title: Diabetes and cardiovascular disease interventions by community pharmacists: a systematic review.
abstract: OBJECTIVE
  To systematically review and assess the quality of studies evaluating community pharmacist interventions for preventing or managing diabetes or cardiovascular disease (CVD) and/or their major risk factors.
  
  
  METHODS
  A comprehensive literature search was performed using MEDLINE (1950-February 2011), EMBASE (1980-February 2011), International Pharmaceutical Abstracts (1970-February 2011), Cumulative Index to Nursing and Allied Health Literature (1982-June 2007), and Cochrane Central Register of Controlled Trials (1898-February 2011). Search terms included: community pharmacy(ies), community pharmacist(s), cardiovascular, diabetes, and intervention. The grey literature was searched using the ProQuest Dissertations and Theses, Theses Canada, and OAlster databases.
  
  
  METHODS
  Articles published in English or French with all study designs were considered for the review. Studies were included if they contained interventions designed to reduce the incidence, risk, or mortality of CVD or diabetes; affect clinical indicators of CVD or diabetes mellitus (including hypertension, dyslipidemia, or hemoglobin A(1c)); and/or improve adherence to treatment strategies. Only studies involving interventions carried out primarily by pharmacists in community pharmacy settings were included. Study quality was assessed using a checklist validated for both randomized and nonrandomized studies.
  
  
  RESULTS
  A total of 4142 studies were initially identified, with 40 meeting our inclusion criteria. Eleven studies were randomized controlled trials, 4 were cluster randomized trials, and 2 studies had randomized before-after designs. The remaining studies were controlled before-after (n = 2), cohort (n = 4), and uncontrolled before-after (n = 17) designs. Interventions focused on diabetes (n = 12), hypertension (n = 9), medication adherence (n = 9), lipids (n = 5), evidence-based medication initiation or optimization (n = 3), risk factor prediction scores (n = 1), and body mass index (n = 1). All studies contained interventions focused at the patient level and the majority of studies (34/40) involved interventions directed at both the physician and patient. No specific intervention emerged as superior, and study quality was generally poor, making it difficult to determine the true effect of the interventions.
  
  
  CONCLUSIONS
  Poor study quality, time-intensive interventions, and unproven clinical significance warrant the need for further high-quality studies of community pharmacist interventions for preventing or managing diabetes or CVD and/or their major risk factors.
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Charity D
authors.initials: CD
authors.lastname: Evans
authors.forename: Erin
authors.initials: E
authors.lastname: Watson
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
authors.forename: Jeff G
authors.initials: JG
authors.lastname: Taylor
authors.forename: Erin M
authors.initials: EM
authors.lastname: Yakiwchuk
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Shevchuk
authors.forename: Alfred
authors.initials: A
authors.lastname: Remillard
authors.forename: David
authors.initials: D
authors.lastname: Blackburn
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control*; D003157:Community Pharmacy Services / Q000592:standards*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D010594:Pharmacies / Q000592:standards*; D024382:Professional Role; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors