The Effect of Pharmacist Services on Patient Health Outcomes in a Low Middle-income Country: a Systematic Review

Abstract

Background: The pharmacist's role is shifting from dispensing to bedside care, resulting in better patient health outcomes. However, pharmacist services on healthcare utilization in low- and middle-income countries such as Pakistan are unclear. As a result, we intend to conduct a systematic review of pharmacists' roles in improving Pakistani patients' health outcomes.Methods: We searched PubMed, Scopus, EMBASE, CINAHIL, and Cochrane Library for relevant articles published from inception to February 2021. Original studies investigating the therapeutic, humanistic, safety, and economic impact of pharmacists in Pakistani patients (hospitalized or outpatients) were selected. Two reviewers independently assessed the bias in studies, and mutual consensus resolved discrepancies. Results: The literature search found 751 articles from which ten studies were included; seven were randomized controlled trials (RCTs), and three were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having high ROB. Pharmacist interventions comprised one or more components like provision of education about the disease, medication adherence counselling, medication therapy management, and consultation with a physician regarding change of prescription. In most studies, pharmacists provided therapeutic care, followed by humanistic and safety outcomes with significant improvements. Intervention effect on cost-effectiveness and long-term outcomes were unclear.Conclusions: Positive but not always statistically significant pharmacist effects on therapeutic, humanistic, and safety outcomes have been reported. Therefore, the results favour adding on the benefit of pharmacist services but lack evidence of economic feasibility and long-term impact of pharmacist interventions.