Impact of pharmaceutical care interventions in improving clinical outcomes among patients with pulmonary tuberculosis: a systematic review

ABSTRACT

Background

Pharmacists can play an important role in the fight against tuberculosis (TB) through optimising medication use and safety, promoting adherence to anti-TB drugs, and providing patient education. Limited evidence is available on the effectiveness of pharmacist’s interventions on health outcomes in patients with pulmonary TB. This systematic review aims to assess the effectiveness of pharmaceutical care interventions in the management of pulmonary TB.

Methods

English language studies assessing the impact of pharmaceutical care interventions in TB management were searched across three electronic databases (PubMed, Embase, Cochrane), a RCT registry ClinicalTrial.gov, a peer-reviewed journal ‘The Lancet Infectious Diseases’, and the references of retrieved articles. Interventions delivered by pharmacists alone or as part of multidisciplinary teams were included in the review. Data were extracted using the modified Cochrane EPOC standardised data collection tool. The Cochrane Risk of Bias 2 and the NIH quality assessment tools were used to assess the risk of bias among included studies. Data were synthesised narratively. (PROSPERO Protocol Registration CRD42022325771).

Results

Thirteen studies, including two randomised controlled trials (RCTs) with a total of 3886 patients were included. Many of the included studies had a high risk of bias and lacked cohert reporting of treatment outcomes. The most common pharmaceutical care interventions were education and counselling regarding adverse drug reactions and resolution of drug-related problems. Five studies showed a relatively high TB completion rate yet only one study reached the targeted treatment success goal of (>90%).

Conclusion

The current evidence suggests that pharmaceutical care interventions can potentially improve treatment outcomes among patients with pulmonary TB. However, no definitive conclusion can be drawn given the low methodological quality of the included studies and lack of long-term follow-up data. Well-designed RCTs with careful attention to study methodology, standardised outcomes assessment aligned with the World Health Organization’s guidelines are warranted to guide future practice and policy.

KEYWORDS:

• Pharmacist interventions
• systematic review
• tuberculosis
• adverse drug reactions
• adherence

Acknowledgements

KA and MAH contributed to the conception and design of the study, acquisition of data, and analysis. MJ conducted an updated search. All authors contributed to the interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated or analysed during this study are included in the published article [and its supplementary information files]

Additional information

Notes on contributors

Kheloud Awad

Kheloud Awad completed her BSc in Pharmacy and PharmD degrees from Qatar University. She is currently working as a research assistant at the College of Pharmacy, Qatar University. She has a research interest in evidence synthesis.

Myriam Jaam

Myriam Jaam completed her MSc in Clinical Pharmacy and Practice from Qatar University. She is working as a teaching assistant in the Department of Clinical Pharmacy and Practice, College of Pharmacy, Qatar University. She has co-authored over 15 peer-reviewed publications. Her research interests are in the fields of medication adherence and safety.

Ahmed Awaisu

Professor Ahmed Awaisu is a Professor of Clinical Pharmacy and Practice in the Department of Clinical Pharmacy and Practice, College of Pharmacy, Qatar University. He has co-authored over 200 papers in international peer-reviewed journals. His main areas of research include medication safety, medicines optimization, and pharmacy education.

Derek Stewart

Professor Derek Stewart is a Professor of Clinical Pharmacy and Practice in the Department of Clinical Pharmacy and Practice, College of Pharmacy, Qatar University. He has co-authored over 200 papers in international peer-reviewed journals. His main areas of research include evidence synthesis, medication safety, and pharmaceutical health services research.

Hassaan Anwer Rathore

Dr. Hassaan Anwer Rathore is an Associate Professor in the Department of Pharmaceutical Sciences, College of Pharmacy, Qatar University. He has co-authored over 70 peer-reviewed papers. His main areas of research include evidence synthesis and understanding the pathophysiological basis of disease.

Muhammad Abdul Hadi

Dr. Muhammad Abdul Hadi is an Associate Professor of Clinical Pharmacy and Practice in the Department of Clinical Pharmacy and Practice, College of Pharmacy, Qatar University. He has co-authored over 80 papers in international peer-reviewed journals. He is a research methodologist and likes to work across clinical disciplines. He has a special interest in the development and evaluation of pharmaceutical health services.