背景:疼痛是一项重大的医疗保健挑战,影响全球数百万人。药剂师在管理疼痛方面的作用越来越大,特别是在初级和门诊护理环境中。本综述旨在系统地评估已发表的系统综述中的证据,这些综述探讨了药剂师提供的干预措施对临床,人文,以及与疼痛相关的经济结果。
方法:在六个电子数据库中进行了系统搜索,包括OvidEmbase,MEDLINE,CINAHL,Scopus,中部,APAPsycINFO,DARE,从成立到2023年6月。在加入之前,两名独立审稿人评估了研究标题和摘要.纳入后,对纳入研究的方法学质量进行了评估.AMSTAR2用于评估纳入SRs的方法学质量。
结果:从2055检索到的标题,包括11项系统审查,11个中有5个是荟萃分析。这些SR包括不同的药剂师主导的干预措施,如教育,药物评价,以及针对疼痛管理各个方面的多组分策略。这些发现显示了良好的临床结果,包括减轻疼痛强度,改善药物管理,增强整体身心健康,减少住院时间。由于药剂师的干预,发现疼痛强度显著降低,不同研究和亚组的标准化平均差(SMD)范围为-0.76至-0.22。观察到身体功能改善,SMD范围从-0.38到1.03。还报告了积极的人文成果,例如增加医疗保健提供者的信心,患者满意度,和生活质量(QoL)。据报道,QoL有所改善,SMD范围从0.29到1.03。三项系统评价检查了药剂师干预对疼痛相关经济结果的影响,强调不同的成本影响,以及需要稳健的研究方法来获取成本和收益。
结论:这篇综述强调了药剂师提供的干预措施在改善临床,人文,以及与疼痛管理相关的经济结果。现有证据强调需要将法老纳入多学科疼痛管理团队。需要进一步的研究来研究创新的护理模式,例如协作疼痛管理诊所中独立于药剂师的处方计划。
BACKGROUND: Pain is a significant healthcare challenge, impacting millions worldwide. Pharmacists have increasingly taken on expanded roles in managing pain, particularly in primary and ambulatory care contexts. This umbrella
review aims to systematically evaluate evidence from published systematic reviews that explore the impact of pharmacist-delivered interventions on clinical, humanistic, and economic outcomes related to pain.
METHODS: A systematic search was conducted across six electronic databases, including Ovid Embase, MEDLINE, CINAHL, Scopus, CENTRAL, APA PsycINFO, and DARE, from inception until June 2023. Prior to inclusion, two independent reviewers assessed study titles and abstracts. Following inclusion, an assessment of the methodological quality of the included studies was conducted. AMSTAR 2 was used to evaluate the methodological quality of the included SRs.
RESULTS: From 2055 retrieved titles, 11 systematic reviews were included, with 5 out of 11 being meta-analyses. These SRs encompassed diverse pharmacist-led interventions such as education, medication reviews, and multi-component strategies targeting various facets of pain management. These findings showed favorable clinical outcomes, including reduced pain intensity, improved medication management, enhanced overall physical and mental well-being, and reduced hospitalization durations. Significant pain intensity reductions were found due to pharmacists\' interventions, with standardized mean differences (SMDs) ranging from -0.76 to -0.22 across different studies and subgroups. Physical functioning improvements were observed, with SMDs ranging from -0.38 to 1.03. Positive humanistic outcomes were also reported, such as increased healthcare provider confidence, patient satisfaction, and quality of life (QoL). QoL improvements were reported, with SMDs ranging from 0.29 to 1.03. Three systematic reviews examined pharmacist interventions\' impact on pain-related economic outcomes, highlighting varying cost implications and the need for robust research methodologies to capture costs and benefits.
CONCLUSIONS: This umbrella
review highlights the effectiveness of pharmacist-delivered interventions in improving clinical, humanistic, and economic outcomes related to pain management. Existing evidence emphasises on the need to integrate pharamacists into multi-disciplinary pain management teams. Further research is needed to investigate innovative care models, such as pharmacist-independent prescribing initiatives within collaborative pain management clinics.