Impact of pharmacist interventions in reducing therapeutic inertia among people with diabetes in ambulatory and primary care settings: A systematic review and meta-analysis.

Abstract

Therapeutic inertia is a growing concern in diabetes management. Pharmacist interventions have shown mixed results in addressing this issue in ambulatory and primary care settings. This review aims to evaluate the impact of pharmacist interventions on therapeutic inertia and glycemic control among patients with diabetes in these settings. A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases were searched from inception to October 2025 for studies assessing pharmacist interventions. DEPICT tool was used to characterize intervention components. A random-effects meta-analysis was performed to estimate pooled mean HbA_1c difference. Thirty-one studies (n = 34,735) were included in the review. Patients in the intervention group underwent treatment intensification 2.4 months earlier and achieved glycemic targets 4.6 months earlier than those in the usual care group. Pharmacist interventions achieved greater HbA_1c reduction than usual care (MD= -1.11%, 95% CI [-1.29%, -0.92%]; p < 0.05). Interventions were most effective when pharmacists had full autonomy through collaborative practice agreements. The certainty of evidence ranged from low to moderate due to the risk of bias and heterogeneity in study designs. Pharmacist interventions improve glycemic control and reduce therapeutic inertia. Future studies should employ standardized definitions and validated measures of therapeutic inertia to inform evidence-based practice and policy.