Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 9, 2024
Date Accepted: Apr 19, 2025
Effectiveness of telepharmaceutical services before and after the outbreak of the COVID-19 pandemic: a systematic review and meta-analysis
ABSTRACT
Background:
Telepharmaceutical services (TPS) led by pharmacists, an emerging telehealth service, improve access to medical services and enable patients to receive specialized services in areas with limited resources. With a lower risk of infection and no restriction of isolation measures, TPS posed great potential during the COVID-19 pandemic. However, whether the effectiveness of TPS changed before and after the outbreak of COVID-19 remained unclear.
Objective:
To evaluate the effectiveness of TPS, compare the effectiveness before and after the outbreak of COVID-19 and explore whether the effectiveness changed over time.
Methods:
We searched PubMed, Embase (Ovid), Sinomed, China National Knowledge Infrastructure, Wanfang and VIP databases for randomized controlled trials that evaluated the effectiveness of TPS from inception to 24 October 2023. We used random-effect model to pool the results and GRADE to assess the certainty of evidence. To explore whether the effectiveness of TPS changed overtime, we applied subgroup analyses (studies conducted before 31 December 2019, and studies conducted after 1 January 2020). When a significant difference raised between the two subgroups, we conducted meta-regression analysis to further evaluate the trend of effectiveness overtime.
Results:
Forty studies were finally included. Compared with no TPS or usual care (i.e., face-to-face pharmaceutical services), TPS probably increased patient medication adherence (risk difference [RD], 0.15, 95% confidence interval [CI] 0.09 to 0.20, moderate certainty), may reduce the occurrence of adverse events (RD -0.10, 95% CI -0.18 to -0.02, low certainty) and improve the proportion of patients who were satisfied with medication (RD 0.16, 95% CI 0.05 to 0.26, low certainty). Moderate to high evidence indicated that patients accepting TPS probably achieved superior management of diabetes and hypertension. The effectiveness of TPS was not significantly different before and after the outbreak of COVID-19 except medication adherence (RD 0.12, 95% CI 0.03 to 0.21, z = 2.122, P = .007), which also increased overtime (coefficient = 0.01, 95% CI 0.01 to 0.02, P < .001).
Conclusions:
TPS probably improved patient medication adherence, may lead to the better satisfaction and the incidence of adverse events. The effectiveness of TPS in general was not changed after the outbreak of the COVID-19 pandemic. Clinical Trial: PROSPERO (CRD42023487476); https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=487476
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