Sistematični pregled in meta-analiza kliničnega ovrednotenja storitev kliničnega farmacevta v psihiatrični bolnišnici

Balaško, Kaja (avtor), Locatelli, Igor (mentor), Štuhec, Matej (komentor)

Ozadje: Bolniki z duševnimi motnjami, hospitalizirani v psihiatričnih bolnišnicah, so izpostavljeni povečanemu tveganju za neželene izide zdravljenja, predvsem zaradi pogoste polifarmakoterapije, somatskih komorbidnosti in kompleksnih režimov zdravljenja. Klinični farmacevti lahko s sodelovanjem v interdisciplinarnem timu pomembno prispevajo k optimizaciji farmakoterapije, vendar je podatkov o njihovem vplivu v psihiatričnih bolnišnicah malo. Namen: Sistematično pregledati in kritično ovrednotiti raziskave o vplivu intervencij kliničnih farmacevtov na klinične in z zdravili povezane izide pri odraslih bolnikih z duševnimi motnjami, hospitaliziranih v psihiatričnih bolnišnicah. Metode: Sistematični pregled smo izvedli v skladu s smernicami PRISMA 2020, protokol pa je bil predhodno registriran v bazi PROSPERO (CRD420261309290). Literaturo smo iskali v bibliografskih podatkovnih zbirkah PubMed, Scopus, CINAHL in CENTRAL. Vključili smo raziskave, izvedene pri odraslih bolnikih z duševnimi motnjami, hospitaliziranih v psihiatričnih bolnišnicah, ki so primerjale učinke intervencij kliničnega farmacevta z obravnavo brez njegove vključitve. Tveganje za pristranost smo ocenili z orodjema RoB 2 in ROBINS-I. Meta-analizo smo izvedli v programu R z modelom naključnih učinkov. Rezultati: V sistematični pregled smo vključili 18 raziskav, od katerih je bila ena randomizirana kontrolirana raziskava, 17 pa jih je temeljilo na nerandomiziranih raziskovalnih zasnovah. Meta-analiza je pokazala zmanjšanje težav, povezanih z zdravili (70,7 %; 95-% interval zaupanja (IZ) 46,5–87,0), potencialno neprimernih zdravil pri starejših bolnikih (36,2 %; 95-% IZ 10,2–73,8) in povprečnega števila predpisanih zdravil na bolnika (−1,0; 95-% IZ −1,5 do −0,5). Klinični izidi, kot so kakovost življenja, dolžina hospitalizacije in ponovne hospitalizacije, so bili redko raziskani, zato vpliva intervencij nanje ni bilo mogoče zanesljivo kvantitativno ovrednotiti. Med raziskavami je bila prisotna izrazita klinična in metodološka heterogenost. Sklep: Intervencije kliničnih farmacevtov pomembno izboljšajo z zdravili povezane izide ter prispevajo k optimizaciji farmakoterapije hospitaliziranih bolnikov z duševnimi motnjami. Potrebne so nadaljnje visokokakovostne večcentrične randomizirane kontrolirane raziskave za oceno vpliva na dolgoročne klinične izide.

• Jezik: Slovenski jezik
• Ključne besede: klinični farmacevt, psihiatrična bolnišnica, težave, povezane z zdravili, sistematični pregled, meta-analiza
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: FFA - Fakulteta za farmacijo
• Založnik: [K. Balaško]
• Leto izida: 2026
• PID: 20.500.12556/RUL-187496
• UDK: 615.15:616.89-008.1(043.2)
• COBISS.SI-ID: 291120131
• Datum objave v RUL: 11.09.2026

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Clinical evaluation of the clinical pharmacist services in psychiatric hospitals: a systematic review and meta-analysis

Izvleček

Background: Patients with mental disorders hospitalized in psychiatric hospitals are at increased risk of adverse treatment outcomes, primarily due to frequent polypharmacy, somatic comorbidities, and complex treatment regimens. Clinical pharmacists can contribute significantly to pharmacotherapy optimization through their participation in multidisciplinary teams. However, data on their impact in psychiatric hospitals remain limited. Aim: To systematically review and critically evaluate studies investigating the impact of clinical pharmacist interventions on clinical and medication-related outcomes in adults with mental disorders hospitalized in psychiatric hospitals. Methods: The systematic review was conducted in accordance with the PRISMA 2020 statement, and the protocol was prospectively registered in PROSPERO (CRD420261309290). Literature searches were performed in PubMed, Scopus, CINAHL, and CENTRAL. We included studies conducted in adults with mental disorders hospitalized in psychiatric hospitals that compared the effects of clinical pharmacist interventions with care without the involvement of a clinical pharmacist. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. The meta-analysis was performed in R using a random-effects model. Results: Eighteen studies were included in the systematic review, of which one was a randomized controlled trial and 17 were based on non-randomized study designs. The meta-analysis showed reductions in drug-related problems (70.7%; 95% confidence interval [CI] 46.5–87.0), potentially inappropriate medications in older patients (36.2%; 95% CI 10.2–73.8), and the mean number of prescribed medications per patient (−1.0; 95% CI −1.5 to −0.5). Clinical outcomes, such as quality of life, length of hospital stay, and hospital readmissions, were infrequently investigated; therefore, the impact of the interventions on these outcomes could not be reliably quantified. Considerable clinical and methodological heterogeneity was observed across studies. Conclusions: Clinical pharmacist interventions significantly improve medication-related outcomes and contribute to pharmacotherapy optimization in hospitalized patients with mental disorders. Further high-quality multicentre randomized controlled trials are needed to assess their impact on long-term clinical outcomes.

• Ključne besede: clinical pharmacist, psychiatric hospital, drug-related problems, systematic review, meta-analysis