title: Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis.
abstract: BACKGROUND
  Pharmacists can play a decisive role in the management of ambulatory patients with depression who have poor adherence to antidepressant drugs.
  
  
  OBJECTIVE
  To systematically evaluate the effectiveness of pharmacist care in improving adherence of depressed outpatients to antidepressants.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. RCTs were identified through electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, Institute for Scientific Information Web of Knowledge, and Spanish National Research Council) from inception to April 2010, reference lists were checked, and experts were consulted. RCTs that evaluated the impact of pharmacist interventions on improving adherence to antidepressants in depressed patients in an outpatient setting (community pharmacy or pharmacy service) were included. Methodologic quality was assessed and methodologic details and outcomes were extracted in duplicate.
  
  
  RESULTS
  Six RCTs were identified. A total of 887 patients with an established diagnosis of depression who were initiating or maintaining pharmacologic treatment with antidepressant drugs and who received pharmacist care (459 patients) or usual care (428 patients) were included in the review. The most commonly reported interventions were patient education and monitoring, monitoring and management of toxicity and adverse effects, adherence promotion, provision of written or visual information, and recommendation or implementation of changes or adjustments in medication. Overall, no statistical heterogeneity or publication bias was detected. The pooled odds ratio, using a random effects model, was 1.64 (95% CI 1.24 to 2.17). Subgroup analysis showed no statistically significant differences in results by type of pharmacist involved, adherence measure, diagnostic tool, or analysis strategy.
  
  
  CONCLUSIONS
  These results suggest that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. However, data are still limited and we would recommend more research in this area, specifically outside of the US.
authors.affiliation: Research and Development Unit, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain. mrubio@pssjd.org
authors.forename: Maria
authors.initials: M
authors.lastname: Rubio-Valera
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
authors.forename: Jesús
authors.initials: J
authors.lastname: Magdalena-Belío
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández
authors.forename: Javier
authors.initials: J
authors.lastname: García-Campayo
authors.forename: Marian March
authors.initials: MM
authors.lastname: Pujol
authors.forename: Yolanda López
authors.initials: YL
authors.lastname: del Hoyo
mesh_terms: D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D010593:Pharmaceutical Services; D016032:Randomized Controlled Trials as Topic; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents