Effectiveness of Hospital Pharmacist Interventions for COPD Patients: A Systematic Literature Review and Logic Model

Figures & data

Table 1 Search Term Identifiers

Concept 1 Pharmacist	Concept 2 COPD	Concept 3 Hospital setting
Pharmac*	Chronic Obstructive Pulmonary Disease COPD Chronic Airflow Obstruction Bronchial Respiratory Airway AECOPD Acute exacerbation	Hospital Clinical Inpatient Hospitalization Intensive care unit Emergency department Patient discharge Ambulatory care

Figure 1 PRISMA flow chart of systematic review.

Note: Adapted from Page MJ, Moher D. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:23. Open Access.²⁴

Table 2 Summary of Basic Information of Selected Articles

No.	Authors	Study Location	Sample Size	Numbers of Hospitals	Key Components of the Intervention	Duration of Intervention	Pharmacist Only?
1	De et al^Citation26	USA	IG: 30 patients CG: 30 patients	1 hospital	Comprehensive verbal instruction on how theophylline works and the importance of drug compliance	6 months	√
2	Khdour et al^Citation27	USA	IG: 86 patients CG: 87 patients	1 hospital	A structured education programme on disease state, medications and breathing techniques	12 months	√
3	Shen et al^Citation28	China	IG: 176 patients CG: 178 patients	1 hospital	Pharmacist interventions on rational antibiotic use	10 months	Hospital Pharmacist and doctors
4	Jarab et al^Citation29	Jordan	IG: 66 patients CG: 67 patients	1 hospital	A structured education on COPD and management of its symptoms	6 months	√
5	Wei et al^Citation30	China	IG: 75 patients CG: 75 patients	1 hospital	Pharmaceutical care plan on knowledge of drugs and diseases	6 months	√
6	Wei et al^Citation31	China	IG: 58 patients CG: 59 patients	1 hospital	A comprehensive pharmaceutical care program composed of individualized education (including effective use of respiratory devices, pathophysiology of the disease, interpretation of medical testing and rationale for medication) and a series of telephone counseling	6 months	√
7	Farris et al^Citation32	USA	Enhanced:314 Minimal:315 Usual care:316	1 hospital	Pharmacist case manager project composed of admission medication reconciliation, pharmacist visits for patient education, discharge counseling and discharge medication list	90 days	Hospital Pharmacists and inpatient physicians, primary care physicians and community pharmacists
8	Wei et al^Citation33	China	IG: 150 patients CG: 150 patients	1 hospital	Medication guidance and medication education, including drug use methods and precautions	Not specified	√
9	Yan et al^Citation34	China	IG: 50 patients CG: 46 patients	1 hospital	Pharmaceutical care plan including monitoring the whole process of medication, putting forward adjustment opinions, preventing and treating adverse drug reactions and drug interactions, and conducting pharmaceutical follow-up for some patients	Not specified	√
10	Wang et al^Citation35	China	IG: 100 patients CG: 92 patients	1 hospital	Pharmaceutical care plan including reviewing medical orders, pharmaceutical education, and monitoring of non-medication treatment	Not specified	√
11	Lin et al^Citation36	China	Pharmacist education: 34 Nursing education: 35 Self-medication: 32	1 hospital	Education about oxygen-driven aerosol inhalation	Not specified	Hospital Pharmacist and other health care professionals apart from doctors
12	Suhaj et al^Citation37	India	IG: 98 patients CG: 104 patients	1 hospital	Pharmacist intervention on importance of medication compliance, need for smoking cessation, simple exercise, proper use of inhaler devices and need for timely follow-up	24 months	√
13	Xin et al^Citation38	China	IG: 122 patients CG: 122 patients	1 hospital	A structured education on definition of COPD, pathophysiology of the disease, the importance of medication adherence, the importance of smoking cessation, drug use, use of respiratory devices, the possible ADR, the possible effect of drug combination, the importance of a well-balanced diet, and the necessity of timely follow-up by physicians	12 months	√
14	Qin et al^Citation39	China	IG: 128 patients CG: 128 patients	1 hospital	Pharmaceutical care including medication guidance, telephone follow-up and outpatient follow-up	6 months	√
15	Zhang et al^Citation40	China	IG: 63 patients CG: 62 patients	1 hospital	Pharmaceutical care including review of prescriptions, medication monitoring, patient medication education, discharge medication guidance, and telephone follow-up	Not specified	√
16	Abdulsalim et al^Citation41	India	IG: 98 patients CG: 104 patients	1 hospital	Pharmacist intervention on compliance, smoking cessation, exercise, inhaler use and need for timely follow up	24 months	√
17	Juanes et al^Citation17	Spain	IG: 59 patients CG: 59 patients	1 hospital	A pharmaceutical care programme focusing on resolving potential drug-related problems	12 months	√
18	Chen et al^Citation42	China	IG: 100 patients CG: 100 patients	1 hospital	Pharmaceutical care focusing on education on the etiology and symptoms of COPD, drug classification, correct use of various devices, lifestyle guidance, and smoking cessation	6 months	√
19	Song et al^Citation43	China	IG: 34 patients CG: 26 patients	1 hospital	Integrated pharmaceutical care including in-hospital guidance, classroom teaching, regular follow-up, life guidance, and psychological counseling	12 months	√
20	Bloodworth et al^Citation44	USA	IG: 96 CG: 160	1 hospital and 2 community pharmacies	Pharmacist care including telephonic and face-to-face consultation on indication, effectiveness, safety, and compliance	6 months	Hospital pharmacist and community pharmacist
21	Chen et al^Citation45	China	First time users: 64 Long-term users: 79	1 hospital	Pharmacist medication education on use of inhaler devices	Not specified	√
22	Li et al^Citation46	China	IG: 45 patients CG: 45 patients	1 hospital	Pharmaceutical intervention including medication guidance, education on inhaler device use and follow-up	40 days	√
23	Yang et al^Citation47	China	IG: 43 patients CG: 43 patients	1 hospital	Pharmaceutical education including disease knowledge, drug treatment, smoking cessation, introduction of common misunderstandings, guidance on living habits, and the necessity and importance of adherence to medication	1 month	√
24	Abdulsalim et al^Citation48	India	IG: 104 patients; CG: 98 patients	1 hospital	Structured pharmacist-led interventions on improving medication adherence	24 months	√
25	Wang et al^Citation49	China	IG: 133 patients CG: 126 patients	1 hospital	Multidimensional pharmaceutical care including establishment of a special dispensing window, face-to-face demonstration and education, brochure education, video education, online consultation and education, and follow-up reeducation	3 months	√
26	Wang et al^Citation50	China	IG: 64 patients CG: 65 patients	1 hospital	Medication management services including patient education, formulation of personal drug list, formulation of rehabilitation plan, and follow-up	6 months	√
27	Wang et al^Citation51	China	IG:88 patients CG:88 patients	1 hospital	Pharmaceutical care focusing on education of inhaler device use	3 months	√
28	Prasungriyo et al^Citation52	Thailand	IG: 23 patients CG: 21 patients	1 hospital	Pharmacist counseling on basic knowledge of COPD, the health consequences of smoking cigarettes, the technique for using inhalers, the importance of medication adherence, self-management and lifestyle modification, and breathing exercises	90 days	√
29	Liu et al^Citation53	China	IG: 96 patients CG: 97 patients	1 hospital	Medication therapy management services focusing on medication education	6 months	√

Abbreviations: IG, intervention group; CG, control group.

Table 3 Interventions Implemented by Hospital Pharmacists for COPD Patients

No.	Study	Components of Intervention							Description
		Areas of the Medicine Use Process in Hospitals According to the Basel Statement (A=Procurement; B=Prescribing; C=Preparation; D=Administration; E=Monitoring; F=Training)						Others
		A	B	C	D	E	F
1	De et al^Citation26			√	√	√			C = Preparation: Labeling - Prescription containers carried both conventional and auxiliary labels. Delivery - All medications were refillable by mail. D = Administration: Instruction to patients (theophylline therapy, medication questions, other related drugs). E = Monitoring: Serum level - The serum levels for the experimental group patients were drawn on their next regularly scheduled clinic visit after the consultation (a few months apart). Refills - Prescription records for patients were reviewed for the 6-month period following the recorded drug level to determine how often patients received refills on theophylline products
2	Khdour et al^Citation27		√		√	√		√	B=Prescribing: Antibiotics - Give advice to general practitioners to provide a prescription for an antibiotic D=Administration: Education o content - Disease, prescribed medication, the importance of adherence, inhaler technique and the management of COPD symptoms. o materials - Booklet to take home, a customized action plan for acute exacerbations. o programme - Reinforcement of the education on COPD and its treatment at each outpatient clinic visit (every 6 months arranged) by the clinical pharmacist. E=Monitoring: Follow-up telephone calls - Telephone calls by the clinical pharmacist at 3 and 9 months, ie between outpatient clinic appointments. Assessment - SGRQ, Morisky scale, COPD knowledge questionnaire, BMI values at 6 and 12 months. Others: A special smoking cessation programme. Simple exercises that patients can do at home.
3	Shen et al^Citation28		√						B=Prescribing: Antibiotics - Collaboration with general practitioners to provide a prescription for an antibiotic, including: indication, choice, dosage, dosing schedule, duration and oral therapy.
4	Jarab et al^Citation29		√		√	√		√	B=Prescribing: A medication table - Discuss types, indications, doses, frequency of administration, and possible side effects for each prescribed medication. D=Administration: Education: o content - COPD and management of its symptoms, symptoms control and the technique for expectoration. o materials - Booklet to take home. o Adherence - Clinical pharmacist used the motivational interviewing technique to improve adherence. E=Monitoring: Assessment - Quality of life improvement, healthcare utilization, COPD knowledge and medication adherence were repeated at 6 months. Others: Smoking cessation programme. Giving advice of simple exercises.
5	Wei et al^Citation30				√	√		√	D=Administration: Education: o Outpatient medication consultation - Introduced the main effects, undesirable applications, and taking methods of the medication. o Telephone follow-up - Solve the doubts in the medication process, and remind the patient when to return to the clinic. o Lecture - Introduce the pharmacological effects, taking methods, side effects and treatment methods of related drugs. E=Monitoring: Follow-up phone calls - Record the patient’s adverse drug reactions and the number of acute attacks. Others: Lecture - Suggest the healthy diet and living habits of COPD needs.
6	Wei et al^Citation31				√	√			D=Administration: Education: o Interview - Use of respiratory devices, pathophysiology of the disease. o Telephone follow-up - Solve the doubts in the medication process, and remind the patient when to return to the clinic. E=Monitoring: Medication management records - Evaluated each participant’s preferences and analyzed possible barriers to medication adherence.
7	Farris et al^Citation32		√		√	√			B=Prescribing: Admission medication reconciliation. D=Administration: Education- Pharmacist visits every 2–3 days for patient education during inpatient stay. Discharge counseling - Focused on goals of therapy, medication administration, barriers to adherence including cost and patient concerns. Telephone follow-up - Participants received a telephone call at 3–5 days post-discharge. Discharge care plan - Primary care physician and community pharmacist received a discharge care plan, including the discharge medication list, plans for dosage adjustments and monitoring, recommendations for preventing adverse drug events, with patient specific concerns such as adherence or cost issues highlighted. E=Monitoring: Usual care - The usual care discharge summary was transcribed and received in the mail by the primary care physician several days or weeks after discharge. Adverse events and healthcare utilization - At 30 and 90 days post-discharge, all participants were phoned to gather self-reported adverse events and symptoms and self-reported healthcare utilization.
8	Wei et al^Citation33				√	√			D=Administration: Education - including medication usage, precautions, etc. E=Monitoring: Pharmacist rounds - Record the ward rounds and consultation content in the medical record in detail, and establish a record sheet for the patient to record the participation of clinical pharmacists in treatment.
9	Yan et al^Citation34		√		√	√			B=Prescribing: Propose treatment plans. D=Administration: Follow-up - Pharmacological follow-up of some key patients. E=Monitoring: Adverse drug reactions - Monitor the whole process of patient medication, prevent and treat adverse drug reactions and drug interaction.
10	Wang et al^Citation35		√		√	√		√	B=Prescribing: Propose a personalized medication plan - join patient rounds, develop treatment plans. Oversee physician prescriptions - Regarding the contraindications of the therapeutic drugs, the administration status, the combined medication status, and the presence or absence of repeated medications. D=Administration: Education - Admission education, in-hospital education, and discharge education. Follow-up - Pharmacological follow-up of some key patients. E=Monitoring: Monitor the administration time, medication course, appropriate administration method, monitor drug-drug interactions, and record the ADR. Non-medication monitoring - oxygen therapy, rehabilitation therapy, and monitoring of related common complications. Others: Healthy diet, strengthen their physique, and take appropriate physical exercise.
11	Lin et al^Citation36				√	√			D=Administration: Inhalation technique education - Instruct the operation process of using the inhaler. E=Monitoring: Observe operating conditions and medication comfort, and record changes in pulse and oxygen saturation (SpO2).
12	Suhaj et al^Citation37				√	√		√	D=Administration: Education o Content - Symptom management, inhaler technique, to emphasized about medication compliance. o Method - Counselling sessions. o Materials - Patient information leaflets (PILs). Follow up - Every six months, patients were trained for proper use of inhaler devices and were motivated for medication adherence. E=Monitoring: SGRQ assessment - Repeated at 6, 12, 18 and 24 months. Others: Smoking cessation programme. Simple exercises that patients can do at home.
13	Xin et al^Citation38				√	√		√	D=Administration: Education - o Content - disease, prescribed medication, the importance of adherence, inhaler technique and drug combination. o Materials, telephone or network counseling - Remind the possible ADR and when to return to the clinic. E=Monitoring: SGRQ assessment -Reassessed every 6 months. Others: Smoking cessation programme. Giving life health advice.
14	Qin et al^Citation39		√		√	√		√	B=Prescribing: Review of prescriptions for special populations. Adjustment of the treatment plan. D=Administration: Inhaler technique Special drug consulting services. o The use of high-risk drugs. o Rationality of the use of special antibiotics. Long-term medical advice on medication. Interpretation of the instructions. Checked the remaining amount of drug and the scale window of the inhalation device. E=Monitoring: Telephone follow-up - Evaluated adverse drug reaction. Outpatient follow-up - MMAS-8 score and lung function monitoring - performed at 3 months and 6 months after the intervention. Others: Smoking cessation programme. Healthy lifestyle suggestions.
15	Zhang et al^Citation40		√		√	√			B=Prescribing: Conducted evaluation of long-term, temporary and changed medical orders through the respiratory medicine medical order review platform. Focused on the indications, drug selection, dosage and treatment course of antibacterial drugs, glucocorticoids, theophylline, proton pump inhibitors, adjuvant medications. D=Administration: Education o Patient medication education - In medical or pharmacy rounds, bedside explanations and educational materials are used to inform patients about disease-related knowledge, indications of commonly used drugs, pharmacological effects, usage and dosage, possible ADEs and precautions, etc. o Discharge medication guidance - provide medication guidance, including discharge medication treatment plan, discharge medication education (purpose of medication, usage and dosage, life precautions, ADE and treatment, drug storage, response measures after missed medication, Self-monitoring, etc. Follow-up: In the first month after discharged, the designated clinical pharmacist will conduct a 20–30 minute telephone follow-up. E=Monitoring: The clinical pharmacist asks whether there is an increase, forgotten, discarded, or used off-prescription drugs. Medication compliance - the patient reported whether the drug was used as prescribed by the doctor, whether there was a missed or wrong dose, whether patient mastered the correct use of the special dosage form, etc.
16	Abdulsalim et al^Citation41				√	√		√	D=Administration: Counselling sessions and patient information leaflets (PILs) - the importance of medication compliance, dose and frequency of medications, proper use of inhaler devices and need for timely monitoring by the pulmonary medicine department. Followed up - for a period of two years, and adherence was re-assessed after every six months. During follow up, patients in IG were trained for proper use of inhaler devices. Medication adherence - Used monthly telephone calls for ensuring medication adherence. E=Monitoring: The medication adherence assessment - was repeated at 6, 12, 18 and 24 months in both the groups. Others: Smoking cessation programme. Simple exercise.
17	Juanes et al^Citation17		√		√	√			B=Prescribing: Medicine review and validation of physician prescriptions. The indication for each medication in relation to the patient’s condition. The appropriateness of each medication, dose, schedule. Duration of the treatment for the patient’s age and/or clinical status (renal function or liver function). Potential drug-related problems - The pharmacist reported the problem causing this problem and proposed an alternative prescription that would be available for the health team in the electronic health record. Medication reconciliation - including drug name, dosage, frequency and route, and comparing that list against the physician’s admission, transfer and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital. D=Administration: Obtaining and recording the medication chart. By interviewing the patient or caregiver, the medication taken at home as listed in the electronic health records. Follow-up. E=Monitoring: Therapeutic drug monitoring - was performed for drugs with a narrow therapeutic range.
18	Chen et al^Citation42				√	√		√	D=Administration: Education -The pharmacist personally demonstrated the correct use of inhalants, and informs patients of precautions, adverse reactions, etc. WeChat interactive platform - Pushed publicity and education videos and popular science articles. Brochure - Prepared and distributed the ”Asthma and COPD Patients Chronic Disease Management Brochure”. E=Monitoring: Within 6 months of treatment were recorded through telephone follow-up, and the incidence of adverse reactions was calculated to evaluate the drug safety. After 3 or 6 months of enrollment, performed MMAS-8 score, CAT score (COPD), MasterScreen lung function test system, device use score, and recorded the number of acute attacks/exacerbations. Others: Smoking cessation programme Scientific life style
19	Song et al^Citation43		√		√	√		√	B=Prescribing: Ant-infective treatment plan - The clinical pharmacist determines the intervention points of antimicrobial treatment based on the patient’s condition, and works with the clinician to formulate. D=Administration: Inhalation administration guidance - Established an education model for the use methods and precautions of commonly used inhalation preparations. Education-Organized classroom teaching, with the help of slides, comic book propaganda books. Nursing guidance - Informed the nurses of the precautions during drug infusion, including drug infusion speed, compatibility contraindications, etc. E=Monitoring: Followed up by telephone for a period of one year. Assessed the use of common respiratory medicines and awareness of adverse reactions, the application of inhaled preparations, changes in lung function, and related medical expenses. Others: Life Guidance - During the follow-up period, explained the daily diet and life aspects of the patients that need to be noted and avoided, and encouraged the patients to increase exercise appropriately Psychological counseling - Helped patients to correctly understand ACOS and reduced the negative emotions caused by the disease
20	Bloodworth et al^Citation44		√	√	√				B=Prescribing: Medication issues -The pharmacist transitions coordinator worked with the decentralized clinical pharmacist, prescriber, or social worker to resolve identified medication issues. C=Preparation: Supply of discharge medications - On the day of discharge, a 30-day supply of discharge medications was offered to each patient at usual cost or co-pay and delivered to the bedside by the hospital’s outpatient pharmacy. D=Administration: Duration - On hospital discharge, patients received telephonic and face-to-face interventions. Patients were contacted by telephone on post-discharge days 2, 9, and 25 by the pharmacist. Content -The pharmacist completed a comprehensive medication review and assessed health status, identified any potential or actual drug therapy problems (DTPs), adverse drug events, or other concerns. Adherence -The pharmacist answered any patient questions, assessed and reinforced adherence with medications, provided information on discharge instructions. Transition -To facilitate communication during the transition, a pharmacist transitions coordinator uploaded the patient’s discharge summary into the Health Navigator system for the pharmacists providing telephonic follow-up and faxed a copy of the summary to the community pharmacists providing the medication therapy management visits.
21	Chen et al^Citation45				√				D=Administration: Education o Explanation o Demonstration o Exercise
22	Li et al^Citation46				√	√		√	D=Administration: Education o Medication guidance o Inhalation device use o Medication compliance Follow up -Asking about the drugs currently used and their usage and dosage, and correcting the medication deviation according to the discharge doctor’s advice E=Monitoring: Follow up Special reaction Adverse reaction Others: Respiratory function exercise Diet and lifestyle education
23	Yang et al^Citation47				√	√		√	D=Administration: Education-disease knowledge, common misunderstandings, drug therapy, the necessity and importance of adhering to medication Guiding medication - filled in the medication guidance card in detail, and explained the precautions E=Monitoring: Follow up - urged patients to adhere to medication and understood the improvement of patients’ condition and the occurrence of adverse drug reactions. Others: Smoking cessation Living habits
24	Abdulsalim et al^Citation48				√			√	D=Administration: Education-the dose and frequency of the prescribed medicines, the importance of medication compliance and the proper use of prescribed inhaler devices Medication adherence - Patients were further contacted by telephone each month to enhance medication adherence and timely follow-up. Counselling - were conducted during the 2-year follow-up period. Others: Smoking cessation Simple exercise
25	Wang et al^Citation49				√				D=Administration: Inhalation Technical Guidance - A pharmacist demonstrated, observed the patient’s inhaler technology, guided the incorrect steps until there were no errors in each step. Education - Brochure, videos, popular science articles were regularly delivered to patients. Consultation - Established an online consulting platform for online consultation and education Telephone follow-up - Monthly telephone follow-ups were conducted for three months to guide correct operation.
26	Wang et al^Citation50		√		√	√		√	B=Prescribing: Formulation of personal drug list - Listed the name, dosage, indications, usage, start time, stop time, and drug unit price of each drug used by the patient, which would be reviewed and updated by the pharmacist at the next return visit. D=Administration: Education- Provided education on the proper use of drugs and inhaled preparations E=Monitoring: Collect evaluation indicators at the first visit and follow-up for 3 months and 6 months: FEV1%, EQ-5D, CAT score, Morisky score Identified DRPs in patients, recorded and proposed methods to resolve DRPs Others: Developed a rehabilitation plan- smoking cessation, exercise
27	Wang et al^Citation51				√				D=Administration: Education - Made videos and relevant popular science education articles. Inhalation Technical - Demonstrated the operation steps of the inhaler device for the patients and corrected the operation error of the patients Telephone follow-up - Repeatedly deepened the patient’s impression of the precautions for the use of the inhaler device. Online consultation - Established an online platform for online consultation and education.
28	Prasungriyo et al^Citation52		√		√	√		√	B=Prescribing: Medication reconciliation - Together with medication dispensing, hospital pharmacists provided medication reconciliation. D=Administration: Counseling - Included basic knowledge of COPD, pathophysiology and risk factors in the development of the disease, a review of the technique for using inhalers, the importance of medication adherence Education - Printed material containing succinct information regarding the disease, medications, and instructions on using the inhalers was made available to intervention patients. E=Monitoring: Patients were contacted by phone to investigate any adverse events. Others: Smoking cessation Self-management and lifestyle modification Breathing exercises
29	Liu et al^Citation53		√		√	√			B=Prescribing: Analyzed the patient’s prior use of medication and adjusted the prescription. D=Administration: Medication education for COPD patients. E=Monitoring: Recorded adverse drug events and misuse of drugs. Two follow-up surveys were carried out 1 and 6 months after discharge (self-administering medication at home, CAT score, and patient medication adherence)

Table 4 Output and Outcome of Hospital Pharmacist Intervention

No.	Authors	Intervention Design				Output							Outcome
		Service Components	Duration of Study (Months)	Duration of Intervention (Months)	Multi-Disciplinary	Adherence	Rational Drug Use	Knowledge	Serum Level	Health Resources Utilization	Inhalation Technique	Smoking Cessation	Patient
													Economic	Humanistic	Clinical
Section 1: Inpatient
1	Shen et al^Citation28	Prescribing	10	10	Yes		+						Hospitalization cost (-) Antibiotics cost (-)		Length of hospital stay (-)
2	Wei et al^Citation33	Administration Monitoring	N/A	N/A	No		+						Hospitalization cost (-) Drug cost (-) Antibiotics cost (-)		Length of hospital stay (-)
3	Yan et al^Citation34	Preparation Administration Monitoring	6	N/A	No										CAT score (-) mMRC grading score(-)
4	Wang et al^Citation35	Prescribing Administration Monitoring Others	6	N/A	No		+								CAT score(-) mMRC grading (-) Adverse drug reactions(-)
5	Lin et al^Citation36	Administration Monitoring	N/A	N/A	Yes						+			Patients’ satisfaction (+)	Dyspnea phenomenon(-)
6	Suhaj et al^Citation37	Administration Monitoring Others	36	24	No										SGRQ score (+)
7	Xin et al^Citation38	Administration Monitoring Others	12	12	No	+						+			SGRQ score (+) Severe exacerbation (-) Hospitalizations(-)
8	Zhang et al^Citation40	Prescribing Administration Monitoring	N/A	N/A	No	+	+							Patients’ satisfaction (+)	Adverse drug reactions(-)
9	Abdulsalim et al^Citation41	Administration Monitoring Others	36	24	No	+
10	Song et al^Citation43	Prescribing Administration Monitoring Others	12	12	No			+			+		Total medical cost (-) Antibiotics cost (-) cost of inhaled preparations (+)		readmission %(+) Adverse drug reactions(-)
11	Bloodworth et al^Citation44	Prescribing Preparation Administration Monitoring Others	6	6	Yes										Readmission rates(-) Time to readmission(-)
12	Chen et al^Citation45	Administration	N/A	N/A	No						+
13	Li et al^Citation46	Administration Monitoring Others	N/A	40 days	No	+	+	+					Hospitalization cost (=) Drug cost (=) Antibiotics cost (=) Daily cost(=)	Patients’ satisfaction (+)	Clinical symptom improvement (=) Complication (=) Prognosis (=) Mortality (=)
14	Yang et al^Citation47	Administration Monitoring Others	6	1	No	+									FEV1%(+) 6MWD score (-) CAT score (-) mMRC grading(-) Adverse drug reactions (-) Hospital readmission rate(-)
15	Wang et al^Citation49	Administration	3	3	No	+					+			Quality of life(+) Patients’ satisfaction (+)	CAT score(-)
16	Prasungriyo et al^Citation52	Prescribing Administration Monitoring Others	3	3	No								Direct costs(=)		Hospital readmissions(=) CAT scores(-) PDC scores(=)
Section 2: Outpatient
1	De et al^Citation26	Preparation Administration Monitoring	6	6	No	+			+
2	Khdour et al^Citation27	Prescribing Administration Monitoring Others	12	12	No	+		+		+				Quality of life (HRQoL scores) (+)	Hospital admissions (-) ED visits (-) Total of hospital days (-) FEV1 (=) BMI scores (=)
3	Jarab et al^Citation29	Prescribing Administration Monitoring Others	6	6	NO	+		+		+				Quality of life (=)	Hospital admission (-) FEV1 (=) BMI scores (=)
4	Wei et al^Citation30	Administration Monitoring Others	6	6	No	+		+							Adverse drug reactions (-)
5	Wei et al^Citation31	Administration Monitoring	6	6	NO	+								Quality of life (HRQoL scores) (+)	Admission rate (-)
6	Chen et al^Citation42	Administration Monitoring Others	6	6	No	+					+				FEV1% (+) Acute attacks/exacerbations(-) Clinical effective control rate(+) Adverse drug reactions (=)
7	Wang et al^Citation50	Prescribing Administration Monitoring Others	6	6	No	+	+						Drug cost(-)	Quality of life (EQ-5D) (=)	CAT scores(-)
8	Wang et al^Citation51	Administration	3	3	No	+					+			Patients’ satisfaction(+)	The clinical effective control rate(+) Adverse drug events(=) Acute exacerbation(-)
Section 3: Inpatient & Outpatient
1	Farris et al^Citation32	Administration Monitoring	5 years	3	Yes		=			=					Adverse events(=)
2	Qin et al^Citation39	Prescribing Administration Monitoring Others	6	6	No	+									Clinical effect(+) Pulmonary function indicators(+) Acute exacerbation(-) Adverse drug reactions (-)
3	Juanes et al^Citation17	Prescribing Administration Monitoring	12	12	No										Hospital stay (=) Mortality(=) Drug-related negative outcomes(-)
4	Abdulsalim et al^Citation48	Administration Monitoring Training Others	24	24	No								Drug cost(-)
5	Liu et al^Citation53	Prescribing Administration Monitoring	12	6	No	+	+						Costs of hospitalization(-)		CAT scores(+) length of stay (-) Adverse drug reactions (-)

Abbreviation: CAT, COPD assessment test.

Figure 2 Reporting quality of the included studies according to the CONSORT Guideline (n=29).

Figure 3 The logic model of hospital pharmacist interventions for COPD patients.

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