Practice-based pharmaceutical services: a systematic review

Abstract

Abstract Background General practice-based pharmaceutical services are increasingly common, ranging from global medication changes (eg, generic switch) to individual patient medication review and educational interventions. Aim To conduct a systematic review of the effectiveness of practice-based pharmaceutical interventions. Design A systematic review of general practice-based pharmaceutical services. Setting General practice in the UK, Australia, Canada, Scandinavia and the US. Outcome measures The effect and cost of practice-based pharmaceutical services. Methods Electronic databases were searched and pharmaceutical organisations were contacted. Studies fulfilling the review criteria were considered for inclusion. Duplicate independent data screening and abstraction was undertaken. Three indicators were used to assess the quality of included studies: method of random allocation; allocation concealment; and proportion of subjects followed to the end of the study. Results A total of 2,707 references were identified: 256 full publications were retrieved and 16 randomised, controlled trials (RCTs) met the inclusion criteria. Included studies assessed either the professional interface (educational outreach and general prescribing advice) or the patient interface (medication review and patient-specific prescribing advice). Three trials included all three quality markers. Most studies were effective in achieving one or more of the desired outcomes from pharmaceutical intervention. Two trials showed no statistically significant differences between the study and control groups post intervention. Conclusions Many evaluations of practice-based pharmaceutical s***érvices have been published but few meet recognised standards of trial methodology. The results of this review suggest that practice-based pharmaceutical services are effective in achieving desired changes; however, more robust evidence is needed to confirm whether they are effective, efficient and sustainable.