Development of DEPICT tool
The first version of DEPICT was developed after the performance of an overview of systematic reviews published in PubMed between 2000 and 2010 addressing the impact of clinical pharmacy services whether on indicators of the medication use process or patient health outcomes (economic, clinical or humanistic), and extraction of all components that best described the pharmacistęs interventions performed.
The components were then grouped in domains according their similarity, resulting in the DEPICT tool version #1 (The Annals of Pharmacotherapy.2013;11;47(7-8): 946–52).
After the experience acquired with the application of DEPICT to studies describing pharmacistęs interventions in the management of patients with chronic kidney disease, a need to create an improved version of the instrument arose. In that study, the authors identified several gaps with some interventions that were specific of this setting not being appropriately reflected on the instrument (The Annals of Pharmacotherapy.2013;47(11):1498-506).
For the development of this improved version, a qualitative analysis of the description of pharmacist interventions contained in the randomized controlled trials included in the systematic reviews retrieved in the overview process that served as the basis for the creation of DEPICT 1 was performed. The components extracted were coded and ordered by thematic similarity. This process resulted in the addition of more items to the original instrument and subdivision of others to better describe the components of the interventions performed as part of clinical pharmacy services (J Eval Clin Pract. 2015 Feb 12. doi: 10.1111/jep.12339).
The DEPICT database
To produce a database containing relevant articles reporting the impact of clinical pharmacy services on medication use process or patient health outcomes, a systematic review was conducted. The search for randomized controlled trials (RCTs) published until July 31, 2013 was performed in the electronic databases Medline (PubMed), SCOPUS, DOAJ and SCIELO. The references of included articles were handily searched for additional studies not retrieved from the databases.
The exclusion criteria included the following:
1) RCTs in which the health interventions involved pharmacists but their specific activities could not be isolated from the activities of other professionals;
2) RCTs that not described the pharmacist interventions;
3) RCTs in which the pharmacist performed non-clinical activities such as drug compounding, storage, administration or other logistic activities;
4) studies published in a language other than English, Spanish, Portuguese or Italian;
5) studies that presented only the protocol for conducting the RCT;
6) studies in which were performed post-hoc analysis of intervention groups of RCTs published;
7) RCTs that described the pharmacist interventions but not assessed their impact on indicators of the medication use process or patient outcomes;
8) studies that compared two or more pharmacist interventions, with the control group not exposed only to a usual care.
To complement the database, an overview of systematic reviews gathering evidence on impact of clinical pharmacy services was also conducted. Systematic reviews published between 2000 and 2010 were searched in Medline (PubMed) in December 2012. Only systematic reviews that satisfactorily fulfilled the items 4, 7 and 9 of the PRISMA statement checklist were included. Besides the exclusion criteria cited above, were not considered systematic reviews that not included at least one RCT. Regarding systematic reviews published in duplicate or updated versions of Cochrane reviews, only the most recent publication was considered. Finally, all RCTs included in each systematic review that met the inclusion criteria were extracted.
In the systematic review and in the overview, the methodology applied for the selection of studies was the same. Two reviewers (IR and TTS) independently selected studies based initially on their title and abstract and those considered potentially relevant were obtained for full-analysis. Any discrepancies were resolved through consensus and a third reviewer (CJC) was consulted when necessary.
The flowchart of selection process is depicted below:
RCTs = randomized controlled trials; CPS = clinical pharmacy service; SR = systematic reviews. *The number of reasons for exclusion of articles after full-text analysis is greater than 321 since some articles were excluded because more than one reason.
In order to keep de database up to date, a new systematic review was performed, searching RCTs published in the same databases until November 30, 2014. The flowchart of selection process is depicted below:
RCTs = randomized controlled trials; CPS = clinical pharmacy service; RS = systematic reviews.
Thus, the current DEPICT DATABASE comprises 569 articles and 488 studies (RCTs).