Steed, L; Sohanpal, R; Todd, A; Madurasinghe, VW; Rivas, C; Edwards, EA; Summerbell, CD; ... Walton, RT; + view all Steed, L; Sohanpal, R; Todd, A; Madurasinghe, VW; Rivas, C; Edwards, EA; Summerbell, CD; Taylor, SJ; Walton, RT; - view fewer (2019) Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews (12) , Article CD011207. 10.1002/14651858.CD011207.pub2.

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Abstract

BACKGROUND Community pharmacies are an easily accessible and cost‐effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health‐promoting behaviours that aim to improve health and to optimise the management of long‐term conditions. However, it remains uncertain whether these health‐promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health‐promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health‐promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health‐related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health‐related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty‐nine studies were conducted in high‐income countries, and eight in middle‐income countries. We found no studies that had been conducted in low‐income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow‐up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination ‐ mainly in individually randomised studies ‐ and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias.

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