Pharmacist care in hypertension management: systematic review of randomized controlled trials

Abstract Background Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. Our objective is to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on BP amongst hypertensive outpatients compared with usual care. One major focus is to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting. Methods In collaboration with a medical librarian, a systematic literature search was conducted for any article published up to 22.10.2021 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. The outcomes are the change in BP, BP at follow-up, or BP control. Results will be synthesized descriptively and, if appropriate, will be pooled across studies to perform meta-analysis. We published the study protocol in BMJ Open. Results A total of 1768 study records were identified by electronic database searching and loaded to the systematic review management software Covidence. After removal of duplicates, 1744 were independently screened based on title and abstract by two authors (VG, ST), and 242 full texts were evaluated. A total of 72 studies with 32641 patients are currently included for data extraction. These studies were published between 1973 and 2021 and conducted in different regions (North America: n = 34, Europe: n = 13, other: n = 25). The data extraction and analysis are ongoing. Results will be presented at the congress. Conclusions This systematic review provides updated evidence on the effect of pharmacist intervention on BP management. Heterogeneity in the effect of interventions will be carefully evaluated which will help the implementation of effective interventions in various healthcare settings. Key messages • Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. • This systematic review provides updated evidence on the effect of pharmacist intervention on blood pressure management.


Issue/problem:
In 2020, the World Health Organization (WHO) called for the elimination of cervical cancer.In order to get it, vaccination against Human Papillomavirus (HPV), screening of cervical cancer and treatment of high-grade cervical disease and cancer must be implemented at country level.Description of the problem: Italy has implemented HPV vaccination and cervical cancer screening for many years.Nevertheless, nationwide data show that both vaccination coverage and adherence to screening programs are unsatisfactory as compared to the WHO 90 and 70 targets, namely 90% of girls fully vaccinated by the age of 15 years and 70% of women screened with a high-performance test (i.e., HPV-DNA test) by age 35 and again by 45.

Results:
In order to address the progress of vaccination and screening at regional level in Italy, a project was conducted in 2021-2022 in order to collect data on relevant indicators and issues.In particular, information was collected on both coverage indicators (for both vaccination and screening) adherence (for screening) and history and characteristics of the vaccination offer (e.g., targets, gratuity) and of screening (e.g., presence of clinical pathways, type of tests used).Collected data were shared with a multidisciplinary panel of experts on HPV-related diseases to issue recommendations to foster the elimination of cervical cancer in Italy.For this purpose, a survey was also conducted to identify potential actions in respect to vaccination, screening and treatment.

Lessons:
A great heterogeneity across Italian regions was observed.The following actions were identified to implement vaccination, screening and treatment: educational campaigns, reminders and active calls for both vaccination and screening and more interoperability of data and definition of clinical pathway involving a multidisciplinary medical team for the proper management of all HPV-related diseases.

Background:
Hypertension management remains a major public health challenge in primary care.Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension.Our objective is to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on BP amongst hypertensive outpatients compared with usual care.One major focus is to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting.

Methods:
In collaboration with a medical librarian, a systematic literature search was conducted for any article published up to 22.10.2021 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases.Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included.The outcomes are the change in BP, BP at follow-up, or BP control.Results will be synthesized descriptively and, if appropriate, will be pooled across studies to perform meta-analysis.We published the study protocol in BMJ Open.

Results:
A total of 1768 study records were identified by electronic database searching and loaded to the systematic review management software Covidence.After removal of duplicates, 1744 were independently screened based on title and abstract by two authors 15th European Public Health Conference 2022 (VG, ST), and 242 full texts were evaluated.A total of 72 studies with 32641 patients are currently included for data extraction.These studies were published between 1973 and 2021 and conducted in different regions (North America: n = 34, Europe: n = 13, other: n = 25).The data extraction and analysis are

Background:
The United Arab Emirates Healthy Future Study (UAEHFS) is one of the first large prospective cohort studies in the region which examines causes and risk factors for chronic diseases among adult UAE nationals.The aim of this study was to explore the relationship between body fat percentage (BF%) and the eight-item Patient Health Questionnaire (PHQ-8) as a screening instrument for depression among the UAEHFS pilot study participants.

Methods:
We analyzed the UAEHFS pilot data to investigate the association between BF% and PHQ-8 adjusted for age and gender.We used multivariate logistic ordinal regression model.To impute missing values, 100 multiple imputations (MI) were performed using multivariate imputation of classification and regression tree.The statistical analysis was performed using R Statistical Software (version 4.2.0)Results: Out of 517 participants, data from 487 (94.2%) were analyzed after excluding participants who didn't fill out the questionnaires.The median age was 30 years (Interquartile Range: 23 -38).There were more males (67.8%) than females in the UAEHF pilot data.Approximately, 64 (13.1%) of the participant reported depression.The prevalence of obesity was 35.2% in this study population.The estimated odds ratio of BF% from the fitted multivariate logistic ordinal regression model was OR = 1.046 (95% CI: 1.012-1.08),and OR = 1.03 (95% CI: 1.003-1.057)for the omitted data, and MI (sensitivity analysis) respectively.

Conclusions:
High body fat percentage was statistically significantly associated with high risk of reporting depression.Additional research is needed, using the main UAEHFS data (after recruitment is complete), to further investigate the association between body fat percentage and depression.Key messages: Our results can help contribute to the knowledge based on current and potential population mental health in the UAE and Gulf Region.
The main finding of this study that excess body fat is associated with an increased risk of developing depression and vice versa; thus, this could add to the future direction of mental health research.

Background:
Diverticulosis is increasing worldwide as a public health problem.
The Combined Overview on Diverticular Assessment (CODA) score, merging Diverticular Inflammation and Complication Assessment (DICA) and few clinical parameters, may reliably predict the occurrence of acute diverticulitis and surgery due to complications.Thus, the aim of the study is to confirm the value of DICA classification and to develop and validate the CODA endoscopic-clinical score.DICA endoscopic classification was confirmed to have a significant predictive value in terms of acute diverticulitis occurence/recurrence and risk of surgery.CODA score could provide a new risk stratification tool useful for everyday clinical practice and also with a significant public health impact in terms of treatment effectiveness and decision making.Key messages:DICA endoscopic classification of diverticular disease is a clear predictor of the outcome of diverticulosis/diverticular disease.
The CODA score, combining DICA and few clinical parameters, may reliably predict the occurence of acute diverticulitis and surgery due to complications.