Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) assesses the effect of pharmacist care on cardiovascular disease (CVD) risk factors among outpatients with diabetes.

Research design and methods: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched. Pharmacist interventions were classified, and a meta-analysis of mean changes of blood pressure (BP), total cholesterol (TC), LDL cholesterol, HDL cholesterol, and BMI was performed using random-effects models.

Results: The meta-analysis included 15 RCTs (9,111 outpatients) in which interventions were conducted exclusively by pharmacists in 8 studies and in collaboration with physicians, nurses, dietitians, or physical therapists in 7 studies. Pharmacist interventions included medication management, educational interventions, feedback to physicians, measurement of CVD risk factors, or patient-reminder systems. Compared with usual care, pharmacist care was associated with significant reductions for systolic BP (12 studies with 1,894 patients; -6.2 mmHg [95% CI -7.8 to -4.6]); diastolic BP (9 studies with 1,496 patients; -4.5 mmHg [-6.2 to -2.8]); TC (8 studies with 1,280 patients; -15.2 mg/dL [-24.7 to -5.7]); LDL cholesterol (9 studies with 8,084 patients; -11.7 mg/dL [-15.8 to -7.6]); and BMI (5 studies with 751 patients; -0.9 kg/m(2) [-1.7 to -0.1]). Pharmacist care was not associated with a significant change in HDL cholesterol (6 studies with 826 patients; 0.2 mg/dL [-1.9 to 2.4]).

Conclusions: This meta-analysis supports pharmacist interventions-alone or in collaboration with other health care professionals-to improve major CVD risk factors among outpatients with diabetes.

Figure 1

Selection of studies for systematic review of pharmacist care interventions. (A high-quality color representation of this figure is available in the online issue.)

Figure 2

Forest plots show the effect of pharmacist care on the mean difference in systolic BP (A) and in diastolic BP (B). Mean differences of less than 0 between pharmacist care and usual care groups indicate an effect in favor of pharmacist care. (A high-quality color representation of this figure is available in the online issue.)

Figure 3

Forest plots show the effect of pharmacist care on the mean difference in TC (A), LDL cholesterol (B), HDL cholesterol (C), and BMI (D). Mean differences of less than 0 between pharmacist and usual care groups indicate an effect in favor of pharmacist care. (A high-quality color representation of this figure is available in the online issue.)

Figure 3

Forest plots show the effect of pharmacist care on the mean difference in TC (A), LDL cholesterol (B), HDL cholesterol (C), and BMI (D). Mean differences of less than 0 between pharmacist and usual care groups indicate an effect in favor of pharmacist care. (A high-quality color representation of this figure is available in the online issue.)