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Table 1 Detailed characteristics of studies included in the review

From: The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

Author (Year) Objective Study design Sample size Mean age Years Follow up Setting Patients’ description Pharmacist intervention Outcomes
Thera Hum safety eco
Samtia et al. 2013 [39] Pharmacist led interventions on glycaemic control, medication adherence, disease knowledge, and lifestyle modifications among patients with diabetes RCT N = 348
IG = 178
CG = 170
IG = 46.1
CG = 42.3
5 months, follow up visit after every month Outpatient settings of Nishtar Hospital Multan and DHQ Hospital Layyah Diabetic patients who were receiving oral hypoglycaemic medication from at least the last 6 months and were having a BMI of more than 25 were included in this study. Patients solely on insulin therapy were not included. Patients in the intervention group received pre-defined specialised care, i.e., education regarding the disease, adherence, dietary restrictions, self-monitoring of blood glucose, fasting blood glucose and guide patients about control of HBA1c, smoking cessation and exercise impact on glucose control. Also provide education regarding sensory changes, including foot examination × ×
Khan et al. 2014 [47] To check the impact of academic clinical pharmacists in reducing drug-related problems prospective, observational, and interventional study N = 373 NR 3 months Inpatients of 250 bedded teaching-based hospital, located in Karachi Inpatients of neonatal intensive care unit, Female surgical ward, male surgical ward, post-natal ward, cardiac ward, and medical ward. Pharmacist on daily basis, monitored all aspects of patients’ drug therapy along with the past medical history, laboratory reports and practitioner’s notes. The identified drug-related problems were then discussed with the pharmacist team members, and with the development of consensus interventions were conveyed to the respective physician along with the best possible approach to rectify drug-related problem × × ×
Kaukab et al. 2015 [40] To analyse the effect of pharmacist individual counselling on depression in MDR-TB patients to improve depressive symptoms RCT N = 70
IG = 35
CG = 35
NR 10 months TB department of Nishtar Hospital, Multan, Pakistan Outpatients having drug resistance TB Pharmacist provided educational intervention with economic help, e.g. monthly food basket (Ghee, flour, milk, sugar, tea, and all cereals). Two-way transportation fares free lab facilities, free medical check-up and free of cost medicines for whole month. × × ×
Saleem et al., 2015 [41] To assess the impact of an educational intervention provided to hypertensive through hospital pharmacists to improve their knowledge on hypertension, their adherence to the medication and their HRQoL RCT N = 385
IG = 193
CG = 192
39 ± 6.5 9 months, 3 follow up visits; first visit 15 min, later visits of 10 min Cardiac units of SPH and BMCH located in Quetta Outpatients of Patients aged 18 or over with an established medical diagnosis of hypertension, familiarity with Urdu (the national language of Pakistan) and on antihypertensive medication for the last 6 months. Pharmacist provided health education about hypertension (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 book on hypertension, information leaflets and medication adherence cards (all in Urdu) during the counselling process × ×
Amer et al. 2018 [42] To evaluate the effect of pharmacist educational intervention to the patients of hypertension to improve knowledge, adherence to medicines, blood pressure control and HRQoL RCT N = 394
IG = 192
CG = 192
NA 9 months with 3 follow ups Polyclinic hospital of Islamabad Hypertension Outpatients visiting the cardiology section of the hospital Pharmacist conducted interviews of patients at each visit and identified causes of lack to adherence towards medication and provided disease-related education to the patients (lifestyle education, medication counselling to increase knowledge about hypertension, adherence to medication and HRQol). A printed booklet (in Urdu language) of hypertension-related educational material was also provided to the patients. × ×
Ali et al. 2019 [43] 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 3 months, three follow up visits, Gastroenterology outpatient department of SIMS, Lahore and the PIMS Islamabad Confirmed HCV-positive patients aged ≥18 years who presented to the gastroenterology department during the study period were included. Clinical pharmacist-provided individualised patient care, including direct patient monitoring, provision of medication diary, education on lifestyle modifications, and counselling on the appropriate use of HCV medication. Clinical pharmacy services continued until treatment completion. ×
Javaid et al. 2019 [44] To demonstrate the pharmacist-led improvements in glycaemic, blood pressure and lipid controls in type 2 diabetes mellitus (T2DM) patients RCT N = 244
IG = 123
CG = 121
50.92 9 months with 3 follow-ups; 15–30 min primary care facility, Murad clinic Shalamar link road, Lahore, Un-controlled T2DM patients (HbA1c > 8%) were included in study. Pharmacist performed PWDT, CORE, PRIME, non-adherence, adverse drug reactions, monitoring and screening of patients at each follow-up. ×
Chatha et al. 2020 [45] To investigate pharmacist-led interventions to improve adherence to antiretroviral therapy (ART) for people living with HIV RCT N = 66
IG = 33
CG = 33
IG = 36. 18
CG = 31.39
2 months, two follow ups of 30 min duration Antiretroviral therapy centre (ART), Pakistan institute of medical sciences HIV positive, >  18 age, taking ART for > 3 months. Patients were exluded if having incomplete baseline blood tests, pregnancy, or a cognitive impairments. 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, also included advice on the potential negative impact of diet and supplementary herbs or medicines on the effectiveness of ART × ×
Khokhar et al. 2020 [46] To evaluate the impact of pharmacist-led intervention among pre-dialysis CKD patients to improve disease knowledge, adherence, body composition and physiological profile of CKD patients. Pre-post prospective N = 120
IG = 60
CG = 60
55.88 ± 13.83 3 months; 45 min first session Nephrology outpatient departmen, National Institute of Kidney Diseases, Sheikh Zayed Hospital, Lahore All patients with an established diagnosis of CKD stage 2 to 4 (GFR between 15 and 89 ml/min per 1.73 m2) according to KDOQI guidelines of the National Kidney Foundation were enrolled in the study. Pharmacist provided information about the disease, dietary recommendations, counselling to improve medication adherence along with telephonic follow-up × ×
  1. Thera = Therapeutics, Hum = Humanistic, Eco = Economic, FIVs = Follow on interventions, DHQ = District headquarter hospital, BMCH = Bolan Medical Complex Hospital, BMI = Body mass index, MDR-TB = Multidrug-resistant tuberculosis RIVs = rejected interventions, HRQoL = Health Related Quality of Life, SPH = Sandeman Provincial Hospital, SIMS = Services, Institute of Medical Sciences, PIMS = Pakistan Institute of Medical Sciences, PWDT = Pharmacist’s work up of drug therapy, CORE = Condition, Outcome, Regime, Evaluation, PRIME = Problem, Risk, Interaction, Mismatch, Efficacy, CKD = chronic kidney disease, KDOQI = Kidney Disease Outcomes Quality Initiative, GFR = Glomerular filtration rate