Systematic review of independent pharmacist prescribing for the treatment of cardiometabolic factors in chronic non-communicable diseases

Objectives
Changes in health regulations in many developed countries have expanded prescribing privileges from medical doctors to other health professionals, notably nurses and pharmacists working in hospital and general practice settings. While some of these prescribers operate in a supervised capacity, increasingly there are those who operate as autonomous prescribers. This development will likely increase capacity for addressing common health challenges in the future. In the present systematic review we evaluated the evidence of independent pharmacist prescribing (IPP) in the treatment of metabolic targets associated with chronic non-communicable diseases (cNCDs), which are common, costly and often diminish quality of life.

Methods
Published evidence evaluating the effects of IPP on cNCDs was reviewed. English language studies evaluating IPP for adults with these conditions and published since 2000 were included. Two reviewers independently evaluated papers for inclusion, IPP effectiveness and risk of bias.

Results
A total of 11 studies were included, which examined IPP for three metabolic targets related to cNCDs—namely, blood glucose, blood pressure and cholesterol. Seven randomised controlled trials (RCTs) provided robust support for IPP in the treatment of hypertension compared with usual prescriber care. For diabetes there was modest support for glycaemic control including one RCT and two non-randomised evaluations. For hypercholesterolaemia, there were two RCTs, both of which were not specifically targeted at cholesterol reduction and yielded unclear results.

Conclusion
Given that hypertension is one of the major risk factors for morbidity and mortality, expansion of care for this condition to include IPPs embedded in both hospital and community settings has marked potential for public health benefit. Although available evidence supports the feasibility of IPP for glycaemic control, more adequate evaluations are needed to determine safety and efficacy. Finally, IPP for hypercholesterolaemia likely requires additional investigation, including studies specifically targeting change in cholesterol.