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Dray J, Soubieux A, Chenailler C, Varin R, Dujardin F, Curado J, Barat E. Economic impact of a clinical pharmacist in the orthopaedic sector: a review of the literature. Eur J Hosp Pharm 2024:ejhpharm-2023-003727. [PMID: 38503475 DOI: 10.1136/ejhpharm-2023-003727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES This review of the literature aimed to evaluate the economic impact of a clinical pharmacist in the orthopaedic sector. METHODS The review followed the PRISMA recommendations. A bibliographic search was conducted on 23 June 2023 using PubMed, Cochrane Library and Web of Science. All articles in French or English with economic data on clinical pharmacy activities in orthopaedics were included. Articles not mentioning the term 'orthopaedics' and those published prior to 1990 were excluded. Data from the studies were compiled in an Excel table. A bias analysis using the ROBINS-I Cochrane tool was performed. The methodology of the studies was compared and weighted using the CHEERS and STROBE checklists. RESULTS Among 529 articles initially identified, 10 were included in the review. The cost-benefit ratio of a clinical pharmacist in orthopaedics ranged from 0.47:1 to 28:1. The maximum savings reached US$73 410 /year in the American study and €1 42 356 /year in the French study. For three studies, the cost of a clinical pharmacist was not evaluated. Eight studies showed a positive economic impact. The Dutch study showed a balance and the Danish study showed a negative economic impact of €3442/month. CONCLUSIONS This literature review has shown an economic benefit of a clinical pharmacist in the orthopaedic sector despite several biases and methodological limitations. The two studies that did not confirm this benefit only evaluated a limited number of expected benefits. Nevertheless, the economic impact of the clinical pharmacist in the orthopaedic sector seems positive and undervalued.
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Affiliation(s)
- Joshua Dray
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | | | | | - Remi Varin
- Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Franck Dujardin
- Department of Orthopedics, Rouen University Hospital, Rouen, France
| | - Jonathan Curado
- Department of Orthopedics, Rouen University Hospital, Rouen, France
| | - Eric Barat
- Department of Pharmacy, Rouen University Hospital, Rouen, France
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2
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Urbańczyk K, Guntschnig S, Antoniadis V, Falamic S, Kovacevic T, Kurczewska-Michalak M, Miljković B, Olearova A, Sviestina I, Szucs A, Tachkov K, Tiszai Z, Volmer D, Wiela-Hojeńska A, Fialova D, Vlcek J, Stuhec M, Hogg A, Scott M, Stewart D, Mair A, Ravera S, Lery FX, Kardas P. Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes. Front Pharmacol 2023; 14:1244151. [PMID: 37601045 PMCID: PMC10433912 DOI: 10.3389/fphar.2023.1244151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.
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Affiliation(s)
- Kamila Urbańczyk
- Department of Clinical Pharmacology, Wroclaw Medical University, Wroclaw, Poland
- Regional Specialist Hospital in Wroclaw, Wroclaw, Poland
| | - Sonja Guntschnig
- Tauernklinikum Zell am See, Zell am See, Austria
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Northern Ireland
| | | | - Slaven Falamic
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Pharmacy Department, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Anna Olearova
- Department of Clinical Pharmacology, University Hospital Bratislava—Hospital Ruzinov, Bratislava, Slovakia
| | - Inese Sviestina
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Children’s Clinical University Hospital, Riga, Latvia
| | - Attila Szucs
- Pharmacy Department, National Institute of Oncology, Budapest, Hungary
| | - Konstantin Tachkov
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Zita Tiszai
- Department of Hospital Pharmacy, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Daisy Volmer
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anna Wiela-Hojeńska
- Department of Clinical Pharmacology, Wroclaw Medical University, Wroclaw, Poland
| | - Daniela Fialova
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia
- Department of Geriatrics and Gerontology, First Faculty of Medicine in Prague, Charles University, Prague, Czechia
| | - Jiri Vlcek
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czechia
- Clinical Pharmacy Department, Hospital Pharmacy, Teaching Hospital Hradec Kralove, Hradec Králové, Czechia
| | - Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia
| | - Anita Hogg
- Medicines Optimisation Innovation Centre, Antrim Hospital, Antrim, United Kingdom
| | - Michael Scott
- Medicines Optimisation Innovation Centre, Antrim Hospital, Antrim, United Kingdom
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- European Society of Clinical Pharmacy, Leiden, Netherlands
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, United Kingdom
| | - Silvia Ravera
- European Directorate for the Quality of Medicines & Healthcare, Council of Europe, Strasbourg, France
| | - François-Xavier Lery
- European Directorate for the Quality of Medicines & Healthcare, Council of Europe, Strasbourg, France
| | - Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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3
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Bouzeid M, Clarenne J, Mongaret C, Pluchart H, Chanoine S, Vermorel C, Bosson JL, Bedouch P, Conort O, Gravoulet J, Janoly-Dumenil A, Juste M, Mongaret C, Bosson JL, Bedouch P. Using national data to describe characteristics and determine acceptance factors of pharmacists' interventions: a six-year longitudinal study. Int J Clin Pharm 2022; 45:430-441. [PMID: 36566276 DOI: 10.1007/s11096-022-01526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND In France, hospital pharmacists perform medication order reviews during patients' hospital stays. This activity can be centralized in the pharmacy or carried out directly in the ward, in collaboration with the healthcare team. During this review, pharmacists can make recommendations to optimize therapeutics. Since 2006, they can document their interventions, via the national Act-IP© observatory. AIM To determine the characteristics of pharmacists' interventions and their acceptance by physicians in French hospitals. METHOD A 6-year observational study of pharmacists' interventions documented on the Act-IP© French observatory between 2009 and 2014 was performed. Multiple logistic regression was undertaken to determine the predictors of physicians' acceptance of interventions. RESULTS A total of 194,684 pharmacists' interventions were documented and concerned mainly "dosage adjustment" (25.6%). These interventions were mostly related to drugs from the central nervous system (23.7%). Seventy percent of pharmacists' interventions were accepted by physicians. Acceptance rate was higher when conducted by a pharmacist regularly practicing in the ward (ORa = 1.60, CI 95 [1.57-1.64]). Physicians' acceptance was significantly associated with (1) ward specialty: emergency (ORa = 1.24, CI 95 [1.14-1.35]); (2) type of intervention: "drug discontinuation", "drug switch" (ORa = 1.15, CI 95 [1.12-1.19]) and "addition of a new drug" (ORa = 1.15, CI 95 [1.12-1.19]); (3) drug group: antineoplastic and immunomodulators (ORa = 3.67, CI 95 [3.44-3.92]). CONCLUSION This 6-year longitudinal study highlights the role of clinical pharmacists, and particularly the impact of those integrated into wards. This was found to improve intervention acceptance, potentially through collaboration with physicians in pursuit of patient care and drug safety.
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Affiliation(s)
- Mayssam Bouzeid
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Justine Clarenne
- BIOS EA 4691, Université de Reims Champagne-Ardenne, 51100, Reims, France.,Pharmacy Department, CHU Reims, 51100, Reims, France
| | - Céline Mongaret
- BIOS EA 4691, Université de Reims Champagne-Ardenne, 51100, Reims, France.,Pharmacy Department, CHU Reims, 51100, Reims, France
| | - Hélène Pluchart
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France.,Pharmacy Department, Grenoble-Alpes University Hospital, 38000, Grenoble, France
| | - Sébastien Chanoine
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France.,Pharmacy Department, Grenoble-Alpes University Hospital, 38000, Grenoble, France
| | - Céline Vermorel
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | | | - Jean-Luc Bosson
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Pierrick Bedouch
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Univ. Grenoble Alpes, 38000, Grenoble, France. .,Pharmacy Department, Grenoble-Alpes University Hospital, 38000, Grenoble, France.
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4
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Wilkes S, Zaal RJ, Abdulla A, Hunfeld NGM. A cost-benefit analysis of hospital-wide medication reviews: a period prevalence study. Int J Clin Pharm 2021; 44:138-145. [PMID: 34498214 PMCID: PMC8866269 DOI: 10.1007/s11096-021-01323-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Background For specific medical specialties it has been shown that clinical pharmacists can have a beneficial effect on the reduction of drug-related problems by performing medication reviews. However, little is known on the cost–benefit ratio of hospital-wide implementation of medication reviews. Aim To investigate the effect of conducting hospital-wide medication reviews on the detection and resolution of drug-related problems, and to calculate the cost–benefit ratio of the intervention. Method In this observational prospective period prevalence study, medication reviews were conducted during five consecutive working days in a Dutch university hospital. Patients admitted for more than 24 h were included. The cost–benefit ratio of conducting the medication reviews was calculated by dividing the total costs by the total savings. Results In 622 medication reviews, 709 potential drug-related problems (1.1 per patient) were detected. The most common advice was to stop medication (38.6%). Patients with a potentially drug-related problem were significantly older, had a higher median number of prescriptions, and the median number of days from admission to the time of medication reviews was longer. Conducting medication reviews showed a positive cost–benefit ratio of 9.7. Conclusions Hospital-wide medication reviews by clinical pharmacists have a positive cost–benefit ratio and contribute to the detection and the resolution of drug related problems (DRPs), mainly by reducing overtreatment.
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Affiliation(s)
- Sarah Wilkes
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Rianne J Zaal
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alan Abdulla
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole G M Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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5
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Faqeer N, Mustafa N, Abd Al-Jalil N, Qur'an T. Impact of clinical pharmacists in an inpatient medical oncology service: A prospective study at a comprehensive cancer center in Jordan. J Oncol Pharm Pract 2020; 27:897-901. [PMID: 32703083 DOI: 10.1177/1078155220943277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Clinical pharmacy is considered an integral discipline in the health care system for optimizing therapy and reducing drug-related problems. The objective of this study was to evaluate the impact of clinical pharmacists in optimizing management in a medical oncology service. METHODS A prospective study was conducted at King Hussein Cancer Center between July 2019 and September 2019 of patients admitted to the medical oncology service. The impact of clinical pharmacists was measured by evaluating their interventions, defined as actions that were expected to result in a change in patient management. Data were collected daily by routine review of patients' profiles and by recording clinical pharmacists' interventions. The data collected were baseline characteristics of patients, numbers and types of clinical pharmacists' interventions, their significance, medications involved, and rate of acceptance of clinical pharmacists' interventions by physicians. The significance of each intervention was assessed by two clinical pharmacists on a Hatoum scale. Physicians' acceptance was assessed by whether the recommendations were implemented. RESULTS During the study period, 748 patients were included, of whom 605 required a total of 1683 clinical interventions. The mean age was 56.3 years (±15.5 SD). Of the interventions, 39% resulted in initiation of a drug and 25% in drug discontinuations. The drug group most commonly associated with clinical pharmacists' interventions was antibiotics (26.5%). Physicians accepted 98% of the clinical pharmacists' interventions, and 92.4% of the interventions brought care to a more appropriate level and were considered significant. CONCLUSION Most patients in the medical oncology service required clinical pharmacists' interventions, as demonstrated by the high number of significant clinical pharmacists' interventions. Studies should be conducted to follow up these findings with respect to patient outcomes and cost savings.
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Affiliation(s)
- Nour Faqeer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Nour Mustafa
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | | | - Tasnim Qur'an
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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6
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Zaal RJ, den Haak EW, Andrinopoulou ER, van Gelder T, Vulto AG, van den Bemt PMLA. Physicians' acceptance of pharmacists' interventions in daily hospital practice. Int J Clin Pharm 2020; 42:141-149. [PMID: 32026348 PMCID: PMC7162822 DOI: 10.1007/s11096-020-00970-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022]
Abstract
Background The physicians' acceptance rate of pharmacists' interventions to improve pharmacotherapy can vary depending on the setting. The acceptance rate of interventions proposed by pharmacists located in the hospital pharmacy over the telephone and factors associated with acceptance are largely unknown. Objective To determine the physicians' acceptance rate of pharmacists' interventions proposed over the telephone in daily hospital practice and to identify factors associated with acceptance. Setting A retrospective case-control study was performed concerning adult patients admitted to a university hospital in the Netherlands. Method Pharmacists' interventions, based on alerts for drug-drug interactions and drug dosing in patients with renal impairment, recorded between January 2012 and June 2013 that were communicated over the telephone were included. Factors associated with physicians' acceptance were identified with the use of a mixed-effects logistic model. Main outcome measure The primary outcome was the proportion of accepted interventions. Results A total of 841 interventions were included. Physicians accepted 599 interventions, resulting in an acceptance rate of 71.2%. The mixed-effects logistic model showed that acceptance was significantly associated with the number of prescribed drugs (16 to ≤ 20 drugs ORadj 1.88; 95% CI 1.05-3.35, > 20 drugs ORadj 2.90; 95% CI 1.41-5.96, compared to ≤ 10 drugs) and the severity of the drug-related problem (problem without potential harm ORadj 6.36; 95% CI 1.89-21.38; problem with potential harm OR 6.78; 95% CI 2.09-21.99, compared to clinically irrelevant problems), and inversely associated with continuation of pre-admission treatment (ORadj 0.55; 95% CI 0.35-0.87). Conclusion Over the study period, the majority of pharmacists' interventions proposed over the telephone were accepted by physicians. The probability for acceptance increased for patients with an increasing number of medication orders, for clinically relevant problems and for problems related to treatment initiated during admission.
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Affiliation(s)
- Rianne J Zaal
- Department of Hospital Pharmacy, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Edwin W den Haak
- Utrecht University, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Elrozy R Andrinopoulou
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arnold G Vulto
- Department of Hospital Pharmacy, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Xie C, Mu X, Hu Z, Wang W, Huang W, Huang G, Wang C, Yin D. Impact of pharmaceutical care in the orthopaedic department. J Clin Pharm Ther 2019; 45:401-407. [PMID: 31800132 DOI: 10.1111/jcpt.13091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In the mid-1960s, clinical pharmacy developed in the USA, and as the demand for pharmaceutical services continued to grow, their impact began to be taken seriously. However, the participation of clinical pharmacists as members of the multidisciplinary team in the orthopaedic department is still in its infancy, although its role in orthopaedics has not been defined. The object of this study was to identify and discuss the impact of pharmaceutical care in the orthopaedic department. METHODS A literature search was conducted on MEDLINE, PubMed, Web of Science, the Cochrane Library and CNKI (China National Knowledge Infrastructure) for papers published between 1998 and 2019, using the keywords pharmacy, pharmacist, and medication or drug combined with orthopaedic. Other available resources were also used to identify relevant articles. RESULTS AND DISCUSSION Based on the available evidence in 74 articles, it was found that clinical pharmacists play an important role in all aspects of rational use of medications, medication review and reconciliation, monitoring adverse drug events, risk assessment, and medication education and counselling. In addition, clinical pharmacy services were developed to minimize medication errors, adverse drug events and medical costs, but clinical pharmacy is still in its early stages in orthopaedics. WHAT IS NEW AND CONCLUSION A multidisciplinary approach should be adopted in the orthopaedic department, as pharmacist interventions can be vital for promoting the safety, effectiveness and cost-effectiveness of pharmacotherapy. Although pharmacists' contributions to orthopaedics are not yet fully recognized, pharmaceutical services can undoubtedly contribute to both clinical and societal outcomes.
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Affiliation(s)
- Chengxin Xie
- Faculty of Graduate Studies, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaoping Mu
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhuangming Hu
- Faculty of Nursing, Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Wang
- Faculty of Graduate Studies, Guangxi University of Chinese Medicine, Nanning, China
| | - Wenwen Huang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ge Huang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chenglong Wang
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Dong Yin
- Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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8
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DVOŘÁČKOVÁ E, PÁVEK P, KOVÁČOVÁ B, RYCHLÍČKOVÁ J, SUCHOPÁR O, HOJNÝ M, TEBBENS JD, VLČEK J. Is Computer-Assisted Aminoglycoside Dosing Managed by a Pharmacist a Safety Tool of Pharmacotherapy? Physiol Res 2019; 68:S87-S96. [DOI: 10.33549/physiolres.934329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This pilot prospective study verified the hypothesis that use of computer-assisted therapeutic drug monitoring of aminoglycosides by pharmacists leads to better safety therapeutic outcomes and cost avoidance than only concentration measurement and dose adjustments based on a physician’s experience. Two groups of patients were enrolled according to the technique of monitoring. Patients (Group 1, n=52) underwent monitoring by a pharmacist using pharmacokinetic software. In a control group (Group 2, n=11), plasma levels were measured but not interpreted by the pharmacist, only by physicians. No statistically significant differences were found between the groups in factors influenced by therapy. However, the results are not statistically significant but a comparison of the groups showed a clear trend towards safety and cost avoidance, thus supporting therapeutic drug monitoring. Safety limits were achieved in 76 % and 63 % of cases in Groups 1 and 2, respectively. More patients achieved both concentrations (peak and trough) with falling eGFR in Group 1. In present pilot study, the pharmacist improved the care of patients on aminoglycoside therapy. A larger study is needed to demonstrate statistically significantly improved safety and cost avoidance of aminoglycoside therapy monitoring by the pharmacist using pharmacokinetic software.
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Affiliation(s)
- E. DVOŘÁČKOVÁ
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
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9
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Rodrigues JPV, Marques FA, Gonçalves AMRF, Campos MSDA, dos Reis TM, Morelo MRS, Fontoura A, Girolineto BMP, Souza HPMDC, Cazarim MDS, Maduro LCDS, Pereira LRL. Analysis of clinical pharmacist interventions in the neurology unit of a Brazilian tertiary teaching hospital. PLoS One 2019; 14:e0210779. [PMID: 30657771 PMCID: PMC6338378 DOI: 10.1371/journal.pone.0210779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/02/2019] [Indexed: 01/23/2023] Open
Abstract
It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.
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Affiliation(s)
- João Paulo Vilela Rodrigues
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Fabiana Angelo Marques
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Maria Rosa Freato Gonçalves
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marília Silveira de Almeida Campos
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- * E-mail:
| | | | - Manuela Roque Siani Morelo
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Andrea Fontoura
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Helen Palmira Miranda de Camargo Souza
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maurílio de Souza Cazarim
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lauro César da Silva Maduro
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Leonardo Régis Leira Pereira
- Pharmaceutical Services and Clinical Pharmacy Research Center, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Bao Z, Ji C, Hu J, Luo C, Fang W. Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital. BMC Health Serv Res 2018; 18:519. [PMID: 29973200 PMCID: PMC6031100 DOI: 10.1186/s12913-018-3306-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the effectiveness of pharmacist interventions on outpatient prescription. The goal of this study was to evaluate the clinical and economic impacts of pharmacist interventions on randomly sampled outpatient prescriptions. METHOD Outpatient prescriptions of our hospital were sampled automatically and reviewed by pharmacists since 2011. Pharmacists intervened in inappropriate prescriptions (IPs) real-timely, and summarized and analyzed the information monthly. Cost-benefit analysis was performed to estimate the economic benefit of the pharmacist intervention. RESULTS From 2011 to 2016, pharmacists reviewed 101,271 prescriptions and intervened in 5155 prescriptions. With the interventions of pharmacists, the number of IPs decreased from 1845 to 238, while the inappropriate percentage decreased from 12.60 to 1.22%. The inappropriate rates of different departments and the types decreased annually. IPs were mainly from the Department of Medicine and Department of Surgery and category 1 (Non-indicated medications) in all years. The benefit-to-cost ratios of pharmacist interventions were always more than 1. In the same years, the benefit-to-cost ratios in public payments were higher than those with insurance and self-payment. CONCLUSION This form of pharmacist intervention constitutes a method that showed positive clinical and economic benefits and is worth expanding in large hospitals. Pharmacists should pay more attention on prescriptions in department of surgery or prescriptions with public payments.
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Affiliation(s)
- Zhiwei Bao
- Department of Pharmacy, Jiangsu Jianhu People’s Hospital, Yancheng, 224700 China
| | - Chunmei Ji
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Jing Hu
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Can Luo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Wentong Fang
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
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Bayoud T, Waheedi M, Lemay J, Awad A. Drug therapy problems identification by clinical pharmacists in a private hospital in Kuwait. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:210-217. [PMID: 29475557 DOI: 10.1016/j.pharma.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To report the types and frequency of drug therapy problems (DTPs) identified and the physician acceptance of the clinical pharmacist interventions in a private hospital in Kuwait. METHODS A retrospective cross-sectional study was conducted on 3500 patients admitted to the hospital between December 2010 and April 2013. A structured approach was used to identify DTPs and recommend interventions. Data were analyzed using MAXQDA version 11. KEY FINDINGS A total of 670 DTPs were identified and recommendations were proposed to treating physicians for each DTP. Overdosage was the most frequently identified drug therapy problem (30.8%), followed by low dosage (17.6%), unnecessary drug therapy (17.3%), need for additional drug therapy (11.6%), and need for different drug product (11.6%). The drug classes most frequently involved were anti-infectives (36.9%), analgesics (25.2%), and gastrointestinal agents (15.5%). More than two-third of the interventions (67.5%) were accepted and implemented by physicians. The most frequently accepted interventions were related to nonadherence, adverse drug reaction, monitoring parameters, inappropriate dosage, and need for additional drug therapy. CONCLUSION The current findings expand the existing body of data by reporting on pharmacist recommendations of identified DTPs and importantly, their high rate of acceptance and implementation by the treating physician. These results could serve as a springboard to support further development and implementation of clinical pharmacy services in other healthcare settings in Kuwait.
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Affiliation(s)
- T Bayoud
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
| | - M Waheedi
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| | - J Lemay
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| | - A Awad
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
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12
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Wongpakaran R, Suansanae T, Tan-Khum T, Kraivichian C, Ongarjsakulman R, Suthisisang C. Impact of providing psychiatry specialty pharmacist intervention on reducing drug-related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open-label study. J Clin Pharm Ther 2017; 42:329-336. [PMID: 28317138 DOI: 10.1111/jcpt.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/25/2017] [Accepted: 02/16/2017] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient's function and quality of life. Due to the complicated neurobiological aetiology of autism spectrum disorder (ASD), a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population. We evaluate the impact of providing specialty psychiatry (PS) pharmacist intervention in identifying and resolving drug-related problems (DRPs) among children with ASD associated with disruptive behaviours. METHODS An eight-week-long, prospective, randomized open-label study was conducted. Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included. They were randomly assigned to an intervention or a control group. Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist, while those in control group were cared by a hospital pharmacist. The primary outcome was the number of patients who resolved of at least one DRP by the end of the study. The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability (ABC-I) scores between the two groups. RESULTS Twenty-five patients were randomly assigned to either an intervention or control group. At week 8, the total number of patients who resolved of at least one DRP was 13 (52%) in the intervention group and 4 (16%) in the control group, respectively (P=.016). Improper drug selection, medication non-adherence and subtherapeutic dosage were the most common DRPs. Mean ABC-I scores improved in the intervention group more than in the control group (9.8±5.6 vs 17.7±7.9; P<.001). WHAT IS NEW AND CONCLUSION To the best of our knowledge, this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD. The reduction in common DRPs mostly resulted from the PS pharmacist interventions, including selection of antipsychotic agent, adjustment of dosage based on ABC-I scores and provision of individualized drug counselling. Reducing DRPs led to the improvement of any disruptive behaviour. In addition, multidisciplinary team should develop drug therapy protocols to promote the role of pharmacists in this setting.
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Affiliation(s)
- R Wongpakaran
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - T Suansanae
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - T Tan-Khum
- Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand
| | - C Kraivichian
- Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand
| | - R Ongarjsakulman
- Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand
| | - C Suthisisang
- Department of Pharmacology, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
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