Cost effectiveness of preventive interventions in type 2 diabetes mellitus: a systematic literature review

A systematic review of the literature was conducted to give an overview of economic evaluations of preventive interventions in type 2 diabetes mellitus. The interventions were sorted by type of preventive intervention (primary, secondary or tertiary) and by category (e.g. education, medication for hypertension). Several databases were searched for studies published between January 1990 and May 2004 on the three types of preventive intervention. For each study selected, inclusion of specific components from a standardised list of items, including quality, was recorded in a database. Summary tables were generated based on the database.A number of conclusions were drawn from this review. The most important was that strict blood pressure control was a more cost-effective intervention than less strict control, as shown by six studies reporting cost savings to very low costs per life-year gained. Primary and secondary prevention of type 2 diabetes were also highly cost effective, but these results were based on very few studies. Medications to reduce weight and hyperglycaemia together were cost effective compared with conventional interventions. Finally, the separate results regarding medications to reduce weight, hyperglycaemia and hypercholesterolaemia varied enormously, thus no conclusion could be drawn and further economic analysis is required.     

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

Background Clinical and cost-effectiveness evidence are needed to justify the existence or extension of routine clinical pharmacy services in hospital settings. Previous reviews have indicated that clinical pharmacist interventions are likely to have a positive economic impact on hospital budgets but highlighted issues relating to the quality of studies. Aim of the review The primary aim of this review was to feature economic evaluations of clinical pharmacy services which targeted hospital inpatients. The review focused on the current cost-effectiveness status of different services, in addition to evaluating the quality of individual studies. Results of this systematic review were compared with cost-effectiveness and quality related findings of reviews which considered earlier time frames and alternative settings. Methods A systematic review of the literature included a review of the following databases: Academic Search Complete, Cochrane Library, EconLit, Embase Elsevier, NHS Economic Evaluation Database and PubMed. Only studies with an economic assessment of a clinical pharmacy service provided in a hospital setting were included. Data relating to the cost-effectiveness was extracted from eligible studies. Methodologies employed and overall quality of the studies was also reviewed. A grading system was applied to determine the quality of studies. Consolidated Health Economic Evaluation Reporting Standards statement was employed to determine which aspects of a high quality health economic study were employed. Results Twenty studies were deemed eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15 %) were deemed to be “good-quality” studies. No ‘novel’clinical pharmacist intervention was identified during the course of this review. Conclusions Clinical pharmacy interventions continue to provide cost savings. However, the standard of studies published has stagnated or even deteriorated in comparison with those included in previous reviews. Utilisation of published guidelines at initial stages of future studies may help improve the overall quality of studies.     

Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis

BackgroundControl of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures.ObjectiveTo review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence.MethodsSix databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies.ResultsFifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) ?0.68; 95% CI -0.79, ?0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions.ConclusionThis finding supports the role of the pharmacist in diabetes care to enhance medication adherence.     

Potentially inappropriate prescribing for adults living with diabetes mellitus: a scoping review

Background

People living with diabetes often experience multiple morbidity and polypharmacy, increasing their risk of potentially inappropriate prescribing. Inappropriate prescribing is associated with poorer health outcomes.

Aim

The aim of this scoping review was to explore and map studies conducted on potentially inappropriate prescribing among adults living with diabetes and to identify gaps regarding identification and assessment of potentially inappropriate prescribing in this group.

Method

Studies that reported any type of potentially inappropriate prescribing were included. Studies conducted on people aged?<?18 years or with a diagnosis of gestational diabetes or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases.

Results

Of the 190 included studies, the majority (63.7%) were conducted in high-income countries. None of the studies used an explicit tool specifically designed to identify potentially inappropriate prescribing among people with diabetes. The most frequently studied potentially inappropriate prescribing in high-income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying drug-drug interactions. The specific events and conditions that were considered as inappropriate were inconsistent across studies.

Conclusion

Contraindications, prescribing omissions and dosing problems were the most commonly studied types of potentially inappropriate prescribing. Prescribers should carefully consider the individual prescribing recommendations of medications. Future studies focusing on the development of explicit tools to identify potentially inappropriate prescribing for adults living with diabetes are needed.

     

A systematic review of interventions for homeless alcohol-abusing adults

Aims: To compile and critically analyse published research on interventions with alcohol-abusing homeless adults. Methods: A systematic review was conducted of research published utilising the MEDLINE, EMBASE, PsycInfo, CINAHL and SocIndex databases from inception to March 2015. A meta-analysis was performed on studies that met the inclusion criteria, to determine if there were any significant pre- and post-intervention effects on alcohol-use. Results: Seventeen studies from three continents were included in this systematic review. A meta-analysis of pre- and post-intervention effects on alcohol use across the 17 studies found highly significant effects (p?<?0.001). A smaller subset of studies (n?=?10), where the same specific alcohol use outcome measurement was employed across all studies, also showed highly significant pre–post intervention effects (p?<?0.001). Results indicate that a range of interventions were effective in reducing alcohol use and abuse within samples of homeless participants, although short-term effects are more apparent than longer term ones. Conclusions: There is a relative paucity of research into alcohol abusing homeless adults, which has implications for evidence-based practice. This systematic meta-analytical review demonstrates that a range of alcohol abuse interventions for homeless adults produces improvements in alcohol use (p?<?0.001).     

Clinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventions

Objectives To describe the rate and nature of pharmacist interventions following clinical medication review of elderly people living in care homes. Setting Care home residents aged 65+ years, prescribed at least one repeat medication, living in nursing, residential and mixed care homes for older people in Leeds, UK. Method Analysis of data from care home residents receiving clinical medication review in the intervention arm of a randomised controlled trial. Intervention outcomes for each medicine were evaluated for each resident. Key findings Three‐hundred and thirty‐one residents were randomised to receive a clinical medication review and 315 (95%) were reviewed by the study pharmacist; 256 (77%) residents had at least one recommendation made to the general practitioner. For the 2280 medicines prescribed, there were 672 medicine‐related interventions: medicines for cardiovascular system (167 (25%)), nutrition and blood (121 (18%)), central nervous system (113 (17%)) and gastrointestinal conditions (86 (13%)) accounted for 487 (73%) of medicine‐related interventions. There were 75 non‐medicine‐related interventions. The most common interventions were ‘technical’ (225 (30%)), ‘test to monitor medicine’ (161 (22%)), ‘stop drug’ (100 (13%)), ‘test to monitor conditions' (75 (10%)), ‘start drug’ (76 (10%)), ‘alter dose’ (40 (5%)) and ‘switch drug’ (37 (5%)). Recommendations to stop a medicine were most common for CNS drugs (32 (32%)). The most common medicine to be recommended to be started was calcium and vitamin D (45 (59%)). Following a recommendation to test to monitor a medicine, 23 (14%) medicines required a change. Conclusions This study has demonstrated that clinical medication review by a pharmacist can identify medicine problems in approximately 80% of care home residents, requiring intervention in 1 in 4 of their prescribed medications.     

Effects of pharmacist interventions on pain intensity: Systematic review and meta-analysis of randomized controlled trials

BackgroundPharmacists can play an important role in pain management.Objective(s)This review aims to summarize the effects of any type of pharmacist intervention, whether led by a pharmacist or in a supportive role, on pain intensity over time in individuals with pain of any etiology.MethodsThree electronic databases (MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) were searched from inception to the end of May 2021 to identify randomized controlled trials (RCTs) that reported the effect of pharmacist interventions on pain intensity. Two reviewers independently extracted data and evaluated study quality. The analyses used a random-effects models and the Grading of Recommendations, Assessment, Development and Evaluation to rate the certainty of the evidence. The primary outcome was reduction in pain intensity and presented as standardized mean differences (SMD).ResultsTwelve RCTs including 1710 participants were included. Pooled estimate of 12 studies demonstrated a statistically significant reduction in pain intensity compared with control (SMD ?0.22 [95% CI ?0.31 to ?0.12], I² = 0%, low certainty). The intervention was more effective when a pharmacist delivered a combination of services comprising educational interventions, medication review, and pharmaceutical care services (SMD ?0.24 [95% CI ?0.35 to ?0.13], I² = 0%, moderate certainty). For educational interventions alone, no statistically significant difference was observed (SMD ?0.15 [95% CI ?0.45 to 0.15], I² = 47.6%, low certainty). Pharmacist intervention was also effective in reducing pain intensity for patients with cancer-related pain (SMD ?0.76 [95% CI ?1.17 to ?0.36], I² = 0%, moderate certainty).ConclusionThere is some promising evidence to suggest that multicomponent pharmacist interventions including medication review or any other pharmaceutical care services, rather than merely educational interventions, are beneficial in reducing pain intensity, particularly in patients with chronic pain. High-quality RCTs are required to confirm the clinical significance of this findings before advocating for its widespread implication in clinical practice.     

Aliskiren in patients with diabetes: a systematic review

Objective: Diabetic patients are at risk of macro- and micro-vascular complications, including diabetic nephropathy, and have difficulties in achieving blood pressure (BP) goals. Aliskiren, a direct renin inhibitor, inhibits the first step of the renin angiotensin aldosterone system. We aimed to systematically address the relevant evidence on the effects of aliskiren in diabetic individuals. Methods: We considered randomized controlled trials (RCTs) evaluating aliskiren in diabetic patients. Information was recorded independently by 2 investigators. We were limited to trials published in English. Results: PubMed search retrieved 16 items. After excluding 12, we ended with 4 eligible studies with 1488 participants. Mean baseline BP levels were 143/82 mmHg and median follow up was 2 months. Aliskiren was compared against angiotensin converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) or aliskiren plus ACE inhibitor/ARB in 2 studies and against placebo in the other 2. The most frequent indication for aliskiren therapy was diabetes plus hypertension and albuminuria. Aliskiren seems to be effective in reducing BP levels, albuminuria in diabetics, either as monotherapy (compared with placebo), or in addition to ACE inhibitors/ARB (compared with monotherapy), without any major safety considerations. Conclusions: There are promising results on the effect of aliskiren in diabetic patients, but the available evidence is limited so far. This is a poorly investigated field with few RCTs and new studies focusing on "hard" outcomes are needed.     

Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review

Background

Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied.

Potential roles of ellagic acid on metabolic variables in diabetes mellitus: A systematic review

Diabetes mellitus is a widespread endocrine disorder globally. Due to its antioxidant and anti-inflammatory properties, ellagic acid has the potential to improve the metabolic effects of chronic non-communicable diseases. This systematic review summarizes current evidence about the potential effects of ellagic acid on metabolic variables in diabetes mellitus. A comprehensive systematic literature search was conducted in databases such as PubMed, Scopus, EMBASE, ProQuest and Google Scholar from inception until March 2022. All animal studies and clinical trials were eligible for inclusion. Studies using in vitro models or published in a non-English language were excluded. Of 1320 articles, 23 were selected for assessment, including 21 animal studies and two randomized controlled trial studies. Following ellagic acid administration, findings reported improvement in FBS, HbA1c, insulin (20, 8 and 12 studies, respectively), TG, TC, HDL-C (13, 10 and 5 studies, respectively), MDA, GSH, CAT, SOD (11, 6, 3 and 4 studies, respectively), and TNF-α and IL-6 (6 and 3 studies, respectively). In conclusion, ellagic acid may improve glycaemic indicators, dyslipidaemia, oxidative stress and inflammation in diabetes mellitus. However, further clinical trials are needed to explore the mechanisms more precisely and to observe the applied consequences.     

Computer-based interventions for drug use disorders: a systematic review

A range of innovative computer-based interventions for psychiatric disorders have been developed and are promising for drug use disorders due to reduced cost and greater availability compared to traditional treatment. Electronic searches were conducted from 1966 to November 19, 2009, using MEDLINE, Psychlit, and EMBASE. Four hundred sixty-eight nonduplicate records were identified. Two reviewers classified abstracts for study inclusion, resulting in 12 studies of moderate quality. Eleven studies were pilot or full-scale trials compared to a control condition. Interventions showed high acceptability despite substantial variation in type and amount of treatment. Compared to treatment-as-usual, computer-based interventions led to less substance use and higher motivation to change, better retention, and greater knowledge of presented information. Computer-based interventions for drug use disorders have the potential to dramatically expand and alter the landscape of treatment. Evaluation of Internet- and telephone-based delivery that allows for treatment-on-demand in patients' own environment is needed.     

Clinical medication review by a pharmacist of elderly patients on repeat medications in general practice — pharmacist interventions and review outcomes

Objectives — To describe the nature and rate of interventions made by a pharmacist conducting clinical medication reviews in general practice. Method — Patients, randomly allocated to the intervention group, in a randomised controlled trial of 1,188 patients, were invited to a pharmacist‐conducted medication review clinic at their general practice. Patients were seen over one year from June 1, 1999, to May 31, 2000. In the consultation an assessment was made of the patient, their clinical conditions and medication. Consultation outcomes for each patient and intervention outcomes for each medicine were evaluated. Setting — Patients were recruited from four randomly selected general practices in Leeds, UK. Patients were eligible if aged 65 years or over and on at least one repeat medicine. Key findings — Consultations were held with 590 patients in the intervention group (97 per cent). A recommendation for change was made in 44 per cent (258/591) of consultations. The most common outcome was a change in medication: 29 per cent of consultations (170/591). Doctor referral occurred for 28 patients (5 per cent) and nurse referral for 25 (4 per cent). Study patients were recorded as taking 2,927 repeat medications (mode of two per patient). Interventions were made for 21 per cent of medications (603). Clinically related interventions accounted for 71 per cent (430/603). Recommendations were spread evenly across therapy groups. At the study end, 90 per cent (433/484) of recommendations remained implemented. Conclusion — A pharmacist who clinically reviewed elderly patients, their conditions and their medications, intervened in nearly half the patients. The pharmacist was able to implement most interventions without referring the patient to a doctor or nurse.     

Psychological interventions with families of alcohol misusers: A systematic review

Aims: To review the literature on psychological interventions for families affected by alcohol misuse, with a focus on outcomes for family members.

Methods: A comprehensive and systematic literature review. A detailed search strategy was developed and implemented with no date, language or time restrictions. Two reviewers screened all identified titles and abstracts, and then independently assessed the eligibility and quality of all potential studies. The studies were analysed according to whether or not the alcohol misuser was involved in the primary intervention under investigation and analysed thematically.

Results: Forty-three publications (34 studies) were included in the review. All were in English, covered the period 1979–2009, were mainly published articles in peer review journals and included 2500–3000 family members. Research with female family members (particularly spouses or partners), and ‘white’ family members dominated. The included studies show how the field has moved from primarily focussing on how family members can engage and support the user through treatment to adopting a wider holistic focus which considers the needs of family members in their own right. Studies in both categories demonstrated positive outcomes for family members across a range of domains.

Conclusions: Adopting a broader review methodology has brought a fuller understanding of a field where few such reviews have been conducted, and offers direction for future research. Further work is needed in terms of broadening the reach of such interventions and embedding them more firmly into routine therapeutic practice.     

Evaluation of pharmacist care for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background In chronic obstructive pulmonary disease (COPD), the value of pharmacist care is not clear. Aim of the review A systematic review was conducted to clarify the impact of pharmacist care for outpatients with COPD. Methods The PubMed, EMBASE, CINAHL, CBMdisc, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist-care interventions among outpatients with COPD. The reference lists were also screened for any additional relevant studies not identified through the electronic database searching. Two reviewers independently assessed each paper for methodological quality and extracted the data. Results Fourteen articles were included. These articles described eight randomized controlled trials (1,327 patients) that pharmacist care was compared with usual care. The pharmacist interventions included those exclusively conducted by pharmacists and those conducted in collaboration with a multidisciplinary team. Although the current evidences failed to illustrate significant improvement in the health-related quality of life in intervention patients, results indicated that pharmacist care was associated with a significant reduction in the risk of hospital admissions [six studies (684 patients); risk ratio 0.50 (95 % CI 0.39–0.64)]. However, no significant effect was found either in emergency department visits or in lung function. In addition, pharmacist care improved medication compliance of patients [four studies (743 patients); risk ratio 1.23 (95 % CI 1.11–1.36)] while reduced health-related cost [three studies (318 patients); standardized mean difference ?0.37 (95 % CI ?0.59 to ?0.15)]. Conclusion Pharmacist care resulted in improvements in the medication compliance as well as reductions in hospital admissions and health-related costs. It is therefore a potent strategy for management of outpatients with COPD.     

Individualising therapy for older adults with diabetes mellitus

The goal when treating patients with diabetes mellitus is to achieve the maximum longevity consistent with an optimal quality of life. To achieve this goal, treatment is typically focused on management of hyperglycaemic symptoms and prevention of microvascular and macrovascular complications. While appropriate for most individuals, including many older adults with robust health, this focus is often too limited for older adults facing diminished life expectancy and co-existing medical illness, frailty and disability. Creating a treatment plan that optimises health and function, and reduces the risk for morbidity and mortality, requires individualised therapy that judiciously manages symptoms and multiple competing health risks while remaining consistent with the patient's or his/her caregiver's healthcare preferences. Physicians caring for older adults with diabetes must be adept at recognising conditions commonly associated with diabetes, including the interplay with co-morbid illness, and be able to assess the patient's health status and use this information to recommend a treatment plan that is consistent with the patient's personal goals for care. The majority of older adults with diabetes will benefit from management of cardiovascular risk, including intensive management of hypertension, lipids, use of aspirin (acetylsalicylic acid) and smoking cessation, and screening for common geriatric syndromes. For a significant minority of older adults with life expectancy of >or=10 years, it is reasonable to consider intensive management of hyperglycaemia (glycosylated haemoglobin [HbA1c] target相似文献   

我国临床药师绩效考核体系的描述性系统评价

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Tobacco interventions delivered by pharmacists: a summary and systematic review

BACKGROUND: As one of the most accessible health care professionals, pharmacists are in an ideal position to provide tobacco-cessation and prevention services. Although there is growing interest in expanding the pharmacist's role in tobacco treatment, few published studies have assessed the efficacy or effectiveness of tobacco-cessation services delivered by pharmacists in the United States. OBJECTIVE: To summarize and critique studies that examined pharmacist-delivered tobacco-cessation services. METHODS: Articles written in English that appeared in peer-reviewed journals were identified from a systematic review of literature published from 1980-2006. Publications were selected for review if the interventions were delivered by pharmacists, if the intervention included United States Food and Drug Administration-approved drugs (if drug therapy was used), and if smoking-cessation rates could be calculated. RESULTS: Fifteen studies met inclusion criteria. Fourteen of the studies targeted smoking, and one targeted spit (chewing) tobacco. Five studies were controlled, and 10 were uncontrolled. One of the controlled studies (chewing tobacco) and eight of the uncontrolled studies were conducted in the United States. Findings of the uncontrolled U.S. studies suggest that pharmacists can deliver smoking-cessation services. Three of the controlled studies found statistically significant differences between the pharmacist-based intervention and the control group, and the trend in the other two studies was toward the effectiveness of the pharmacist-delivered intervention. Only six of the 15 studies reviewed used biochemical measures to verify self-reported cessation. CONCLUSION: The uncontrolled and controlled studies reviewed demonstrate that pharmacists can deliver tobacco-cessation interventions, and the evidence strongly suggests that they are effective in helping smokers to quit. Future studies conducted in the United States that are well controlled and include biochemical verification of smoking status are needed to provide definitive confirmation that pharmacist-delivered interventions are effective for smoking cessation. With the availability and expanded training of pharmacists, this is an opportune time for testing and disseminating evidence-based research evaluating the effectiveness of pharmacist-delivered tobacco-cessation services.