Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials

Author:

Santschi Valérie123,Chiolero Arnaud1,Colosimo April L.4,Platt Robert W.5,Taffé Patrick1,Burnier Michel2,Burnand Bernard1,Paradis Gilles5

Affiliation:

1. Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland

2. Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland

3. La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland

4. McGill Library, Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada

5. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada

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 ( RCT s) 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 RCT s 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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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