%0 Journal Article
%T Does Clinical Pharmacy Improve What Matters to Patients? An Umbrella Review Separating Process Gains from Medication-Related Harm, Health-Care Use, Survival, and Quality of Life, 2017–2024
%A Peter Nagy
%A Amelia Clarke
%A Rakesh Nair
%J Annals of Pharmacy Practice and Pharmacotherapy
%@ 3062-4436
%D 2023
%V 3
%N 2
%R 10.51847/iThEcxX0qY
%P 178-191
%X Clinical-pharmacy interventions are frequently described as effective, yet the meaning of effectiveness changes substantially according to the outcome assessed. Improvements in medication appropriateness, adherence, prescribing quality, and medication-related problems may occur without corresponding reductions in hospital use, mortality, or deterioration in quality of life. Interpretation is further complicated when systematic reviews repeatedly include the same primary studies and are treated as independent corroborating evidence. To determine across systematic reviews of clinical-pharmacy interventions which benefits are concentrated in process and medication-related outcomes and which extend to health-care use, survival, or quality of life, while accounting for methodological quality, outcome heterogeneity, and overlap of primary studies across reviews. An umbrella review of systematic reviews published from 2017 through 2024 was conducted using review-of-reviews methodology informed by PRISMA 2020 and PRIOR principles. Eligible reviews evaluated pharmacist-led or pharmacist-integrated clinical interventions and reported process, medication-related harm, health-care use, mortality, or quality-of-life outcomes. Reviews were characterized by population, setting, intervention, comparator, outcome definitions, and methodological limitations. Methodological quality was assessed using AMSTAR 2 principles. Outcomes were coded into prespecified tiers. Primary-study overlap was examined using study-review membership information where ascertainable; quantitative overlap statistics were restricted to matrices sufficiently complete for reproducible calculation. The searches identified 146 review records, of which 42 duplicates were removed. After screening 104 unique records, 43 full-text reports were assessed and 20 systematic reviews met the formal umbrella-synthesis criteria. Evidence was most consistently favorable for medication appropriateness, medication-related problems, adherence, medication errors, and selected medication-harm outcomes. Effects on admission and readmission were more variable and appeared sensitive to setting and intervention intensity. Mortality was generally unchanged in broad medication-review programmes, although favorable associations occurred in selected high-risk settings. Quality-of-life findings were mixed, with stronger signals in some targeted counseling and pain-management interventions. Repeated primary studies across reviews reduced the extent to which concordant review conclusions could be interpreted as independent replication. Clinical pharmacy improves outcomes that matter to patients under some conditions, but the strength and consistency of benefit differ markedly by outcome. Evidence is strongest for outcomes close to medication management and less uniform for health-care use, survival, and quality of life. Review-level corroboration also requires adjustment for shared underlying primary evidence.
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