Roles and Impacts of the Transplant Pharmacist: A Systematic Review
2018
ABSTRACT Background: Pharmacists have been involved in the care of transplant recipients for several decades, and a growing body of literature shows the beneficial effects of clinical pharmacist care on important outcomes for these patients. Objectives: The primary objective was to describe the roles and impacts of pharmacists in a solid organ transplant setting. The secondary objective was to describe and rate the pharmacists’ interventions. Data Sources: Three databases —PubMed, Embase, and Evidence-Based Medicine Reviews —were searched from January 1, 1990, to June 16, 2015. Study Selection and Data Extraction: All studies addressing the roles of pharmacists and the impacts of clinical pharmacy services on the care of solid organ transplant recipients were considered. Only studies providing a statistical analysis were included. Design, setting, sample size, patient characteristics, pharmacists’ interventions, study bias, and outcomes were extracted for analysis. Data Synthesis: Four randomized controlled trials, 4 cohort studies, 3 pre–post studies, and 1 quasi-randomized controlled trial were included in the review, representing a total of 1837 patients. Of the 12 studies included, 8 specifically focused on renal transplant, and 1 each focused on liver, lung, abdominal organ, and general solid organ transplant. The pivotal pharmacist activities leading to the main patient outcomes were medication counselling (n = 8 studies), medication reconciliation (n = 5), and reviewing and optimizing drug therapy (n = 3). Improvements to medication adherence (n = 6 studies), morbidity (n = 4), costs (n = 2), and medication errors (n = 2) were reported. Conclusion: Currently available evidence suggests that pharmacists can improve patient outcomes in the solid organ transplant setting. Adherence, morbidity, costs, and medication errors were identified as the main outcomes that were improved by pharmaceutical interventions. Transplant programs need to invest more in this resource. RESUME Contexte : Les pharmaciens participent aux soins des greffes depuis plusieurs decennies et un nombre croissant de publications revelent les effets benefiques des soins prodigues par les pharmaciens cliniciens quant aux resultats therapeutiques importants pour ces patients. Objectifs : L’objectif principal etait de decrire les roles des pharmaciens et leurs influences par rapport aux greffes d’organes solides. L’objectif secondaire etait de decrire et d’evaluer les interventions des pharmaciens. Sources des donnees : Les bases de donnees PubMed, Embase et Evidence-Based Medicine Reviews ont ete interrogees pour la periode allant du 1er janvier 1990 au 16 juin 2015. Selection des etudes et extraction des donnees : Toutes les etudes abordant les roles des pharmaciens et l’influence des services de pharmacie clinique sur les soins des receveurs d’organes solides ont ete prises en consideration. Seules les etudes presentant des analyses statistiques ont ete retenues. Le plan d’etude, le contexte, la taille de l’echantillon, les caracteristiques des patients, les interventions des pharmaciens, les biais et les resultats therapeutiques ont servi a l’analyse. Synthese des donnees : Quatre etudes controlees a repartition aleatoire, 4 etudes de cohorte, 3 etudes avant-apres et 1 essai comparatif a repartition quasi-aleatoire ont ete retenus pour l’analyse, ce qui representait au total 1837 patients. Parmi les 12 etudes retenues, 8 abordaient specifiquement la greffe renale et chacune des 4 autres concernait respectivement une greffe hepatique, une greffe pulmonaire, une greffe d’organe abdominal et une greffe d’organe solide. Les activites cles des pharmaciens menant aux principaux resultats therapeutiques etaient les conseils sur les medicaments (n = 8 etudes), l’etablissement du bilan comparatif des medicaments (n = 5) ainsi que l’examen et l’optimisation de la pharmacotherapie (n = 3). On a constate des ameliorations des taux d’observance pharmaco -therapeutique (n = 6 etudes), des taux de morbidite (n = 4), des couts (n = 2) et des taux d’erreurs de medicaments (n = 2). Conclusion : Les donnees probantes disponibles laissent croire que les pharmaciens peuvent ameliorer les resultats therapeutiques en ce qui concerne les greffes d’organes solides. Les taux d’observance pharmaco -therapeutique, les taux de morbidite, les couts et les taux d’erreurs de medicaments ont ete designes comme les resultats principaux qui ont ete ameliores par les interventions pharmaceutiques. Les programmes de greffe doivent investir davantage dans cette ressource.
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