Impact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta‐analysis of randomized clinical trials

Nakanishi, Masayoshi; Mizuno, Tomohiro; Mizokami, Fumihiro; Koseki, Takenao; Takahashi, Kazuo; Tsuboi, Naotake; Katz, Michael L.; Lee, Jeannie K.; Yamada, Shigeki

doi:10.1111/jcpt.13262

Cited by 10 publications

(9 citation statements)

References 42 publications

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“…A similar study conducted in a managed care setting that randomly assigned patients to home BP telemonitoring mixed with pharmacist‐led intervention found 13 mmHg higher reductions in SBP than usual care over a 6‐month period, which agreed with our findings 20 . Also comparable with the result of our study was a randomized controlled trial (RCT) conducted in Canada that reported a short‐term (3 months) significant reduction in SBP of patients with CKD due to pharmacists' interventions 42 . Despite short‐term significant reduction in mean SBP in the present study due to pharmacists' interventions, the proportions of participants that gained BP control in the intervention arm from baseline to 6 months, and baseline to 12 months, respectively, were clinically significant.…”

Section: Discussionsupporting

confidence: 91%

“…20 Also comparable with the result of our study was a randomized controlled trial (RCT) conducted in Canada that reported a short-term (3 months) significant reduction in SBP of patients with CKD due to pharmacists' interventions. 42 Despite shortterm significant reduction in mean SBP in the present study due to pharmacists' interventions, the proportions of participants that gained BP control in the intervention arm from baseline to 6 months, and baseline to 12 months, respectively, were clinically significant. Comparable with our results, an American study of patients with uncontrolled hypertension reported statistically significant improvements in BP control at 6 and 12 months, respectively.…”

Section: Discussioncontrasting

confidence: 66%

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The impact of pharmacist‐led interventions on blood pressure control among patients with chronic kidney disease: A randomized controlled trial

Okoro

Umate

Ohieku

et al. 2022

J Am Coll Clin Pharm

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Introduction Only about 50% of patients with high blood pressure (BP) and chronic kidney disease (CKD) comorbidity have their BP controlled. Objectives The objectives of the study were to determine whether pharmacist‐led interventions reduce mean BP and improve BP control in hypertensive patients with CKD compared with usual care. Methods This 12‐month prospective, double‐blind, randomized, controlled trial was conducted at two major hospitals in Nigeria. Seventy‐four participants were randomized to the usual care arm serving as the control and 73 participants were randomized to the intervention arm. The intervention arm received home BP monitors, and pharmacological and nonpharmacological (education and training on self‐management of CKD and hypertension, and text messages) interventions. Results Baseline characteristics were similar between the intervention (n = 73) and usual care (n = 74) participants. However, significantly more females were in the intervention arm compared with the usual care arm (71.2% vs 52.7%; P = .021). Compared with the usual care arm, systolic BP (SBP) significantly decreased by 7.12 mmHg from baseline (P = .020) in the intervention arm. Higher proportions of patients gained BP control from baseline to 6 months (27.4% vs 13.5%, P = .095), and from baseline to 12 months (20.5% vs 8.1%, P = .096) in the intervention arm than the usual care. There were no statistical differences, but clinical differences were observed. Conclusion This trial demonstrates that including a clinical pharmacist in a team care setting can improve BP reduction and control in patients with CKD and hypertension. Trial registration http://clinicaltrials.gov NCT05254392.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 66%

The impact of pharmacist‐led interventions on blood pressure control among patients with chronic kidney disease: A randomized controlled trial

Okoro

Umate

Ohieku

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

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“…Telehealth facilitates more engaging and efficient management of chronic conditions and allows members of the patient care team, such as pharmacists to connect with patients and thereby improve patient outcomes 5,7‐9 . Telehealth interventions by pharmacists can improve the control of blood pressure and reduce serum levels of hemoglobin A1c when compared with the usual standard of care afforded by primary care providers alone 8,10,11 …”

Section: Introductionmentioning

confidence: 99%

Describing the delivery of clinical pharmacy services via telehealth: A systematic review

Melton

Jasmin

Johnson

et al. 2021

J Am Coll Clin Pharm

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IntroductionTelehealth offers a promising opportunity for the delivery of clinical pharmacy services by increasing the accessibility of health care, extending the reach of clinical services, and allowing pharmacists to engage with patients who might otherwise be overlooked. The objectives of the project were to discover effective strategies for the delivery of clinical pharmacy services via telehealth and to identify core components of comprehensive medication management (CMM) that are deliverable via telehealth.MethodsA systematic literature review was performed by searching four databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], PubMed, Scopus, and Web of Science) for relevant citations using keywords and subject headings relating to telemedicine, clinical pharmacy services, and health conditions. Studies were eligible for inclusion in the review if the interventions they describe involved telehealth technologies and pharmacist care. Blind screening of abstracts and full‐text review was completed by six researchers divided into teams of two. Any discrepancies were resolved by the corresponding author.ResultsFifty‐nine studies met the inclusion criteria, most (n = 53) of which were conducted in the U.S. Five studies (8.5%) reported pharmacist training as an implementation strategy. The telehealth technologies most regularly utilized were telephone‐based interventions (n = 45), videoconferences (n = 13), and web‐based (n = 4) interventions, with five studies using a combination of technologies. Most studies focused on hypertension (n = 22), diabetes (n = 20), or lipid‐related (n = 14) disease state management. Eighteen studies qualified as CMM (n = 18), with most involving all five essential CMM functions.ConclusionThis systematic review study highlights opportunities for pharmacists to deliver clinical pharmacy services using telehealth. The majority of clinical pharmacy services described in the accessed literature was provided via telephone and focused on targeted monitoring of disease states. While studies reporting the use of CMM interventions were limited, there is an opportunity to increase the application of CMM principles as healthcare systems transition to providing more telehealth services.

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“…A previous meta-analysis by Nakanishi et al (2020), including six studies, found pharmacist-led interventions, especially those concerning home-based BP telemonitoring, to be significantly superior to standard care, expressed as odds ratio. The follow-up period ranged from three to eighteen months, and interventions taken by pharmacists included home BP telemonitoring conduction in two out of fifteen studies that reported the BP values [ 5 ]. This paper is also consistent with the present findings.…”

Section: Discussionmentioning

confidence: 99%

“…For example, reaching target blood pressure (BP) goals can dramatically reduce the risks of these complications. Although the rate of BP goal achievement is only around 50% in patients with CKD [ 4 ], a recent meta-analysis found that pharmacist interventions focusing on home-based BP telemonitoring can increase the odds ratio for BP goal achievement in this group [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Pharmacist Interventions in the Management of Patient with Renal Failure: A Systematic Review and Meta-Analysis

Jasińska-Stroschein

2022

IJERPH

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The existing trials have focused on a variety of interventions to improve outcomes in renal failure; however, quantitative evidence comparing the effect of performing multidimensional interventions is scarce. The present paper reviews data from previous randomized controlled trials (RCTs), examining interventions performed for patients with chronic kidney disease (CKD) and transplants by multidisciplinary teams, including pharmacists. Methods: A systematic search with quality assessment was performed using the revised Cochrane Collaboration’s ‘Risk of Bias’ tool. Results and Conclusion: Thirty-three RCTs were included in the review, and the data from nineteen protocols were included in further quantitative analyses. A wide range of outcomes was considered, including those associated with progression of CKD, cardiovascular risk factors, patient adherence, quality of life, prescription of relevant medications, drug-related problems (DRPs), rate of hospitalizations, and death. The heterogeneity between studies was high. Despite low-to-moderate quality of evidence and relatively short follow-up, the findings suggest that multidimensional interventions, taken by pharmacists within multidisciplinary teams, are important for improving some clinical outcomes, such as blood pressure, risk of cardiovascular diseases and renal progression, and they improve non-adherence to medication among individuals with renal failure.

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Impact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta‐analysis of randomized clinical trials

Cited by 10 publications

References 42 publications

The impact of pharmacist‐led interventions on blood pressure control among patients with chronic kidney disease: A randomized controlled trial

The impact of pharmacist‐led interventions on blood pressure control among patients with chronic kidney disease: A randomized controlled trial

Describing the delivery of clinical pharmacy services via telehealth: A systematic review

The Effectiveness of Pharmacist Interventions in the Management of Patient with Renal Failure: A Systematic Review and Meta-Analysis

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