Pharmacist interventions in schizophrenia and bipolar affective disorder: A systematic review and meta-analysis

Schizophrenia and bipolar affective disorder (BAD) are chronic mental disorders that cause severe disability and represent a significant burden of disease. Pharmacists play a critical role in enhancing patient care and improving health outcomes. However, no systematic review with meta-analysis on pharmacist interventions in these populations has been published.

To evaluate the efficacy of pharmacist interventions in improving health outcomes for patients with schizophrenia or BAD.

A literature search was conducted in PubMed, Cochrane Central, Embase, and Google Scholar until March 2024. Randomized controlled trials (RCTs) assessing pharmacist interventions on any health outcome (except pharmacoeconomic) in patients with schizophrenia or BAD were included. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment (Rob 2 tool). Meta-analyses were conducted using random-effect models in the RStudio software.

Seven RCTs, published between 2017 and 2024 in middle-income countries, were included. Four studies focused on schizophrenia, three on BAD. The majority (40-60 %) of participants were female, aged 35-40. Six RCTs implemented health education as a pharmacist intervention, with medication adherence and quality of life being the primary outcomes assessed. Meta-analyses were conducted for quality of life outcomes in schizophrenia and BAD, and demonstrated that pharmacist interventions significantly improved overall scores and all domains of the WHOQOL-BREF instrument (physical, psychological, social relationships, and environmental), with a low certainty of evidence. In addition, clinical and process outcomes showed a significant improvement after the pharmacist intervention. However, all outcomes were classified with a high risk of bias according to the RoB 2 tool, mainly due to issues with outcome measurement.

Pharmacist interventions may significantly impact the health outcomes of patients with schizophrenia or BAD, but more high-quality RCTs are needed to solidify these findings.