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Research Associate, Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
Pharmacy Student, Leslie Dan Faculty of Pharmacy, University of Toronto
Associate Professor, Leslie Dan Faculty of Pharmacy, University of Toronto
PhD Candidate, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
Associate Professor, Leslie Dan Faculty of Pharmacy, University of Toronto
Reprints: Dr. Einarson, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2, Canada, fax 416/978-8511, t.einarson{at}utoronto.ca
BACKGROUND: Hyperlipidemia increases the risk of cardiovascular diseases, and control is pivotal for preventing disease complications. Multidisciplinary interventions, including those performed by pharmacists, are important for improving patients' outcomes.
OBJECTIVE: To quantify the impact of pharmacist interventions in enhancing patients' outcomes.
METHODS: Two reviewers searched International Pharmaceutical
Abstracts, MEDLINE, EMBASE, The Cochrane Central Register of Controlled
Trials, 3rd Quarter, and Cumulative Index to Nursing and Allied Health
Literature (all from inception to July 2007) for pharmacist interventions in
hyperlipidemia. Quality was assessed using the Downs-Black scale. Data
extracted included the number of patients enrolled; study characteristics;
intervention type; and pre- and postintervention measures for low-density
lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C),
triglycerides, total cholesterol, adherence, and quality of life. A random
effects meta-analysis combined data. Heterogeneity of effects was tested using
2 analysis. Publication bias was assessed using funnel
plots and the Begg-Mazumdar statistic.
RESULTS: Forty-eight studies were found; 23 met inclusion criteria. Study settings included medical clinic/center (n = 12), community pharmacy (n = 8), hospital (n = 2), and patient homes (n = 1). Article quality was good (71% ± 7.0%). Patient education (78%) and medication management (74%) were the most common interventions. Total cholesterol was significantly reduced from baseline (mean ± SD; 34.3 ± 10.3 mg/dL; p < 0.001) and above that for controls (22.0 ± 10.4 mg/dL; p = 0.034). LDL-C was reduced significantly from baseline (32.6 ± 11.3 mg/dL; p = 0.004), but not significantly more than controls (17.5 ± 10.9 mg/dL; p = 0.109). A clinically relevant but not statistically significant reduction in triglycerides was found. No impact on HDL-C levels was found. Patients' adherence to pharmacotherapeutic regimens and quality of life were considered possibly not sensitive and possibly sensitive to pharmacist interventions, respectively.
CONCLUSIONS: Total cholesterol is sensitive to pharmacist interventions, while LDL-C and triglyceride levels are possibly sensitive to those interventions. Further research is required for these outcomes.
Key Words: hyperlipidemia, patient outcomes, pharmacist interventions
Published Online, August 5, 2008. www.theannals.com, DOI 10.1345/aph.1K618
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T. L Charrois and R. T Tsuyuki Comment: Sensitivity of Patient Outcomes to Pharmacist Interventions. Part III: Systematic Review and Meta-Analysis in Hyperlipidemia Management Ann. Pharmacother., April 1, 2009; 43(4): 793 - 794. [Full Text] [PDF]
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