Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management.
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 chi(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.
Machado
Márcio
M
Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
Nassor
Nermine
N
Bajcar
Jana M
JM
Guzzo
Giovanni C
GC
Einarson
Thomas R
TR
D019468:Disease Management; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D010595:Pharmacists / Q000592:standards*; D024382:Professional Role
D000960:Hypolipidemic Agents