Table 1 Detailed characteristics of studies included in the review
Author (year, country) | Objective | Study design | Sample size (ITT) | Mean age years | Follow-up | Setting | Patients’ description | Control group (CG) | Intervention group (IG) | Outcome | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Clin | Hum | Eco | ||||||||||
Saeed et al. 2021 Pakistan | To determine the impact of pharmacist-led pharmaceutical care on patients’ medication therapy by comparing Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QOL) between patients on pharmaceutical care (PC) and usual care (UC) models | RCT | N = 300 IG = 150 CG = 150 | NA | 6 months | Tertiary care hospital, Rawalpindi, Pakistan | Inclu: OPD patients aged 18 or over, willing to participate in the study and to take at least three medicines and more Exlcu: Patients with any cognitive impairment and refusal to participate | Participants receiving usual standard care of hospital without pharmacists’ intervention | Participants receiving pharmacists’ counselling and education related to drug use, treatment outcomes, adverse events. etc |  ×  | ✓ |  ×  |
Marasine et al. 2020 Nepal | To evaluate the impact of pharmaceutical service intervention on medication adherence and patient-reported outcomes among patients diagnosed with depression in a private psychiatric hospital in Nepal | RCT | N = 212 IG = 107 CG = 105 | 18 to 65 | 6 months, two follow-up in interval of 2 months | Out-patient department of B.G. Hospital, Nepal | Inclu: 18–65 years patients with depression, taking at least one antidepressant medication for at least two months. Exclu: Pregnant or lactating mothers with history of psychotic, bipolar disorder or drug abuse, those with cognitive impairment and unable to communicate | Patients receiving usual care as provided in the hospital in regular visits, including usual pharmaceutical service from a pharmacist | A clinical pharmacist delivered face-to-face counselling about depression and associated risk factors for approximately 15 min, educated patients on the use of antidepressant medications, their potential adverse effects, and essential lifestyle modifications to be practised by the patients, and also provided a leaflet of the session |  ×  | ✓ |  ×  |
Chatha et al. 2020 Pakistan | To investigate pharmacist-led interventions to improve adherence to ART for PLHA | RCT | N = 66 IG = 33 CG = 33 | IG = 36. 18 ± 12.24 CG = 31.39 ± 9.53 | 2 months, two follow-ups of 30 min duration | Pakistan Institute of Medical Sciences (PIMS) | Inclu: HIV positive, > 18 age, taking ART for > 3 months Exclu: Patients having preliminary baseline blood tests, pregnancy, or cognitive impairments | Participants received a single education and counselling session when their physician-led ART was started | Pharmacist-provided counselling was tailored to each social factor focused on personal barriers to taking medication and was aimed at helping participants understand their medication-taking behaviours while acknowledging the actions needed to maintain a high-level of adherence. It also included advice on the potential negative impact of diet and supplementary herbs or medicines on the effectiveness of ART | ✓ | ✓ |  ×  |
Ali et al. 2019 Pakistan | To evaluate the impact of clinical pharmacy interventions on treatment outcomes, HRQOL, and medication adherence among hepatitis C patients | RCT | N = 931 IG = 465 CG = 466 | 42.35 ± 1.9 | 3 months, three follow-up visits | Gastroenterology OPD of SIMS, Lahore and PIMS, Islamabad, Pakistan | Inclu: Patients confirmed with HCV-positive and aged ≥ 18 years who presented to the GED and who started direct acting antiviral (DAA) treatment Exclu: Pregnants or patients co-infected with HBV, HDV or autoimmune hepatitis | They receive usual care from hospital staff. However, they did not receive pharmacists’ intervention such as counselling sessions | Clinical pharmacists provided individualised patient care, including direct patient monitoring, education on life-style modifications, and counselling on the appropriate use of HCV medication. Clinical pharmacy services were continued until treatment was completed | ✓ | ✓ |  ×  |
Javaid et al. 2019 Pakistan | To demonstrate the pharmacist-led improvements in glycaemic, blood pressure and lipid controls in T2DMpatients | RCT | N = 244 IG = 123 CG = 121 | 50 ± 9.2 | 9 months with 3 follow-ups; 15–30 min | Primary care facility, Murad clinic Lahore, Pakistan | Inclu: Uncontrolled T2DM patients (HbA1c > 8%), age > 18 years, Hb > 13 mg/dL with or without concomitant disease Exclu: Those with cognitive impairment, below 18 years of age and missing visits in the past six months | Patients in the CG continued treatment from physicians, and nurses provided regular check-ups | Pharmacist performed PWDT, CORE, PRIME. PRIME include interaction, mismatch, non-adherence, ADRs, monitoring and screening of patients at each follow-up, 15 to 30 min average interaction time | ✓ | ✓ |  ×  |
Yadav et al. 2019 Nepal | To evaluate the effect of a pharmacists’ interventions on asthma control, HRQOL and inhaler technique in adult patients suffering from asthma | Pre- and post- interventional study | N = 72 IG = 36 CG = 36 | 4 months, | OPD of Crimson Hospital, Rupandehi, Nepal | Inclu: Patients aged ≥ 18 years, clinically diagnosed with asthma with or without co-morbidities and who were on inhalers and/or medications for their asthma Exclu: Asthmatic patients admitted in ED | No intervention was made till the completion of the study | The intervention was carried out outside the Medicine-OPD, and patients were counselled for nearly 20–25 min. Patients were later provided counseled with leaflets. The video-aided materials were shown to the patients at their follow-ups | ✓ | ✓ |  ×  | |
Gorutla et al. 2019 India | To evaluate the impact of pharmacist- delivered counselling on KAP levels and control of BP among hypertensive patients from various regions of Anantapur district | Prospective open-labelled, RCT | N = 102 IG = 95 CG = 97 | IG: 43.7 ± 9.11; CG: 43.9 ± 8.26 | 6 months, 2 follow-ups | Medicine OPD of NGO hospital in Anantapur district, Andhra Pradesh, India | Inclu: Hypertensive patients with ≥ 18 years of age with co-morbidities and who could respond in English/Tamil version of questionnaires. Exclu: Those who were refused to participate and respond to Telugu/English version of questionnaires | The participants in the CG followed the usual care given by the physicians | Pharmacists provided face-to-face counselling on hypertension, regular monitoring of BP and body weight, DASH diet, physical exercise, stress management, salt restriction, lifestyle changes (smoking and alcohol), and regular intake of medications as per the physicians’ instruction to the IG patients | ✓ | ||
Abdulsalim et al. 2018 India | To evaluate the effectiveness of a structured pharmacist-led intervention programme on medication adherence among COPD patients in India | Open labelled RCT | N = 260 IG = 130 CG = 130 | IG = 60.60 ± 7.9 CG = 61.1 ± 8.4 | 3 years, four times follow-up | Kasturba Medical College Hospital, Manipal, India | Inclu: Confirmed diagnosis of COPD as per GOLD guideline | CG received standard hospital care, but did not receive intervention provided by the clinical pharmacist | Clinical pharmacist counselled patients for 15–20 min and provided information on (1) importance of medication adherence, (2) dose and frequency of medications, (3) need for smoking cessation, (4) simple exercise, (5) proper use of inhaler devices and (6) need for timely monitoring of medicines using PILs | ✓ | ||
Cooray et al. 2018 Sri Lanka | To examine the impact of a culturally appropriate health-education on lifestyle modification and self-management of patients with diabetes to improve their glycaemic control and delay disease complications | Descriptive, cross-sectional and randomised intervention study | N = 166 IG = 110 CG = 56 | 56.2 ± 8.95 | 12 months, two follow-up | Two main tertiary care facilities in western and south- ern provinces of Sri Lanka | Inclu: T2DM patients aged > 18 years Exclu: Pregnant, GDM, T1DM, patients on haemodialysis, who were unable to speak or understand Sinhala | CG patients received usual care and the same questionnaires as the IG patients but did not receive health education sessions | Structured health education programme covering pathogenesis, progression and complications of T2DM; importance of proper management and follow-ups, and demonstration on blood glucose monitors and insulin pens were given. Also, education on medications’ mode of action, side effects, and adherence to medication on disease prognosis and development of complications | ✓ |  ×  |  ×  |
Amer et al. 2018 Pakistan | To evaluate the effect of pharmacists’ educational intervention to patients with hypertension to improve their knowledge, adherence to medicines, blood pressure control and HRQOL | RCT | N = 384 IG = 192 CG = 192 | NA | 9 months with 3 follow-ups | Polyclinic hospital of Islamabad | Inclu: Hypertension out-patients who could speak or write Urdu, who visited cardiology section of the hospital and who were aged > 30 years, and who were taking antihypertensive medications for the last 6 months. Exclu: Pregnant women, those with co-morbidities, having dementia, immigrants and those aged < 30 years and > 70 years | No educational sessions were provided, but only standard care (provided by the physicians during scheduled visits to the hospital) was provided | Pharmacists conducted interviews of patients at each visit, identified causes of non-adherence to medications, and provided disease-related education to the patients (lifestyle education, medication counselling to increase their knowledge about hypertension, adherence to medications, and HRQOL). A printed booklet (in Urdu language) of HTN-related educational material was also provided to the patients | ✓ | ✓ |  ×  |
Upadhyay et al. 2016 Nepal | To report the impact of pharmacist-supervised intervention through pharmaceutical care programme on DHCs among the newly diagnosed diabetics in Nepal | RCT | N = 162 IG = 108 CG = 54 | 49.14 ± 12.56 | 12 months, 4 times follow-up | Manipal teaching hospital, Pokhara, Nepal | Inclu: Newly diagnosed T1DM and T2DM patients with age 16 years and above Exclu: Pregnant and mentally incompetent | Usual care without specific care by pharmacist | Education and counselling about different aspects of DM and its management and the correct use of antidiabetic medications were given to the test group by the pharmacist |  ×  |  ×  | ✓ |
Upadhyaya et al. 2015 Nepal | To determine the baseline satisfaction level of newly diagnosed diabetics and explore the impact of pharmaceutical care intervention on patients’ satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal | Interventional pre-post non-clinical RCT | N = 152 IG = 102 CG = 50 | 49.14 + 12.56 | 18 months, four times follow-up | Manipal teaching hospital, Pokhara, Nepal | Inclu: T1DM and T2DM patients aged 16 years and above. Exclu: Pregnant women and mentally incompetent patients | CG patients did not receive pharmaceutical care intervention from pharmacist and maintained on usual care obtained from physician/nurses throughout the study | IG received information about diabetes such as its types, sign and symptoms, reasons for high BG, risk factors, acute and chronic complications and role of pharmacological (anti-diabetic medications) and non-pharmacological (lifestyle modification, diet and exercise) measures in managing DM and administration of insulin at home | ✓ | ||
Saleem et al. 2013 Pakistan | To assess the impact of an educational intervention provided to hypertensive patients through hospital pharmacists to improve their knowledge on HTN, their adherence to the medications and HRQOL | RCT | N = 385 IG = 193 CG = 192 | 39 ± 6.5 | Nine months, 3 follow-up visits; first visit 15 min, later visits of 10 min | Cardiac units of SPH and BMCH located in Quetta | Inclu: Out-patients aged 18 or over with an established medical diagnosis of HTN, familiarity with Urdu, and who were taking antihypertensive medication for the last 6 months. Exclu: Patients with dementia, pregnancy and immigrants | The control group had no hospital pharmacists' involvement, and only received traditional service provided by the hospitals (receiving prescription orders, counselling about medication use and information about follow-up visits) | Hospital pharmacist-provided health education about HTN (nature, management, treatment and recommended diet and lifestyle modification), medication adherence and its importance in pharmacotherapy and HRQOL (conceptualisation and importance in treatment outcomes for hypertensive patients). The pharmacist also provided a pocket-sized educational booklet about HTN, information leaflets and medication adherence cards (all in Urdu) during the counselling process | ✓ | ✓ |  ×  |
Wal et al. 2013 India | To assess the effects of pharmaceutical care interventions in patients with essential HTN | RCT | N = 142 IG = 72 CG = 70 | IG = 59.50 ± 8.55 CG = 60.62 ± 8.32 | 4 months | Medicine OPD at Lakshmi Pat Singhania, Institute of Cardiology, Kanpur | Inclu: Newly diagnosed hypertensives aged 20 to 75 years and who had an average DBP > 90 mmHg or an average SBP > 140 mmHg and who were with or without other co‑morbidities. Exclu: Those who refused to come on the scheduled follow-ups | CG did not receive any pharmaceutical care | Patients were counselled on their antihypertensive medications, indications of medicine, specific instructions on the administration of medication, adverse effects, drug interactions, and the importance of adherence to diet and medication therapy using health education materials (in Hindi and English). Appropriate storage conditions of medications, mean obtaining follow-up supplies of medication, and action to be taken in the event of a missed dose were made clear to the patients. | ✓ |  ×  |  ×  |
Ramanath et al. 2012 India | To know the impact of clinical pharmacists’ interventions on medication adherence and HRQOL | RCT | N = 52 IG = 26 CG = 26 | NA | 7 months, two follow-*up | Medicine IPD or OPD at Adichunchanagiri Hospital and Research Center, India | Inclu: Patients aged 18 years or above and who were taking medication for HTN for over 6 months Exclu: Patients with more than four co-morbidities | CG did not provide any counselling and PILs at the baseline and first follow-up. However, they were provided with oral instruction and PILs at the end of the second follow-up | IG patients were counselled about medications, lifestyle changes, and disease management and informed if any unintended effects of medications occurred at any follow-ups. | ✓ | ✓ |  ×  |
Malathy et al. 2011 India | To assess the baseline levels of KAP of diabetics, develop a counselling programme, and assess whether this intervention could produce any improvement in DM awareness and practices | RCT | N = 207 IG = 137 CG = 70 | IG = 52.07 ± 9.47 CG = 51.02 ± 9.83 | 9 months | Two selected multispeciality hospitals and one diabetic clinic in Erode, Tamilnadu, India | Inclu: DM diagnosed among patients aged > 30 years Exclu: Pregnant women and paediatric patients | Usual care without counselling but the group received pharmacists’ counselling at the end of the study only | Pharmacist counselled patients in their local language for 20–25 min on each visit at 1-month intervals over 3 months Pharmacist explained pathophysiology and etiology of DM, acute and chronic complications, importance of BG control lifestyle changes (e.g., exercise, smoking cessation, etc.), nutrition and foot care. After the first counselling session, the test group patients were provided with printed handouts in their local language (Tamil) containing information on DM and dietary and lifestyle changes. | ✓ | ✓ |  ×  |
Sriram et al. 2011 India | To evaluate the impact of pharmaceutical care on HRQOL among T2DM patients | Prospective, CG versus IG clinical trial | N = 120 IG = 60 CG = 60 | IG = 53.65 ± 2.38 CG = 57.98 ± 2.62 | 8 months | Medicine department of, multi-speciality tertiary care teaching hospital, Coimbatore, India | Inclu: T2DM patients aged > 18 years. Exclu: Pregnant women, mentally incompetent patients and critically ill patients | CG patients did not receive any pharmaceutical care | IG received pharmaceutical care, such as medication counselling, instructions on dietary regulation, exercise and other lifestyle modifications using PILs, diabetic diet chart (in both Tamil and English) and diabetic diary. | ✓ | ✓ |  ×  |
Adepu et al., 2010 India | To assess the influence of structured patient education on therapeutic outcomes among patients with T2DM and HTN | Prospective randomised and interventional study | 240 | 57 | 3 months | Medicine OPD of a South Indian tertiary care teaching hospital, India | Inclu: T2DM or hypertensive patients who knew Kannada or English language Exclu: Pregnant women with GDM or pre-eclampsia, those with uncontrolled and complicated DM and HTN, or those who had any significant cardiac complications in the last six months | CG patients received detailed education only at the final follow-up visit | IG patients received education regarding the disease, medication, diet and lifestyle modification at baseline and on each follow-up. | ✓ | ✓ | |
Adepu et al. 2007 India | To assess the impact of pharmacist-provided counselling on treatment outcomes and HRQOL among T2DM patients by improving their KAP | Randomised prospective controlled study | N = 70 IG = 35 CG = 35 | IG = 51.45 ± 12.27 CG = 53.77 ± 10.35 | 6 months | Two selected community pharmacies in Calicut, Kerala, India | Inclu: T2DM patients aged > 30 years who were of either gender and were treated with either diet alone or diet and OHAs. Exclu: Paediatric patients, pregnant and those with uncontrolled DM with complication | Usual care without counselling but received pharmacists’ counselling and PILs at the end of study only | IG received counselling on their disease, drugs, diet and lifestyle modification, and PILs highlighting the disease, diet, and lifestyle modifications. | ✓ | ✓ | × |
Ponnusankar et al. 2004 India | To assess the impact of medication counselling on patients’ medication knowledge and improvements in their adherence | Randomised interventional study | N = 90 IG = 30 CG = 60 | 41 to 60 | 9 months, two follow-up | Out-patient clinic of private hospital, India | Inclu: Patients with chronic conditions (HTN, DM, CV conditions, and bronchial asthma) since at least 6 months. Exclu: Patients with cognitive or perceptual problems | The usual care group did not receive any counselling | Counselled group received medication counselling from the pharmacist for 15–20 min | × | ✓ |  ×  |