Abstract: Twelve studies comparing pharmacist-provided services versus usual care were included in this review. Of the 12 studies, seven were from lower middle income countries and five were from upper middle income countries. Eleven studies examined pharmacist-provided services targeted at patients and one study evaluated pharmacist interventions targeted at healthcare professionals. Pharmacist-provided services targeting patients resulted in a small improvement of clinical outcomes such as blood pressure (-25 mm Hg/-6 mm Hg and -4.56 mm Hg/-2.45 mm Hg), blood glucose (-39.84 mg/dl and -16.16 mg/dl), blood cholesterol (-25.7 mg/dl)/ triglyceride levels (-80.1 mg/dl) and asthma outcomes (peak expiratory flow rate 1.76 l/min). Moreover, there was a small improvement in the quality of life, although four studies did not report the effect size explicitly. Health service utilisation, such as rate of hospitalisation and general practice and emergency room visits, was also found to be reduced by the patient targeted pharmacist-provided services. A single study examined the effect of patient targeted pharmacist interventions on medical expenses and the cost was found to be reduced. A single study that examined pharmacist services that targeted healthcare professionals demonstrated a very small impact on asthma symptom scores. No studies assessing the impact of pharmacist-provided non-dispensing services that targeted healthcare professionals reported health service utilisation and cost outcomes. Overall, five studies did not adequately report the numerical data for outcomes but instead reported qualitative statements about results, which prevented an estimation of the effect size. Studies for the comparison of patient targeted services provided by pharmacists versus the same services provided by other healthcare professionals or untrained healthcare workers were not found. Similarly, studies for the comparison of healthcare professional targeted services provided by pharmacists versus the same services provided by other healthcare professionals or untrained healthcare workers were not found. Pharmacist-provided services that target patients may improve clinical outcomes such as management of high glucose levels among diabetic patients, management of blood pressure and cholesterol levels and may improve the quality of life of patients with chronic conditions such as diabetes, hypertension and asthma. Pharmacist services may reduce health service utilisation such as visits to general practitioners and hospitalisation rates. We are uncertain about the effect of educational sessions by pharmacists for healthcare professionals due to the imprecision of a single study included in this review. Similarly, conclusions could not be drawn for health service utilisation and costs due to lack of evidence on interventions delivered by pharmacists to healthcare professionals. These results were heterogenous in the types of outcomes measured, clinical conditions and approaches to measurement of outcomes, and require cautious interpretation. All eligible studies were from middle income countries and the results may not be applicable to low income countries.

Plain-language summary: In 11 of the studies, pharmacists gave education and counselling to patients with chronic illnesses such as asthma and diabetes. Pharmacists gave the patients information about how to use their medicines properly and about possible side effects of the medicines, and helped them to identify and solve problems with their medicines. They also gave the patients information about the disease and advice about self-management and the importance of a healthy lifestyle. The patients who were given these services were compared to patients who were given the usual pharmacist services without education or counselling. In one study, pharmacists gave education to general practitioners (GPs) about care of children with asthma. These GPs were compared to GPs who were given usual pharmacist services. No studies were found where pharmacist-provided services were compared to the services provided by other health workers. What happens when pharmacists provide services other than dispensing medication? When pharmacists give education and counselling to patients with chronic illnesses: · patients may experience small improvements in health outcomes such as blood pressure levels and glucose levels (low quality evidence), · patients may use health services less (for instance fewer visits to the doctor, fewer stays in hospital) (low quality evidence), · patients probably experience small improvements in quality of life (moderate quality evidence), · patients’ medication costs may be lower (low quality evidence). When pharmacists give education and counselling about asthma care to GPs: · their patients may experience slightly fewer asthma symptoms (low quality evidence).