Impact of pharmacist-led services on antimicrobial stewardship programs: a meta-analysis on clinical outcomes. Issue 4 (16th July 2021)

• Record Type: Journal Article
• Authors: Mahmood, Rana Kamran; Gillani, Syed Wasif; Saeed, Muhammad Waqas; Vippadapu, Prasanna; Alzaabi, Maryam Jaber Mohamed Abdulla
• Is Part Of: Journal of pharmaceutical health services research. Volume 12:Issue 4(2021)
• Page Start: 615
• Page End: 625
• Publication Date: 2021-07-16
• Subjects: pharmacist -- antimicrobial stewardship -- appropriateness -- mortality -- antibiotics; Pharmacy -- Research -- Periodicals; Drugs -- Research -- Periodicals; Medical care -- Research -- Periodicals; Public health -- Research -- Periodicals; Pharmaceutical industry -- Periodicals; Health Services Research -- Periodicals; Economics, Pharmaceutical -- Periodicals; 615.1072
• DOI: 10.1093/jphsr/rmab036
• Languages: English
• ISSNs: 1759-8885

Abstract

Abstract: Purpose: This meta-analysis aims to find out the impact of pharmacists on clinical outcomes of antimicrobial stewardship (AMS). Method: Articles were searched and analyzed based on quality assessed through the JSM quality assessment tool to filter articles with a low level of bias. Two thousand three hundred sixty articles were reviewed for initial screening and 28 articles were included for critical analysis. Statistical analysis used to risk ratio (RR) and standard mean differences calculated using Review manager 5.4. Confidence intervals (CI 95%) were calculated using the fixed-effect model. The I 2 statistic assessed heterogeneity. A random-effect model performed in the case of statistical heterogeneity, subgroup and sensitivity analyses. The primary outcome is mortality and inappropriateness, whereas the secondary outcome is cost, readmission, length of stay, consumption and duration of therapy. Result: A detailed review and analysis of 28 AMSs programs led by pharmacists showed low inappropriateness with pharmacist versus without pharmacist RR = 0.36 with 95% CI of (0.32 to 0.39) and mortality RR is 0.68 with 95% CI of 0.59 to 0.79. Secondary outcomes such as consumption, length of stay, duration of therapy and cost are standard mean difference of −1.61 with 95% CI (−1.72 to −1.50), −0.58 with 95% CI (−0.62 to −0.53), −0.95 with 95% CI (−1.01 to −0.89) and −0.99 with 95% CI (−1.12 to −0.86), respectively, whereas for 30 days readmission is RR = 0.81 with 95% CI (0.70 to 0.93). Conclusion: AMS with pharmacist effectively reduces mortality, inappropriateness, cost, length of stay, duration of treatment, consumption of antimicrobials and the return rate to hospital. So it is suggested pharmacists should lead or play a vital role in antimicrobial stewardship programs to get better outcomes.