Development of a primary care pharmacy outcomes framework : an umbrella literature review

Weir, Natalie M. and Preston, Kate and Newham, Rosemary and Bennie, Marion (2021) Development of a primary care pharmacy outcomes framework : an umbrella literature review. Research in Social and Administrative Pharmacy. ISSN 1551-7411

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    Abstract

    Background An aging population and rising multi-morbidity has shifted healthcare provision from secondary to primary care. Pharmacy-led services have been introduced to support this. The development of an outcomes framework for these services would facilitate conclusions to be drawn on their effectiveness. Objectives To identify outcomes used to evaluate pharmacy-led medication therapy and disease management services within primary care settings to develop an outcomes framework for future studies. Methods An umbrella literature review was conducted. MEDLINE, EMBASE, The Cochrane Library and PsycINFO were searched in June 2020 to identify relevant articles. Eligible reviews were those including studies published from 2010 onwards which reported on the outcomes of pharmacy-led medication therapy and disease management services within primary care, excluding community pharmacy settings. Data were extracted and a content analysis, guided by the ECHO model, stratified the outcomes into four areas: economic, clinical, humanistic and service. Results Twenty-four reviews covering 52 unique studies were identified. Pharmacy-led services included: medication reviews (n = 24, 46.2%), disease and therapy management (n = 17, 32.7%), educational services (n = 6, 11.5%), medicines reconciliation (n = 3, 5.8%), and medication compliance support (n = 1, 1.9%). Services were commonly targeted towards endocrine (n = 23, 44.2%) or cardiovascular diseases (n = 20, 38.5%). Outcomes most commonly explored were clinical (n = 38, 73.1%) and service outcomes (n = 37, 71.2%), followed by humanistic (n = 23, 44.2%) and economic outcomes (n = 13, 25.0%). Overall, 17 sub-categories of outcomes were identified; common sub-categories were: disease indicators [clinical]; medication use and healthcare utilisation [service]; adherence to medicines [humanistic]; and healthcare costs [economic]. Conclusions The findings informed the development of an outcomes framework to guide the evaluation of medication therapy and disease management services, and facilitate international standardised outcome measures within primary care pharmacy to be developed. This could help offer vital evidence on the effectiveness of these services to ensure the pharmacy workforce is working optimally to support primary care.

    ORCID iDs

    Weir, Natalie M. ORCID logoORCID: https://orcid.org/0000-0003-1422-9415, Preston, Kate, Newham, Rosemary ORCID logoORCID: https://orcid.org/0000-0001-6816-3111 and Bennie, Marion ORCID logoORCID: https://orcid.org/0000-0002-4046-629X;