Skip to main content

Table 1 Summary of included studies evaluating implementation of clinical guidelines in community pharmacy

From: Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review

First author, year

Country

Sample size

Time frame

Clinical area (guidelines)

Methodology for collecting outcome data

Key findings for main outcome (++, +, minimal effect, variable results, no evidence of effect)

Curtain, C. et al, 2011 [54]

Australia

Community pharmacies, Total (n = 185), Intervention (n = 73), Control (n = 112)

12 weeks

Proton pump inhibitors (National Prescribing Service proton pump inhibitor dosage recommendation)

Clinical intervention software data, Prescription data, Patient survey, Economic data

++

De Almeida Neto, A.C. et al, 2000 [55]

Australia

Pharmacists, Total (n = 43) from community pharmacies, Total (n = 30), Intervention, (n = 15 pharmacies), Control (n = 15 pharmacies)

Three-week baseline data collection followed by a 6-week intervention period, immediately after the workshop

Non-prescription drugs—analgesics

Simulated patient methodology, Pharmacist survey

+

    

(Protocol for non-prescription medicines with a focus on identifying inappropriate “off-label” use of compound analgesics)

  

De Almeida Neto, A.C. et al, 2001 Study 1 [56]

Australia

Community pharmacies, Total (n = 24), Intervention group (n = 16), Control group (n = 8)

Three 4-week periods: before and immediately

Non-prescription drugs—analgesics

Simulated patient methodology

++

   

after a 3-h training workshop, and after a further interval of 14 weeks

(Protocol for non-prescription medicines with a focus on identifying inappropriate “off-label” use of compound analgesics)

  

De Almeida Neto, A.C. et al, 2001 Study 3 [64]

Australia

Not stated

Three 2-week periods (baseline, post workshop1 and post workshop2)

Non-prescription drugs—cough and cold medicines

Simulated patient methodology

++

    

(Protocol for non-prescription cough and cold medicines)

  

De Almeida Neto, A.C. et al, 2001 Study 5 [68]

Australia

Pharmacists and pharmacy assistants from community pharmacies, total (n = 99)

12 weeks of pseudo-patron and feedback visits, post a training visit

Non-prescription drugs—heartburn and indigestion treatments (protocol for heartburn management)

Simulated patient methodology

++

De Almeida Neto, A.C. et al, 2001 Study 5A [69]

Australia

Not stated

Not mentioned in paper

Non-prescription drugs—analgesics

  
    

(Protocols specific for analgesics)

  

Egen, V. et al, 2003 [70]

Germany

Gynaecologists, total (n = 311), interviewed baseline (n = 24), post-intervention (n = 27), pharmacists, total (n = 418), baseline (n = 21), post (n = 21), women in childbed: baseline (n = 131), post (n = 118)

16 months intervention with interviews pre and post

folic acid (The Societies of Nutrition, Gynaecology and Obstetrics, Human Genetics, Paediatrics, and Neuropaediatrics jointly issued corresponding recommendations)

Simulated patient methodology, Patient interview, Gynaecologist telephone interview

No evidence of effect

Guirguis, L.M. et al, 2007 [71]

Canada

Practicing pharmacists, Total (n = 8) tested the diabetes tool

Participants were introduced to the tools, and their experience was evaluated after 2 weeks. One year later a survey was faxed to investigate any sustained use/change in practice

Diabetes

Pharmacist self-report forms. Pharmacist survey, Focus group discussion

+

    

(Canadian Diabetic Guidelines)

  

Koster, E.S, et al, 2014 [72]

The Netherlands

Community pharmacies, Total (n = 78), Pharmacists, (n = 95) and technicians (n = 337) were interviewed, dispensing data—only available for (n = 52) pharmacies

Dispensing data was collected for the period between 1 Jan. 2008 to 10 May. 2011.

Methotrexate (Safe Methotrexate Dispensing Recommendations published by the Royal Dutch Pharmaceutical Society in accordance with the Dutch Health Care Inspectorate)

Pharmacist-structured interviews, Electronic dispensing records

+

Kradjan, W.A. et al, 1999 [57]

USA

Community pharmacies, Total (n = 90)

Intervention period 4th

Asthma

Patient survey

No evidence of effect

  

Intervention, (n = 44)

March 1996 to 30th June 1996

(Current asthma treatment guidelines)

  
  

Control, (n = 46)

    

Legrand, S.A. et al, 2012 [67]

Belgium

Pharmacists, Total (n = 100)

Intervention pharmacies completed a baseline questionnaire, and after a 6-month intervention period participants (including controls) were asked to complete a post-questionnaire

Medicines and driving

Pharmacist survey

+

  

(IS) intervention group (n = 68), (SA) intervention group (n = 12), Control group (n = 20)

 

(DRUID (driving under the influence of drugs, alcohol and medicines project) dispensing guidelines)

  

Martin, B.A. et al, 2010 [73]

USA

Pharmacists, Total (n = 25)

The study was conducted during 2002–2003

Smoking cessation

Pharmacist survey

+

    

(National tobacco cessation guidelines (Treating Tobacco Use and Dependence: Clinical Practice Guideline), which incorporates the 5A’s counselling process)

Pharmacist telephone interview

 
     

Invoices submitted—(remuneration claims)

 

Naunton, M. et al, 2004 [65]

Australia

GPs, total (n = 200)—74 % visited

Baseline data collection

Osteoporosis

Pharmacist survey

+

  

Community pharmacies, total (n = 69)—100 % visited pharmacists, total (n = 81) to complete surveys

(Mar–Sept 2001) Intervention mail out (Oct 2001) Detailing visits (Jan–May 2002), post intervention data collection (Mar–Sept 2002)

(Locally produced guidelines adapted from American College of Rheumatology, UK Consensus Group and Osteoporosis Australia guidelines on the management of glucocorticoid induced osteoporosis)

GP survey

 
     

Hospital admission data

 
     

Prescription data—(remuneration claims)

 

Patwardhan, P.D. et al, 2012 [58]

USA

Intervention group:

The research was carried out from July 2008 until March 2009 with a 1-month study period in November 2008

Smoking cessation

Pharmacist self-report forms

+

  

Community pharmacies (n = 8), Pharmacists (n = 16), Technicians (n = 24)

 

(Treating tobacco use and dependence: Clinical practice guideline (2008 update)

Quit-line referral reports (from an external agency)

 
  

Control group

 

The specific recommendation to use AAR in situations in which the 5A’s approach may not be feasible)

  
  

Community pharmacies (n = 8),

    
  

Pharmacists (n = 16), Technicians (n = 24),

    

Puumalainen, I. et al, 2005 [74]

Finland

Pharmacists, Total (n = 734)

TIPPA implementation, 4 years (2000–2003).

Guideline-based counselling

Pharmacist survey

Minimal effect

   

Data collection for this research, 1 month—June 2002

(The United States Pharmacopeia (USP) Medication Counselling Behaviour Guidelines disseminated through a 4-year project (TIPPA))

  

Raisch, D.W. 1998 [59]

USA (New Mexico)

Community pharmacies, Total (n = 301)

Ketorolac claims records were reviewed for 3 months before intervention (Aug–Oct 1995) and for 3 months after intervention (Dec–Feb 1996)

Ketorolac

Dispensing data

+

  

Intervention (n = 150), Control (n = 151)

 

(Manufacturers prescribing guidelines for ketorolac)

Economic data

 
  

Data obtained from:

    
  

Community pharmacies (n = 167), Intervention (n = 90)

    
  

Control (n = 77)

    

Reeve, J.F. et al 2008 [60]

Australia

Community pharmacies, Total (n = 52), Pharmacists, Total (n = 150) recruited to attend training

6-week study period where the computer-generated prompt was active plus another 2-week period where interventions were recorded but the prompt was deactivated

Diabetes

Clinical intervention software data, Prescription data, Pharmacist survey

++

  

Intervention (n = 31) pharmacies

 

(American Diabetes Association- Clinical practice recommendations. Aspirin therapy in diabetes. Recommendation for the addition of low-dose aspirin therapy to medication regimen of high-risk patients with diabetes)

  
  

Control (n = 21) pharmacies

    

Sigrist, T. et al, 2002 [66]

Switzerland

Community pharmacies, Total (n = 27)

2 months

Non-prescription drugs

Simulated patient methodology

Variable results

  

Intervention (n = 14)

 

(Personalised advice protocol based on change and health belief models and used in assessment of appropriate use of non-prescription medications)

  
  

Control (n = 13),

    
  

intervention participants to attend workshops,

    
  

Pharmacists (n = 20),

    
  

Pharmacy assistants (n = 65),

    

Thorley, T. et al, 2006 [75]

UK

Community pharmacies, Total (n = 1222)

March 2003 (initial implementation communication), mystery shopping data collected over 4 months (May–Aug 2003)

Asthma

Simulated patient methodology

+

    

(Evidence-based questions (×3) from Royal College of Physicians (RCP) to determine patient asthma control and to direct response based on answers)

  

Van de Steeg-van Gompel, C. et al 2011 [61]

The Netherlands

Community pharmacies, Total (n = 71) grouped into 36 clusters

Sept 2006–Feb 2008

Statins drugs

Prescription data

No evidence of effect

  

Intervention (n = 37) (18 clusters), Control (n = 34) (18 clusters)

 

(Protocol for Education at First Dispensing of a Statin (EAFD) and Protocol for Education at Second Dispensing of a Statin (EASD))

Pharmacist self-report forms

 
     

Pharmacist telephone interview,

 

Watson, M.C. et al, 2002 [62]

UK

Community pharmacies, Total (n = 60)

Mar–Apr 2000 baseline data July–Nov 2000 post intervention data collection

Non-prescription

Simulated patient methodology, Pharmacist survey, Economic data

No evidence of effect

  

EO intervention (n = 15), CPE intervention (n = 15), EO and CPE intervention (n = 15), Control (n = 15)

 

Drugs—vulvovaginal candidiasis

  
    

(Evidence-based guidelines for OTC treatment of vulvovaginal candidiasis)

  

Watson, M.C. et al, 2007 [63]

UK

Community pharmacies, Total (n = 20)

The intervention comprised two training sessions 1 month apart (Sept and Oct 2005)

Good pharmacy practice

Simulated patient methodology

No evidence of effect

  

Medication care assistants (n = 30)

 

(Royal Pharmaceutical Society of Great Britain (RPSGB) guidelines and WWHAM guideline. Professional and good practice guidelines for the supply of non-prescription medicines)

Pharmacist survey

 
  

Intervention (n = 20 MCAs), Control (n = 10 MCAs)

    
  1. Key:
  2. Simulated patient methodology: this involves data collection using covert patients (mystery shoppers) to assess pharmacy practice [95]