PHARMALAB NEXUS: BRIDGING LABORATORY DIAGNOSTICS AND CLINICAL PHARMACY IN PRACTICE — A SYSTEMATIC REVIEW

Abstract

Background. Laboratory diagnostics and clinical pharmacy have historically operated as parallel services, yet the medication-use process depends on laboratory data at almost every step — selection, dosing, monitoring, and de-escalation. The point at which a laboratory result is converted into a prescribing action, here termed the lab–pharmacy interface or “PharmaLab Nexus,” is increasingly recognised as a determinant of medication safety and therapeutic effectiveness.

Objective. To systematically synthesise the evidence on the integration of laboratory diagnostics with clinical pharmacy practice and its effect on clinical, safety, and economic outcomes across the medication-use pathway.

Methods. Following PRISMA principles, a structured multi-database search (PubMed, Scopus, and Semantic Scholar, aggregated through the Consensus evidence engine) was conducted across six thematic domains: pharmacist laboratory-test monitoring, therapeutic drug monitoring (TDM), pharmacogenomics, diagnostic and antimicrobial stewardship, point-of-care testing (POCT), and anticoagulation management. Peer-reviewed studies reporting a lab–pharmacy interface and a clinical, safety, process, or economic outcome were eligible. Data were extracted into a structured evidence table and synthesised narratively; representative effect estimates were compared across domains.

Results. Thirty studies were included, of which 22 were tabulated. Across every domain, integrating laboratory data with pharmacist interpretation and action improved outcomes: TDM services reduced vancomycin nephrotoxicity and increased clinical efficacy (pooled odds ratio [OR] for efficacy 2.62; nephrotoxicity OR 0.25); pre-emptive pharmacogenomic panels reduced clinically relevant adverse drug reactions (OR 0.70); rapid diagnostics coupled with stewardship reduced bloodstream-infection mortality (OR 0.66–0.72) and shortened time to optimal therapy by up to 29 hours; pharmacist-managed anticoagulation improved time in therapeutic range and reduced complications (hazard ratio 0.61); and pharmacy-based POCT with interpretive guidance reduced unnecessary antibiotic prescribing. A consistent signal emerged: diagnostic technology delivered benefit chiefly when paired with pharmacist-led interpretation and intervention rather than in isolation.

Conclusions. The lab–pharmacy interface is a high-value, under-exploited leverage point in the medication-use system. Health systems should formalise it through collaborative practice, embedded clinical decision support, and shared quality metrics. Evidence gaps remain for community and low-resource settings and for standalone diagnostic technologies without an accompanying pharmacist workflow.