Pharmaceutical care services: A systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes

Objective: To systematically review the evidence for the effect of pharmaceutical care practice on patient outcomes. Setting: Community and outpatient setting. Method: Randomised controlled trials (RCTs) published in English between 1990 and 2003 were identified through a systematic literature search. To be included, studies had to assess the effect of a pharmaceutical care intervention, defined as a one-to-one consultation between each patient and a pharmacist with a focus on managing health or resolving drug-related problems, development of a care plan and follow-up. Key findings: Twenty-two RCTs met the review criteria. Studies targeted general patient populations at risk of drug-related problems, disease-specific target groups or patients with risk factors including hypertension and raised cholesterol. While a number of trials have been undertaken, the variability in the application of endpoints utilised means the evidence for effectiveness of single endpoints apart from quality of life is generally limited to one or two controlled trial results. Collectively, the studies provide evidence that the service improves signs and symptoms for people with asthma, surrogate endpoints such as blood pressure, cholesterol levels and glycosylated haemoglobin and medication use, but do not provide evidence supporting improved health-related quality of life. One study showed an improvement in combined all-cause mortality and non-fatal heart failure-related events in patients with heart failure. Conclusion: Pharmaceutical care services are effective in improving medication use and surrogate endpoints, but improvement in other outcomes is less conclusive. Given that the focus of the service is to resolve medication-related problems, consideration should be given to the use of adverse drug events and resolution of medication-related problems as an outcome measure in future studies.