1
|
Alabbasi AK, Cohen S, Green MS, Preis M, Klang S, Brammli-Greenberg S. Assessing the Impact of a Designated Pharmacist Intervention on Drug Treatment Costs and Technical Efficiency in the Hemato-Oncology Outpatient Clinic. Value Health Reg Issues 2024; 44:101034. [PMID: 39180881 DOI: 10.1016/j.vhri.2024.101034] [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: 12/19/2023] [Revised: 04/28/2024] [Accepted: 07/03/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES This study aimed to investigate the impact of a designated pharmacist (DPha) intervention in a hemato-oncology unit, focusing on reducing drug treatment costs and improving technical efficiency (TE). METHODS Data from an 8-month intervention in the Israeli Clalit Health Services hemato-oncology outpatient unit were analyzed. During the study, the DPha reviewed the drug therapies being administered. After the review, a recommendation letter was sent, if relevant, to the treating physician. Data on drug treatment costs and interventions were meticulously collected and analyzed from the perspective of the insurer. A simple design was used to assess the DPha intervention's contribution to TE and cost reduction, which was used to generate credible and transparent estimates. Sensitivity analyses were conducted to assess the robustness of 2 major variables: drug prices and pharmacist salaries. RESULTS Over 8 months, DPha interventions led to a $279 191 cost reduction for 91 patients, resulting in net savings of $269 420 ($2960 per patient). Noteworthy is the $411 savings for each hour worked by the pharmacist, with a major impact on medications not insurer approved for the patient's condition ($101 151) and discontinuing inappropriate medications ($52 681). Biological drug optimization accounted for 81% of total savings. Sensitivity analyses demonstrated significant cost savings across various drug prices and pharmacist salary scenarios. CONCLUSIONS The study proposes a practical framework for optimizing pharmacist services and reducing the inappropriate use of costly oncology medications. Incorporating a DPha enhances TE and yields significant cost reductions, offering valuable insights for insurers, policy makers, and healthcare professionals.
Collapse
Affiliation(s)
- Areen Khateeb Alabbasi
- School of Public Health, University of Haifa, Haifa, Israel; Pharmacy Department, Clalit Health Services, Haifa, Israel
| | - Shai Cohen
- Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Internal Medicine B, Lady Davis Carmel Medical Center, Haifa, Israel
| | | | - Meir Preis
- Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Hemato-oncology Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Shmuel Klang
- School of Public Health, University of Haifa, Haifa, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|
2
|
Carter M, Abutheraa N, Ivers N, Grimshaw J, Chapman S, Rogers P, Simeoni M, Antony J, Watson MC. Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis. Fam Pract 2023; 40:615-628. [PMID: 36633309 PMCID: PMC10745261 DOI: 10.1093/fampra/cmac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics. METHODS Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome. RESULTS Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions. CONCLUSIONS A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.
Collapse
Affiliation(s)
- Mary Carter
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | - Nouf Abutheraa
- School of Medicine, University of Aberdeen, Aberdeen, United Kingdom
| | - Noah Ivers
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jeremy Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarah Chapman
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | - Philip Rogers
- Department of Life Sciences, University of Bath, Bath, United Kingdom
| | | | - Jesmin Antony
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Margaret C Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| |
Collapse
|
3
|
Kroon D, Stadhouders NW, van Dulmen SA, Kool RB, Jeurissen PP. Why Reducing Low-Value Care Fails to Bend the Cost Curve, and Why We Should Do it Anyway. Int J Health Policy Manag 2023; 12:7803. [PMID: 37579380 PMCID: PMC10461860 DOI: 10.34172/ijhpm.2023.7803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/16/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Daniëlle Kroon
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|
4
|
Van Dulmen SA, Verkerk EW, Born K, Gupta R, Westert GP, Kool RB. Challenges and Opportunities for Reducing Low-Value Care; A Response to Recent Commentaries. Int J Health Policy Manag 2023; 12:7954. [PMID: 37579421 PMCID: PMC10461886 DOI: 10.34172/ijhpm.2023.7954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Simone A. Van Dulmen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eva W. Verkerk
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karen Born
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Reshma Gupta
- University of California Health, Los Angeles, CA, USA
| | - Gert P. Westert
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudolf B. Kool
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
5
|
Abu Farha R, Awwad O, Abdurazaq B, Abu Hammour K, Akour A. Evaluation of drug use pattern in adults’ outpatient clinics in a tertiary teaching hospital using WHO core prescribing indicators. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Objectives
This study has evaluated the drug use pattern among adults attending the outpatient clinics of the Jordan University Hospital (JUH), by assessing the adherence of prescriptions to the World Health Organization (WHO) core prescribing indicators.
Methods
This is a cross-sectional study that was conducted during the period from October 2011 to January 2022 at JUH. Several prescriptions from 10 different adult outpatient clinics were reviewed to evaluate hospital adherence to the five WHO core prescribing indicators.
Key findings
To assess the WHO core prescribing indicators, data for 2451 prescriptions were reviewed. Around one-third of the patients (33.4%) were receiving polypharmacy (five medications or more). Results revealed that two core prescribing indicators were not following the standard values specified by the WHO; the average number of drugs prescribed per encounter (3.8 medications/prescription), and the percentage of drugs from the essential drug list (EDL) (54.1%). Endocrine clinics showed the highest average of drugs (6.3) per prescription and the highest percentage of prescriptions with injectable medicines (51.7%). On the other hand, ophthalmology clinics showed the highest percentage of prescriptions with antibiotics (29.9%) and the lowest percentage of drugs prescribed from the EDL at JUH (14.1%). Evaluating factors affecting the number of prescribed medications per encounter revealed that elderly patients (> 60 years), being female, referring to the endocrine clinic, and having insurance have a higher average number of medications per encounter compared with others (P < 0.05).
Conclusion
The proper prescribing practices in a sizable tertiary hospital in Amman, Jordan, are clarified by this study. The percentage of medications from EDL and the typical number of drugs/encounters did not comply with WHO requirements. The study findings should guide the Jordanian health policymakers in designing and implementing strategies to limit irrational prescribing practices and raise awareness of and ensure physician adherence to the national EDL.
Collapse
Affiliation(s)
- Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University , Amman , Jordan
| | - Oriana Awwad
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
| | - Bashar Abdurazaq
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
| | - Khawla Abu Hammour
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
| | - Amal Akour
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan , Amman , Jordan
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University , Al Ain , United Arab Emirates
| |
Collapse
|
6
|
Kroon D, van Dulmen SA, Westert GP, Jeurissen PPT, Kool RB. Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study. BMJ Open 2022; 12:e062902. [PMID: 36343997 PMCID: PMC9644331 DOI: 10.1136/bmjopen-2022-062902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework. DESIGN AND METHODS This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies. RESULTS The literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients' perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters. CONCLUSIONS The SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.
Collapse
Affiliation(s)
| | | | | | | | - Rudolf B Kool
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Mintzes B, Reynolds E, Bahri P, Perry LT, Bhasale AL, Morrow RL, Dormuth CR. How do safety warnings on medicines affect prescribing? Expert Opin Drug Saf 2022; 21:1269-1273. [PMID: 36208037 DOI: 10.1080/14740338.2022.2134342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Many adverse effects of medicines only become known after approval, prompting regulatory agencies to issue post-market safety advisories to inform clinicians and support safer care. Our team evaluated advisories issued by national regulators in Australia, Canada, Denmark, the United Kingdom, and the United States from 2007 to 2016 inclusive, comparing regulators' decisions to warn, effects on prescribing, doctors' awareness and responses to warnings, relevant regulatory policies, and specific case studies. AREAS COVERED Based mainly on our research program and a narrative review, this commentary describes how often regulators issue safety advisories and effects on clinical practice. We found extensive differences in decisions to warn, timing and content of warnings. Monitoring advice is often inadequate. The most systematic estimate suggests an average reduction in prescribing of around 6% compared with settings with no advisory. Interviews with doctors suggest limited awareness, uptake, and at times belief in these warnings. EXPERT OPINION Post-market safety advisories are an important intervention aiming to improve prescribing and use of medicines. However, differing warnings mean that some patients may be exposed to riskier prescribing than others. Better integration of new safety information into clinical practice is needed, as well as improved transparency, independence, and public engagement in regulatory decision-making.
Collapse
Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ellen Reynolds
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Priya Bahri
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Pharmacovigilance Office, European Medicines Agency, Amsterdam, the Netherlands
| | - Lucy T Perry
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alice L Bhasale
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Richard L Morrow
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
8
|
Galimberti F, Olmastroni E, Casula M, Merlo I, Franchi M, Catapano AL, Orlando V, Menditto E, Tragni E, EDU.RE.DRUG Group OBO. Evaluation of Factors Associated With Appropriate Drug Prescription and Effectiveness of Informative and Educational Interventions—The EDU.RE.DRUG Project. Front Pharmacol 2022; 13:832169. [PMID: 35548361 PMCID: PMC9081494 DOI: 10.3389/fphar.2022.832169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: EDU.RE.DRUG study is a prospective, multicentre, open-label, parallel-arm, controlled, pragmatic trial directed to general practitioners (GPs) and their patients. Methods: The study data were retrieved from health-related administrative databases of four local health units (LHUs) of Lombardy and four LHUs in Campania. According to the LHUs, the GPs/patients were assigned to (A) intervention on both GPs (feedback reports about appropriate prescribing among their patients and online courses) and patients (flyers and posters on proper drug use), (B) intervention on GPs, (C) intervention on patients, and (D) no intervention (control arm). A set of appropriate prescribing indicators (potential drug–drug interactions [pDDIs], potential and unnecessary therapeutic duplicates [pTDs], and inappropriate prescriptions in the elderly [ERD-list]) were measured at baseline and after the intervention phase. The effectiveness of the intervention was evaluated estimating the absolute difference in percentages of selected indicators carrying out linear random-intercept mixed-effect models. Results: A cohort of 3,586 GPs (2,567 in intervention groups and 1,019 in the control group) was evaluated. In Campania, the mean pre-intervention percentage of patients with at least one pDDI was always greater than 20% and always lower than 15% in Lombardy. The pre–post difference was quite heterogeneous among the LHUs, ranging from 1.9 to −1.4 percentage points. The mean pre-intervention percentage of patients with pTDs ranged from 0.59 to 2.1%, with slightly higher values characterizing Campania LHUs. The magnitude of the pre–post difference was very low, ranging from −0.11 to 0.20. In Campania, the mean pre-intervention percentage of patients with at least one ERD criterium was considerably higher than in Lombardy (approximately 30% in Lombardy and 50% in Campania). The pre–post difference was again quite heterogeneous. The results from the models accounting for GP geographical belonging suggested that none of the interventions resulted in a statistically significant effect, for all the three indicators considered. Conclusion: The proposed strategy was shown to be not effective in influencing the voluntary changes in GP prescription performance. However, the use of a set of explicit indicators proved to be useful in quantifying the inappropriateness. Further efforts are needed to find more efficient strategies and design more tailored interventions.
Collapse
Affiliation(s)
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Manuela Casula
- IRCCS MultiMedica, Sesto S. Giovanni, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- *Correspondence: Manuela Casula,
| | - Ivan Merlo
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Alberico Luigi Catapano
- IRCCS MultiMedica, Sesto S. Giovanni, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
- Department of Pharmacy, Federico II University of Naples, Naples, Italy
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
- Department of Pharmacy, Federico II University of Naples, Naples, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | | |
Collapse
|
9
|
OUP accepted manuscript. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|