Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review

Abstract

Background Pharmacists' counseling has improved health-related outcomes in many acute and chronic conditions. Several studies have shown how pharmacists have been contributing to reduce morbidity and mortality related to drug-therapy (MMRDT). However, there still is a lack of reviews that assemble evidence-based clinical pharmacists' counseling. Equally, there is also a need to understand structure characteristics, processes and technical contents of these clinical services. Aim of the review To review the structure, processes and technical contents of pharmacist counseling or education reported in randomized controlled trials (RCT) that had positive health-related outcomes. Methods We performed a systematic search in specialized databases to identify RCT published between 1990 and 2013 that have evaluated pharmacists' counseling or educational interventions to patients. Methodological quality of the trials was assessed using the Jadad scale. Pharmacists' interventions with positive clinical outcomes (p < 0.05) were evaluated according to patients' characteristics, setting and timing of intervention, reported written and verbal counseling. Results 753 studies were found and 101 RCT matched inclusion criteria. Most of the included RCTs showed a Jadad score between two (37 studies) and three (32 studies). Pharmacists were more likely to provide counseling at ambulatories (60 %) and hospital discharge (25 %); on the other hand pharmacists intervention were less likely to happen when dispensing a medication. Teaching back and explanations about the drug therapy purposes and precautions related to its use were often reported in RCT, whereas few studies used reminder charts, diaries, group or electronic counseling. Most of studies reported the provision of a printed material (letter, leaflet or medication record card), regarding accessible contents and cultural-concerned informations about drug therapy and disease. Conclusion Pharmacist counseling is an intervention directed to patients' health-related needs that improve inter-professional and inter-institutional communication, by collaborating to integrate health services. In spite of reducing MMRDT, we found that pharmacists' counseling reported in RCT should be better explored and described in details, hence collaborating to improve medication-counseling practice among other countries and settings.

What works for whom in pharmacist-led smoking cessation support: realist review

“…Our findings substantiate some key recommendations of previous systematic reviews: that pharmacists and their staff, when properly trained and supported, are capable of delivering the non-dispensing elements of a smoking cessation service as well as providing nicotine replacement products [4, 15–18, 20, 74, 75, 76]; that training improves their confidence and performance in this area [74, 75]; that there may be role ambiguity and/or issues of professional identity when pharmacists are invited to take on non-dispensing roles [13]; that primary studies have, to date, produced a very limited evidence base on the real-world implementation of smoking cessation services (for example, the active components of interventions have been poorly described and rarely theorised) [4, 13, 17, 20, 74]; that pharmacies may be run according to different business models but the evidence base on how these different models support non-dispensing pharmacy services is limited [4, 76]; and that there are policy implications of a major change in the professional jurisdiction of pharmacists [4, 17]. …”

“…These consisted of the following (some papers described more than one study type):12 systematic reviews (5 of RCTs of pharmacist-led behavioural interventions for smoking [15–19], 1 of process elements of such interventions [20], 3 of pharmacist-led behavioural interventions other than smoking cessation [15, 19, 21], 1 of the scope of pharmacy practice [4], 1 of pharmacists’ perceptions [13], and 1 of qualitative studies of the patient experience [22]);6 reviews not described as ‘systematic’, of pharmacy business models, pharmacist scope of practice, pharmacist training programmes or the process elements of RCTs [2, 23–27];18 RCTs, of which 14 related to smoking cessation [28–41] and 4 to other behavioural interventions [42–45];1 cost-effectiveness study linked to a RCT [40];1 paper describing additional process detail on a RCT [46];12 evaluations of pharmacist training courses, using either pre-post classroom assessments or ‘mystery shopper’ assessments of performance in practice, comprising 2 linked to RCTs [28, 29] and 10 before and after studies [47–56];7 papers reporting quantitative surveys (6 of pharmacists [57–62] and 4 of service users [57, 58, 63, 64]);6 papers describing qualitative studies, 5 based on semi-structured interviews (3 of pharmacists [3, 65, 66], 1 of pharmacy owners [67], 2 of service users [3, 65], 1 of researchers [68]) and 1 a focus group study of service users [69];2 in-depth case studies [70, 71];2 business models [67, 72];1 paper describing the development of a complex intervention [73]. …”

“…12 systematic reviews (5 of RCTs of pharmacist-led behavioural interventions for smoking [15–19], 1 of process elements of such interventions [20], 3 of pharmacist-led behavioural interventions other than smoking cessation [15, 19, 21], 1 of the scope of pharmacy practice [4], 1 of pharmacists’ perceptions [13], and 1 of qualitative studies of the patient experience [22]);…”

Nordic Pharmacy Schools’ Experience in Communication Skills Training

“…Practical training with real patients occurred during the PPE and was used by all schools. In median, 12 teaching methods were in use at each school (range [3][4][5][6][7][8][9][10][11][12][13][14]. The most commonly used textbook was "Communication Skills in Pharmacy Practice-A Practical Guide for Students and Practitioners" by Beardsley and colleagues, 35 used by four schools in five PPE courses and one CSC course.…”

“…[1][2][3][4] However, studies from community pharmacies worldwide found patients receiving limited counseling with many not receiving any counseling at all, pharmacists using inappropriate questioning techniques, and patients receiving a patient centered-care that is not optimal. 5,6 In the Nordic setting, studies report of a similar pattern.…”