https://orcid.org/0000-0002-3871-7088
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ABSTRACT
Background
Transition of care (TOC) is associated with an increased risk of medication-related problems. Despite recent advancements in pharmacy practice and research in the Middle East and North Africa (MENA), the characteristics and impact of regional pharmacy-supported TOC interventions remain unclear.
This systematic review and meta-analysis aimed to describe pharmacist-supported TOC interventions in the MENA region and evaluate their effectiveness.
Methods
PubMed, CINAHL, EMBASE, Web of Science, World Health Organization’s International Clinical Trials Registry Platform (ICTRP) were searched from their inception to March 9, 2023, for experimental studies published in English, comparing pharmacist-supported TOC interventions with usual care for adults (age ≥18 years) discharged from the hospital. The risk of bias was evaluated using Cochrane’s risk-of-bias tool for randomised trials (ROB2) and the risk of bias in non-randomised studies of interventions (ROBINS-I) tool for randomised and non-randomised studies respectively. Narrative syntheses and meta-analysis methods were employed depending on the outcomes evaluated.
Results
Twelve studies (n = 2377 subjects), 10 randomised controlled trials and 2 quasi-experimental studies, were included. Most studies had high or serious risk of bias. The included studies were quite heterogeneous in terms of nature and the delivery of intervention, and assessment of outcome measures. Compared to the usual care group, pharmacist-led TOC interventions contributed to a significant reduction in preventable drug-related (N = 2) and cardiac-related healthcare utilisation (N = 1), a significant reduction in preventable adverse drug events (ADEs) (Odds ratio (OR) 0.34, 95% CI: 0.13-0.94) and an improvement in medication adherence. However, all-cause hospitalisation and medication discrepancies were not significantly reduced.
Conclusion
Pharmacy-supported TOC interventions may improve patient outcomes in the MENA region. However, considering the limited quality of evidence and the variability in intervention delivery, future well-designed clinical trials are needed.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
Notes on contributors
Eman N. Alhmoud
Eman N. Alhmoud is a clinical pharmacist and an assistant director of pharmacy at Al-Wakra Hospital, Hamad Medical Cooperation, Qatar. She is also a PhD student at Qatar University. Her research interests include medication safety, health services research and medicines optimisation.
Safa Farooq Fouad Alrawi
Safa Farooq Fouad Alrawi is a clinical pharmacist with an interest in general internal medicine at Al-Wakra Hospital, Hamad Medical Cooperation, Qatar. Her research interests include medication safety, evidence synthesis and medicine optimisation.
Rasha El-Enany
Rasha El-Enany is the director of pharmacy at Al-Wakra Hospital, Hamad Medical Cooperation, Qatar. She is also the director of the pharmacy residency programme (PGY1) and head of CPD. Her research interests include medication safety and evidence synthesis.
Mohamed Izham Mohamed Ibrahim
Mohamed Izham Mohamed Ibrahim is a professor of social and administrative pharmacy at the department of clinical pharmacy and practice, College of Pharmacy, Qatar University. He has authored more than 300 papers in international peer-reviewed journals. His research interests include sociobehavioural aspects of medicine use, medication safety, evidence synthesis and pharmacy education.
Muhammad Abdul Hadi
Muhammad Abdul Hadi is an associate professor of clinical pharmacy and practice at the department of cllinical pharmacy and practice, College of Pharmacy, Qatar University. He has authored more than 85 papers in international peer-reviewed journals. His research interests include health services research, mixed-methods research, medication safety, evidence synthesis and pharmacy education.