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. 2021 Feb 17;21(1):156.
doi: 10.1186/s12913-021-06150-8.

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies

R Varas-Doval  1 , L Saéz-Benito  2   3 , M A Gastelurrutia  3 , S I Benrimoj  3 , V Garcia-Cardenas  3   4 , F Martinez-Martínez  3
Affiliations

Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies

R Varas-Doval et al. BMC Health Serv Res. .

Abstract

Background: Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting.

Methods: A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool.

Results: The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes.

Conclusions: There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.

Keywords: Clinical pharmacy services; Community pharmacy; Community pharmacy services; Comparative effectiveness research; Naturalistic; Pharmaceutical care; Pragmatic clinical trials; Professional pharmacy services.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the screened, assessed for eligibility, included and excluded papers according to PRISMA
Fig. 2
Fig. 2
Assessment of pragmatic degree of trials using PRECIS-2 tool. Image shows PRECIS-2 wheels for PPS according to the degree of pragmatism: author; PPS: PRECIS-2 score out of 45. 1. Eligibility, 2. Recruitment, 3.Setting, 4.Organisation, 5. Flexibility (delivery), 6. Flexibility (adherence), 7. Follow-up, 8. Primary outcome, 9. Primary analysis
See this image and copyright information in PMC

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