Hypertenion: Sensitivity of Patient Outcomes to Pharmacist Interventions. Part II: Systematic Review and Meta-Analysis in Hypertension Management
Bibliographic record
Abstract
BACKGROUND: Hypertension is a major health concern worldwide due to its deleterious impact. Few studies have quantitatively assessed pharmacists' interventions in hypertensive patients. OBJECTIVES: To identify and quantify outcomes sensitive to pharmacists' interventions. METHODS: International Pharmaceutical Abstracts, MEDLINE, Cochrane Central, and EMBASE were searched from inception through December 2006. Two independent reviewers identified articles; results were compared and resolved through consensus. Data extracted included intervention type, patient numbers, demographics, study characteristics, instruments used, data compared, and outcomes reported. A random effects meta-analysis was used to combine data. Study quality was assessed using the Downs-Black scale. RESULTS: Of 203 potential articles identified, 98 were selected and their abstracts were read. Nine of these were reviewed full-text and 19 more were identified from references, resulting in a total of 28 articles. Research designs included 18 randomized controlled trials, 6 single-arm clinical trials, 3 nonrandomized comparative trials, and 1 database study. Average quality score was 66% +/- 12% (fair). Medication management (82%) and hypertension education (68%) were the interventions most used. Thirty-nine study results (57% of all outcomes evaluated) were sensitive to pharmacists' interventions. Meta-analysis of 2246 patients in 13 studies found that pharmacists' interventions significantly reduced systolic blood pressure (10.7 +/- 11.6 mm Hg; p = 0.002), while controls remained unchanged (3.2 +/- 12.1 mm Hg; p = 0.361). Pharmacists' interventions further reduced systolic blood pressure (6.9 +/- 12.1 mm Hg; p = 0.047) over controls. Nonsensitive results included further reduction in diastolic blood pressure (3.6 +/- 3.7 mm Hg; p = 0.06), quality of life (1 of 8 significant), and adherence (5 of 13 significant). CONCLUSIONS: Systolic blood pressure is sensitive to pharmacists' interventions. Other outcomes may also be sensitive; however, more high-quality studies are needed for a comprehensive quantitative assessment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.015 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".