US pharmacists' effect as team members on patient care: systematic review and meta-analyses.
BACKGROUND
One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists.


OBJECTIVE
The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes.


METHODS
The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria.


RESULTS
A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care.


CONCLUSIONS
Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.
Chisholm-Burns
Marie A
MA
Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ 85721, USA. chisholm@pharmacy.arizona.edu
Kim Lee
Jeannie
J
Spivey
Christina A
CA
Slack
Marion
M
Herrier
Richard N
RN
Hall-Lipsy
Elizabeth
E
Graff Zivin
Joshua
J
Abraham
Ivo
I
Palmer
John
J
Martin
Jennifer R
JR
Kramer
Sandra S
SS
Wunz
Timothy
T
D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration* / Q000706:statistics & numerical data; D024382:Professional Role; D011369:Professional-Patient Relations; D014481:United States; D016903:Drug Monitoring