SYSTEMATIC REVIEW article
Front. Med.
Sec. Regulatory Science
Clinical Pharmacist-led Interventions and Their Impact on Outcomes in Patients with Bipolar I Disorder: A Systematic Review and Meta-analysis
Provisionally accepted
Moteb Khobrani1
Sultan M. Alshahrani2*- 1Clinical Pharmacy Department, King Khalid University, Abha, Saudi Arabia
- 2King Khalid University, Abha, Saudi Arabia
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Background: Pharmacist-led interventions have increasingly been recognized as effective strategies for improving outcomes in psychiatric care, yet their role in patients with bipolar I disorder (BD-I) remains underexplored. This systematic review and meta-analysis synthesized existing evidence on the impact of clinical pharmacist-led interventions on medication adherence, relapse prevention, hospitalization, and quality of life among individuals with BD-I. Objectives: To evaluate the effectiveness of pharmacist-led interventions, either alone or in collaboration with psychiatrists, on key clinical and humanistic outcomes in adults diagnosed with BD-I. Methods: Electronic databases (PubMed/MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Cochrane Library) were searched from January 2000 to August 2025 for randomized controlled trials and non-randomized quasi-experimental designs (prospective cohort studies and pre–post intervention studies) assessing pharmacist-led interventions in BD-I. Studies were screened and appraised independently in accordance with PRISMA 2020 guidelines, using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle–Ottawa Scale for non-randomized studies. Meta-analyses were performed using Review Manager. Primary outcomes were medication adherence, relapse, hospitalization, and health-related quality of life (QoL).Secondary outcomes included any additional clinical or humanistic measures reported by the included studies. Effect sizes were expressed as odds ratios (ORs) for dichotomous outcomes and as mean differences (MDs) or standardized mean differences (SMDs) for continuous outcomes. Results: Five studies met the eligibility criteria, and four contributed quantitative data. Pharmacist-led interventions significantly improved medication adherence compared with usual care (MD = 1.47 [95% CI: 1.35–1.59], p < 0.00001). For relapse prevention, pooled analysis from two trials showed reduced relapse episodes (OR = 0.47 [95% CI: 0.28–0.80], p = 0.006; I² = 0%). Improvements were also observed in quality of life (SMD = 0.51 [95% CI: 0.21–0.81], p = 0.0009; I² = 0%). Evidence for hospitalization reduction was limited but directionally favored pharmacist involvement. Conclusions: Clinical pharmacist-led interventions significantly enhance medication adherence and quality of life and may reduce relapse risk among patients with BD-I. However, given the limited number of studies and small pooled sample sizes, the overall evidence remains preliminary, and the findings should be interpreted cautiously rather than as definitive conclusions. PROSPERO Registration Number: CRD420251123737
Keywords: Bipolar I disorder, clinical pharmacist interventions, Medication Adherence, relapse prevention, Quality of Life, Collaborative care, Hospital readmissions
Received: 15 Oct 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Khobrani and Alshahrani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sultan M. Alshahrani
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.