***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To evaluate the effectiveness of a community pharmacist-based home blood pressure ( BP ) monitoring program . DESIGN : Trial of a high-intensity ( HI ) versus low-intensity ( LI ) intervention r and omized in 12 community pharmacies . The HI intervention comprised 4 face-to-face visits with a trained pharmacist . Pharmacists provided patient-specific education about hypertension . Following the first and third visits , patients were provided with a home BP monitoring device and instructed to measure their BP at least once daily for the next month . Home BP readings were used by the pharmacists to develop treatment recommendations for the patient ’s physician . Recommendations were discussed with the physician and , if approved , implemented by the pharmacist . In the LI intervention , pharmacists measured patients BP in the pharmacy and referred them to their physician for evaluation . PARTICIPANTS : Patients with uncontrolled BP at baseline . MEASUREMENTS : The main outcomes were the differences in systolic and diastolic BP ( SBP and DBP ) from baseline to follow-up between the HI and LI patients . RESULTS : The study enrolled 125 patients , 64 in the HI and 61 in the LI group . From baseline , SBP declined 13.4 mmHg in the HI group and 9.0 mmHg in the LI group . At the final visit , the difference in SBP/DBP change between the HI and LI group was −4.5/−3.2 mmHg ( P=.12 for SBP and P=.03 for DBP ) . CONCLUSIONS : The HI intervention achieved a lower DBP and this model could be a strategy for patients with hypertension Background : No r and omised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists . Most r and omised trials of asthma self-management have recruited participants from secondary care ; there is uncertainty regarding its effectiveness in primary care . A r and omised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy . Methods : Twenty four adults attending a community pharmacy in Tower Hamlets , east London for routine asthma medication were r and omised into two groups : the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist . Participants self-completed the North of Engl and asthma symptom scale at baseline and 3 months later . Results : The groups were well matched at baseline for demographic characteristics and mean ( SD ) symptom scores ( 26.3 ( 4.8 ) and 27.8 ( 3.7 ) in the intervention and control groups , respectively ) . Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 ( 4.2 ) and 28.1 ( 3.5 ) , respectively ( p<0.001 ; difference adjusted for baseline scores = 7.0 ( 95 % CI 4.4 to 9.5 ) . Conclusions : A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy . Further studies should attempt to confirm these findings using larger sample s and a wider range of outcome measures The effect of pharmaceutical care on the prevention , detection , and resolution of medication-related problems in high-risk patients in a rural community was studied . Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were r and omly assigned to a control group or an intervention group . The control group received st and ard medical care , and the intervention group received pharmaceutical care , including a medical record review , a medication history review , pharmacotherapeutic evaluation , and patient medication education and monitoring over a one-year period .  A total of 69 patients completed the study ( 33 in the intervention group and 36 in the control group ) . The percentage of patients responding to hypertension , diabetes , dyslipidemia , and anticoagulation therapy increased significantly in the intervention group and declined in the control group . Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group . There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures . Medication compliance scores improved in the intervention group but not in the control group . Medication knowledge increased in the intervention group and decreased in the control group . Pharmaceutical care in a rural , community-based setting appeared to reduce inappropriate prescribing , enhance disease management , and improve medication compliance and knowledge without adversely affecting health-related quality of life OBJECTIVE To compare the effectiveness of an evidence -based , systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension . METHODS Patients in a staff model medical group with uncontrolled hypertension were r and omized to either a usual care ( UC ) or a physician-pharmacist comanagement ( PPCM ) group . All physicians in the study received both group and individual education and participated in the development of an evidence -based hypertension treatment algorithm . Physicians were then given the names of their patients whose medical records documented elevated blood pressures ( defined as systolic > or = 140 mm Hg and /or diastolic > or = 90 mm Hg for patients aged < 65 yrs , and systolic > or = 160 mm Hg and /or diastolic > or = 90 mm Hg for those aged > or = 65 yrs ) . Patients r and omized to the UC group were managed by primary care physicians alone . Those r and omized to the PPCM group were comanaged by their primary care physician and a clinical pharmacist , who provided patient education , made treatment recommendations , and provided follow-up .  Blood pressure measurements , antihypertensive drugs , and visit costs/patient were obtained from medical records . RESULTS One hundred ninety-seven patients with uncontrolled hypertension participated in the study . Both PPCM and UC groups experienced significant reductions in blood pressure ( systolic -22 and -11 mm Hg , respectively , p < 0.01 ; diastolic -7 and -8 mm Hg , respectively , p < 0.01 ) . The reduction in systolic blood pressure was greater in the PPCM group after adjusting for differences in baseline blood pressure between the groups ( p < 0.01 ) . More patients achieved blood pressure control in the PPCM than in the UC group ( 60 % vs 43 % , p = 0.02 ) . Average provider visit costs/patient were higher in the UC than the PPCM group ( $ 195 vs $ 160 , p = 0.02 ) . CONCLUSIONS An evidence -based , systematic approach using physician-pharmacist comanagement for patients with uncontrolled hypertension result ed in improved blood pressure control and reduced average visit costs/patient The Study of Cardiovascular Risk Intervention by Pharmacists , a r and omized , controlled trial in over 50 community pharmacies in Alberta and Saskatchewan , Canada , demonstrated that a pharmacist intervention program improved cholesterol risk management in patients at high risk for cardiovascular disease . In a sub study , costs and consequences were analyzed to describe the economic impact of the program . Two perspectives were taken : a government-funded health care system and a pharmacy manager . Costs were reported in 1999 Canadian dollars . Incremental costs to a government payor and community pharmacy manager were $ 6.40/patient and $ 21.76/patient , respectively , during the 4-month follow-up period . The community pharmacy manager had an initial investment of $ 683.50 . The change in Framingham risk function for the intervention group from baseline also was reported . The 10-year risk of cardiovascular disease decreased from 17.3 % to 16.4 % ( p<0.0001 ) during the 4 months . The intervention program in this study led to a significant reduction in cardiovascular risk in the intervention group during the 4-month follow-up period . The incremental cost to provide the program appeared minimal from both government and pharmacy manager perspectives . It is hoped that these results could support negotiations for reimbursement of clinical pharmacy services with payors STUDY OBJECTIVE To determine whether an electronic tool effectively increases the percentage of patients receiving laboratory monitoring during ongoing drug therapy . DESIGN R and omized trial . SETTING Outpatient medical offices of a group model health maintenance organization . PATIENTS A total of 9,139 patients prescribed ongoing therapy with any of 14 drugs , result ing in 4,871 patient-drug combinations in the intervention group and 4,780 in the usual-care ( control ) group . INTERVENTION Physicians and pharmacists jointly developed monitoring guidelines based on published recommendations . Pharmacists were electronically alerted to missing laboratory results and then ordered tests , reminded patients to undergo tests , and review ed and managed abnormal results . MEASUREMENTS AND MAIN RESULTS In the intervention group , 64 % of patientdrug combinations were monitored , whereas in the usual-care group 58 % were monitored ( p < 0.001 ) . Differences in monitoring were observed in the intervention versus usual-care groups for amiodarone ( 71 % vs 55 % , p<0.01 ) , theophylline ( 54 % vs 28 % , p<0.001 ) , carbamazepine ( 49 % vs 32 % , p<0.001 ) , lithium ( 42 % vs 28 % , p<0.01 ) , phenytoin ( 44 % vs 33 % , p<0.001 ) , and metformin ( 72 % vs 67 % , p<0.001 ) . Of 1981 laboratory tests ordered , 1,472 ( 74 % ) were completed . The tests revealed 181 serum drug concentrations outside the therapeutic range and 126 abnormal serum creatinine , alanine aminotransferase , aspartate aminotransferase , and thyroid-stimulating hormone levels , and complete blood counts . CONCLUSION A computerized tool plus collaboration of health care professionals effectively increased the number of patients who received laboratory safety monitoring of drug therapy Aim : To measure the outcomes of a harmonised , structured pharmaceutical care programme provided to elderly patients by community pharmacists . Method : A r and omised , controlled , longitudinal , clinical trial with repeated measures was performed over an 18‐month period , involving  community pharmacies ( 5 intervention and 5 control ) in Northern Irel and . Elderly , ambulatory patients ( ≥ 65 years ) , taking 4 or more prescribed medications were eligible for participation . Patients attending an intervention pharmacy received education on medical conditions , implementation of compliance strategies , rationalising of drug regimens and appropriate monitoring ; patients attending control sites received normal services . A battery of clinical , humanistic and economic outcomes were assessed . Results : A significantly higher proportion of intervention patients were compliant at the end of the 18‐month study and experienced fewer problems with medication compared to control patients ( P < 0.05 ) . There was little impact on quality of life and health care utilisation . Conclusions : Pharmaceutical care provision to community‐dwelling patients result ed in an improvement in medication compliance and evidence of cost‐savings . Future pharmaceutical care studies may benefit from a more focussed selective approach to data collection and outcomes measurement The effect of clinical pharmacy services on  prescribing patterns and drug costs for nonsteroidal anti-inflammatory drugs ( NSAIDs ) and salicylates in a primary -care clinic operated by a health-maintenance organization ( HMO ) was studied . Two pharmacists provided clinical services to a r and omly selected cluster of family practice physicians in the HMO for six months . A second family practice cluster served as a control group . The pharmacists alerted prescribers to the availability of low-cost alternatives ( such as ibuprofen and salicylates ) and review ed the medication profiles of patients receiving high-cost NSAIDs . Data were collected for both physician clusters for nine months before and six months after the pharmacists ' intervention . Changes in the mean numbers of prescriptions for ibuprofen and piroxicam  per 1000 enrollees per physician in the baseline and evaluation periods were not significantly different between the two groups . Significantly more prescriptions for salicylates  were written by physicians in the intervention group than in the control group during the evaluation period . Annualized mean drug ingredient costs per enrollee and per prescription for NSAIDS and salicylates  decreased during the evaluation period in both groups , but these differences were not significant . In relatively unstructured interactions with physicians and nurses , clinical pharmacists were not able to reduce the costs associated with NSAIDs but did have a modest effect on altering  salicylate prescribing patterns . This clinical pharmacy program was not economically self-sustaining during the first six months of operation , since operating costs exceeded anticipated savings A study was made of the effect of one-to-one educational meetings between prescribers and a pharmacist  on the prescribing of antiulcer agents for out patients in a health maintenance organization ( HMO ) . Ten-minute presentations were developed that communicated the same basic facts through the use of case studies ( vivid interventions ) or statistical data ( nonvivid interventions ) . After a control group ( n = 8) was selected , prescribers ( n = 16 ) were r and omly assigned to receive vivid interventions or nonv 
    Output:
    
Pharmacist interventions result ed in improvement in most clinical outcomes , although these improvements were not always statistically significant .
Most included studies supported the role of pharmacists in medication/therapeutic management , patient counseling , and providing health professional education with the goal of improving patient process of care and clinical outcomes , and of educational outreach visits on physician prescribing patterns .