Integrating digital interventions in healthcare has gained increasing popularity among clinical pharmacists (CPs) due to advances in technology. Although the impacts of telephone-based interventions on patients’ outcomes were decidedly mixed, web-based interventions and mobile apps exerted generally positive influences.
15 studies used a telephone as an intervention tool by clinical pharmacists. The impacts of the phone-based interventions on patients’ outcomes were mixed. Of these 15 studies, five studies reported significant effectiveness of the phone interventions [14][15][16][17][18][17,18,19,20,21]. Specifically, such interventions showed positive effects on lowering serum uric acid (sUA) levels among individuals with gout [14][17], the number of drug-related problems among those visiting outpatient cardiology clinics [15][18], mortality among those using five or more prescription drugs [16][19], and improved control of both BP [17][20] and international normalized ratio (INR) among patients discharged on warfarin [18][21]. However, five other studies showed no significant differences in outcomes between the treatment group who received phone-based interventions and the control group receiving usual care [19][20][21][22][23][22,23,24,25,26]. Specifically, no significant differences were reported between these two groups in these studies with respect to the proportion of individuals who attempted tobacco cessation among tobacco users [19][22], adherence to cancer drug for almost all cycles, overall survival (OS), and progression-free survival (PFS) among individuals with metastatic colorectal or gastric cancer [20][23], changes in HbA1c level and adherence to diabetic drugs [21][24], adherence to cardiovascular drugs and the percent of those with LDL-C goal achievement among individuals with coronary heart disease (CHD) [22][25], and the proportion of emergency department (ED) visits and readmission to hospital within 30 days of discharge among those with cancer [23][26]. Five studies revealed inconsistent effects of phone intervention on patients’ outcomes [24][25][26][27][28][27,28,29,30,31]. In other words, the interventions in each of these studies resulted in improvement in some outcomes, but not in others. For example, Bosworth et al. found that telephone intervention by clinical pharmacist specialists significantly reduced total cholesterol at 6 months in the treatment group, but no significant differences were found in CVD risk, sBP, dBP, LDL, HDL, BMI, HbA1c at 6 or 12 months, and total cholesterol at 12 months between the treatment and the control groups [24][27]. In Carter et al.’s study, telephone-based medication therapy management (MTM) services significantly improved individuals’ adherence to the American Heart Association (AHA)’s clinical guidelines, but their levels of BP, HbA1c, and lipids were not significantly different compared to those receiving usual care [25][28].
Overall, the impacts of telephone-based interventions in the studies were inconsistent: five studies showed benefits from these interventions, another five studies revealed no significant effects, and the remaining five studies reported mixed effects from the interventions. Web-based interventions resulted in positive impacts on changes in lab values (e.g., sBP, dBP) and health service use (e.g., antihypertensive drug and aspirin use) in patients with hypertension. Clinical pharmacists’ use of mobile apps significantly improved drug-related outcomes (e.g., reduction in medication errors and severe AEs) and health service use (e.g., reduction in hospitalizations) in kidney transplant recipients. When the study results were analyzed by the types of outcomes, we found that digital interventions were generally effective in lowering health service use (e.g., hospitalization, drug use) and improving drug-related outcomes (e.g., medication errors, AEs). However, they did not always result in significant improvements in other outcomes such as changes in lab values, adherence, survival, and health-related risk.
Physicians use medical apps for many reasons such as searching relevant literature, accessing patient charts, submitting electronic prescriptions, and monitoring disease management [2][3][4][2,3,4]. Pharmacists can also consider more novel technologies such as mobile apps, social media, and wearable devices for their patients where pharmaceutical care is provided. By using more diverse technologies, pharmacists could improve patients’ outcomes in additional domains.
The pharmacists provided their interventions to extensive populations such as patients with CHD, hypertension, hyperlipidemia, diabetes, cancer, gout, kidney conditions, tobacco use, using warfarin, and those using five or more drugs for chronic conditions. Accordingly, the purposes of providing these interventions were also very comprehensive, ranging from improving lab values (e.g., blood pressure, HbA1c), adherence, drug-related outcomes, and survival to lowering health service use and health-related risks. Of note, community pharmacists used digital interventions to serve somewhat limited purposes. Crilly and Kayyali found that community pharmacists’ interventions focused primarily on improvement in medication counseling and adherence, which represents traditional roles of the community pharmacist [33][14]. Crilly et al. argued that community pharmacists using more diverse technologies such as social media and mobile apps could help define their roles for more diverse outcomes/domains such as weight management, sexual health, and alcohol use [34][37]. Findings from both our study and their study suggest that digital interventions by clinical pharmacists are more likely to serve more various purposes compared to those interventions by community pharmacists. Nevertheless, community pharmacists are easily accessible professionals who routinely encounter people in their community. In this sense, digital care services are conveniently designed and efficiently delivered by community pharmacists, which can ultimately result in positive outcomes for patients.
Although digital interventions have gained increasing popularity, there has been little investigation into the cost-effectiveness (CE) of these interventions. Accordingly, whether a digital intervention is cost-effective remains to be elucidated. For example, Pyne et al. investigated the cost-effectiveness of a telemedicine-based collaborative care intervention for individuals with depression in rural areas [35][38]. They found the incremental cost-effectiveness ratio (ICER) of this intervention to be about $86,000/quality-adjusted life year (QALY) gained, which suggests that the intervention may or may not be cost-effective depending on the cost-effectiveness threshold. Another study conducted by Painter et al. evaluated the cost-effectiveness of telemedicine-based collaborative care for veterans with posttraumatic stress disorder (PTSD) in rural areas [36][39].
In summary, clinical pharmacists’ digital interventions were limited to the use of telephones, web tools, and mobile apps. In future studies, clinical pharmacists should consider novel technologies such as social media and wearable devices for patients who receive pharmaceutical care. Additionally, future studies need to be carefully designed by taking the contents of the intervention and the study population into account because these aspects are strongly related to the outcomes of the intervention.