Evaluation of pharmacist care for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background In chronic obstructive pulmonary disease (COPD), the value of pharmacist care is not clear. Aim of the review A systematic review was conducted to clarify the impact of pharmacist care for outpatients with COPD. Methods The PubMed, EMBASE, CINAHL, CBMdisc, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist-care interventions among outpatients with COPD. The reference lists were also screened for any additional relevant studies not identified through the electronic database searching. Two reviewers independently assessed each paper for methodological quality and extracted the data. Results Fourteen articles were included. These articles described eight randomized controlled trials (1,327 patients) that pharmacist care was compared with usual care. The pharmacist interventions included those exclusively conducted by pharmacists and those conducted in collaboration with a multidisciplinary team. Although the current evidences failed to illustrate significant improvement in the health-related quality of life in intervention patients, results indicated that pharmacist care was associated with a significant reduction in the risk of hospital admissions [six studies (684 patients); risk ratio 0.50 (95 % CI 0.39-0.64)]. However, no significant effect was found either in emergency department visits or in lung function. In addition, pharmacist care improved medication compliance of patients [four studies (743 patients); risk ratio 1.23 (95 % CI 1.11-1.36)] while reduced health-related cost [three studies (318 patients); standardized mean difference -0.37 (95 % CI -0.59 to -0.15)]. Conclusion Pharmacist care resulted in improvements in the medication compliance as well as reductions in hospital admissions and health-related costs. It is therefore a potent strategy for management of outpatients with COPD.