Clinical pharmacist-led interventions and their impact on outcomes in patients with bipolar I disorder: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Pharmacist-led interventions have increasingly been recognized as effective strategies for improving outcomes in psychiatric care, yet their role in patients with bipolar I disorder (BD-I) remains underexplored. This systematic review and meta-analysis synthesized existing evidence on the impact of clinical pharmacist-led interventions (defined as medication education, medication review, adherence support, relapse monitoring, and collaborative care with psychiatrists) on medication adherence, relapse prevention, hospitalization, and quality of life among individuals with BD-I. Objectives: To evaluate the effectiveness of pharmacist-led interventions, either alone or in collaboration with psychiatrists, on key clinical and humanistic outcomes in adults diagnosed with BD-I. Methods: Electronic databases (PubMed/MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Cochrane Library) were searched from January 2000 to August 2025 for randomized controlled trials and non-randomized quasi-experimental designs (prospective cohort studies and pre-post intervention studies) assessing pharmacist-led interventions in BD-I. Studies were screened and appraised independently in accordance with PRISMA 2020 guidelines, using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for non-randomized studies. Meta-analyses were performed using Review Manager (RevMan 5.4). Primary outcomes were medication adherence, relapse, hospitalization, and health-related quality of life (QoL). Secondary outcomes included any additional clinical or humanistic measures reported by the included studies. Effect sizes were expressed as odds ratios (ORs) for dichotomous outcomes and as mean differences (MDs) or standardized mean differences (SMDs) for continuous outcomes, each reported with 95% confidence intervals (CIs). Results: = 90%). Evidence for hospitalization reduction was limited but directionally favored pharmacist involvement. Conclusion: Clinical pharmacist-led interventions significantly enhance medication adherence and quality of life and may reduce relapse risk among patients with BD-I. However, given the limited number of studies and small pooled sample sizes, the overall evidence remains preliminary, and the findings should be interpreted cautiously rather than as definitive conclusions. Further large-scale, multicenter studies are warranted to confirm these benefits and assess cost-effectiveness. Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD420251123737 04/10/2025].
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.036 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.039 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".