Background
Methods
Data sources and searches
Study selection
Data extraction and risk of bias assessment
Results
Description of studies and types of interventions
Source; country | Study setting | Study design, duration | Sample size (intervention/control) | Study participants; mean Age | Key components of pharmacist interventions | Intervention frequency | Description of usual care | Outcomes extracted |
---|---|---|---|---|---|---|---|---|
Calvert [14], 2012; US | In hospital and community pharmacy | RCT, 6 months | 143 (71/72) | CAD patients (UA or AMI; or ≥50% coronary occlusion on cardiac catheterization; or prior PTCA or CABG); 62 years | Focused medication counseling performed by the hospital study pharmacist, who identified and addressed barriers to medication adherence. A pocket medication card, a list of tips for remembering to take medications, and a pillbox were provided. Discharge medications were shared with the community pharmacist. The community pharmacist monitored for problems with adherence and communicated issues back to the patient and the patient’s care team | Every 6 weeks | Routine discharge counseling performed by the patient-care nurse and a letter/discharge summary from the hospital physician to the community physician | Medication adherence |
The MEDMAN study [15], 2007; England | Community pharmacy | RCT, 12 months | 1493 (980/513) | CHD patients (previous MI, angina, CABG and/or PTCA); 69 years | Consultations of therapy, medication compliance, lifestyle and social support were provided by the community pharmacist and recommendations were recorded and sent to the GP, who returned annotated copies to the pharmacists. | Depending on pharmacist-determined patient need | Usual care | Medication adherence and BP control |
Faulkner [16], 2000; US | Outpatient clinic | RCT, 2 years | 30 (15/15) | Patients 7 ~ 30 days after PTCA or CABG and baseline fasting LDL-C >130 mg/dl (3.3 mmol/L); 63 years | Pharmacist telephoned patients, emphasized on the importance of therapy, asked patients about when and where prescriptions were filled, how they paid for their prescriptions, potential side effects, overall well-being, and specific reasons for noncompliance when applicable. | Every week for 12 weeks | Counseling of appropriate use of the drugs and dietary instruction | Medication adherence and lipid management |
Olson [17], 2009; US | Medical offices | RCT, 2 years | 421 (214/207) | CAD patients (AMI, CABG, PCI) who had been enrolled in the CPCRS for at least 1 year and who had 2 consecutive controlled LDL-C, non–HDL-C, and blood pressure within 6 months before enrollment; 72 years | Review of laboratory results, blood pressure, medications and adherence, counseling on diet and exercise regimens, making medication adjustments, ordering follow-up laboratory tests, and mailing laboratory reminder letters for patients | Every 1 year | Usual care plus laboratory reminder letters | The occurrence of coronary events, mortality, and hospitalization; medication adherence, BP control, and lipid management |
Straka [18], 2005; US | Outpatient clinic | cluster RCT, 6.5 months of active treatment, and 18 months of follow-up | 481 (150/331) | CHD patients whose LDL-C levels were not at goal; 69 years | Managing lipid-lowering drug therapy and educating patients on cardiovascular risk reduction, communicating the responsible physician about the medication managements. | Every 6 weeks | Usual care | Medication adherence, BP control and lipid management |
Methodological quality of included studies
Primary outcomes
Mortality, cardiac events, and hospitalizations
Secondary outcomes
Medication adherence
Source | Method of measuring adherence | Medication involved | Outcome |
---|---|---|---|
Calvert [14], 2012 | Patient self-report and prescription records assessment | Aspirin, β-blocker, and lipid-lowering drug | No significant difference in self-reported adherence |
Better adherence to β-blocker in prescription assessed adherence in intervention than in control (P = 0.03) | |||
The MEDMAN study [15], 2007 | Patient self-report | Aspirin, lipid-lowering drug, β-blocker, and ACE inhibitor | No significant difference |
Faulkner [16], 2000 | Pill counts at 6 and 12 weeks and prescription records assessment at 1 and 2 years | Lipid-lowering drug | No significant difference at 6 or 12 weeks |
Medication compliance was significantly higher in intervention than in control (P < 0.05) | |||
Olson [17], 2009 | Prescription records assessment | Lipid-lowering drug | No significant difference |
Straka [18], 2005 | Prescription records assessment | Lipid-lowering drug | Medication compliance was higher in intervention than in control (78% versus 44.1%) |
Blood pressure (BP) control
Source | Target for BP or lipid management | Outcome |
---|---|---|
The MEDMAN study [15], 2007 | BP: < 140/85 mmHg | No significant difference |
Faulkner [16], 2000 | LDL-C: ≤ 100 mg/dL (2.6 mmol/L) | No significant difference at 6 or 12 weeks |
More patients achieved target in intervention than in control at 1 and 2 years (P < 0.05) | ||
Olson [17], 2009 | LDL-C and non-HDL-C: < 100 mg/dL (2.6 mmol/L) and < 130 mg/dL (3.3 mmol/L) for all patients, < 70 mg/dL (1.8 mmol/L) and < 100 mg/dL (2.6 mmol/L) for patients with diabetes, multivessel coronary disease, at least 1 recurrent coronary event, or current smokers | No significant difference in maintaining LDL-C and non-HDL-C goal, and BP goal of < 130 mmHg |
BP: < 140/90 mmHg for all patients, <130/80 mmHg for patients with diabetes or CKD | More patients maintained a BP goal of < 140 mmHg in intervention than in control (P = 0.03) | |
Straka [18], 2005 | LDL-C: ≤ 100 mg/dL (2.6 mmol/L) | More patients achieved LDL-C goal in intervention than in control at 6.5 months and the following 18 months (P < 0.001) |