Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review

Abstract

Background Pharmacists in high-income countries routinely provide efficient pharmacy or pharmaceutical care services that are known to improve clinical, economic, and humanistic outcomes (ECHO) of patients. However, pharmacy services in low- and middle-income countries, mainly South Asia, are still evolving and limited to providing traditional pharmacy services such as dispensing prescription medicines. This systematic review aims to assess and evaluate the impact of pharmacists’ services on the ECHO of patients in South Asian countries. Methods We searched PubMed/Medline, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 20th September 2021. Original studies (only randomised controlled trials) conducted in South Asian countries (published only in the English language) and investigating the economic, clinical (therapeutic and medication safety), and humanistic impact (health-related quality of life) of pharmacists’ services, from both hospital and community settings, were included. Results The electronic search yielded 430 studies, of which 20 relevant ones were included in this review. Most studies were conducted in India (9/20), followed by Pakistan (6/20), Nepal (4/20) and Sri Lanka (1/20). One study showed a low risk of bias (RoB), 12 studies showed some concern, and seven studies showed a high RoB. Follow-up duration ranged from 2 to 36 months. Therapeutic outcomes such as HbA1c value and blood pressure (systolic blood pressure and diastolic blood pressure) studied in fourteen studies were found to be reduced. Seventeen studies reported humanistic outcomes such as medication adherence, knowledge and health-related quality of life, which were found to be improved. One study reported safety and economic outcomes each. Most interventions delivered by the pharmacists were related to education and counselling of patients including disease monitoring, treatment optimisation, medication adherence, diet, nutrition, and lifestyle. Conclusion This systematic review suggests that pharmacists have essential roles in improving patients’ ECHO in South Asian countries via patient education and counselling; however, further rigorous studies with appropriate study design with proper randomisation of intervention and control groups are anticipated.

Clinical, economic and humanistic outcomes of medication therapy management services: A systematic review and meta-analysis

“…Basing on the definition from ECHO model for the clinical, economic and humanistic outcomes ( Cheng et al, 2013 ; Shrestha et al, 2022 ; Gunter., 2023 ), the definition of outcomes included in our study was confirmed.…”

“…Although several studies comprehensively evaluated patient’s burden and medical interventions using the ECHO model, such as refill adherence measures and STOPP/START criteria ( Reeder et al, 2000 ; Jeremy et al, 2011 ; Hill-Taylor et al, 2013 ; Zhao et al, 2019 ; Chua et al, 2020 ), few studies evaluated the efficacy of MTM services with full ECHO model. Despite descriptive studies demonstrating that MTM services improved patients’ clinical conditions, quality of life and potentially reduced healthcare disparities ( Bunting and Cranor, 2006 ; Shrestha et al, 2022 ), studies analyzed the three parts of ECHO model in one assessment was little ( Singhal et al, 1999 ; Cheng et al, 2013 ; Johnson et al, 2018 ). The incompleteness of the analysis may result in superficial conclusions and less precise outcomes.…”

Effect of Drug Information Service on Clinical Outcome of Patients with Type 2 Diabetes Mellitus in Padang, Indonesia

“…Drug information service is one of the pharmaceutical services that can improve clinical outcomes in T2DM. Drug information service is a part of pharmaceutical care delivered in public health centers and other settings like hospitals or pharmacies 13 . Drug information service is defined as a service by pharmacists to provide accurate, precise, and up-to-date information to doctors, pharmacists, other health professionals, and patients.…”

Patterns in counselling services provided at Saudi Ministry of Health medication counselling clinics – Reasons for referrals and subjects discussed: A cross-sectional study

“…The impact of pharmacist interventions resulted in medication cost savings of US$3million over 10 years and the improvement of the conditions of 55% of patients ( Oliveira et al, 2010 ). A systematic review conducted in Southeast Asia to evaluate the impact of pharmacist services on economic, clinical and humanistic outcomes ( Shrestha et al, 2022 ). Therapeutic outcomes such as HbA1c level and blood pressure were improved, as were humanistic outcomes such as adherence to prescription instructions, knowledge regarding medication and quality of life ( Shrestha et al, 2022 ).…”