool. The literature search identified 130 publications of which 21 full texts met predetermined inclusion criteria. Results: Studies were of moderate quality. Pharmacist interventions resulted in an average reduction (95% CI) in systolic blood pressure of 5.45 mm Hg (2.95-7.92) and diastolic blood pressure of 3.03 mm Hg (1.09-4.96). The mean reduction in glycosylated hemoglobin was 0.75% (-0.49-1.99) and fasting blood sugar was 36.73 mg/dl (-19.7-93.1). The average reduction in low-density lipoprotein cholesterol was 2.36 (1.8-16.62) mg/dl and triglycerides was 20.16 (6.14-46.47). There was a minimal increase in the level of high-density lipoprotein cholesterol of 1.24 (1.64-4.11) mg/dl. Effects on safety along with humanistic and economic outcomes and long term effects remained unclear.  Conclusion: Published evidence from Jordan highlights service opportunities for clinical pharmacists. Favorable but not always statistically significant impacts were found on therapeutic outcomes. More studies are needed to understand safety, humanistic, economic, and long-term outcomes. Therefore, the add-on benefits of this service to the health system are not well understood. Future studies of higher rigor and multi-perspective outcomes are mandated.