1
|
Gómez Costas D, Ribed A, Gimenez-Manzorro A, Garutti I, Sanz FJ, Taladriz-Sender I, Herrero S, Rioja Y, Carrillo A, Herranz A, Sanjurjo-Saez M. Cost-effectiveness of preoperative pharmaceutical care consultations: a 5-year analysis. Eur J Hosp Pharm 2024:ejhpharm-2024-004222. [PMID: 38964831 DOI: 10.1136/ejhpharm-2024-004222] [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: 04/29/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES Preoperative medication errors can be prevented by screening patients through a preoperative pharmaceutical care consultation. The aim of this study was to analyse the cost-effectiveness of implementing such a consultation and to determine which patients would benefit most. METHODS A retrospective study was conducted that included all patients who underwent a preoperative pharmacy consultation between 2016 and 2020. During this consultation, two part-time pharmacists reviewed patients' appropriate preoperative chronic medication management. All prevented errors were collected and classified by therapeutic group and type of error. A team of pharmacists and anaesthetists assigned to each prevented medication error a probability of causing an adverse event 'p', following the methodology of Nesbit et al by establishing five different 'p' values: 0, 0.01, 0.1, 0.4, and 0.6. 'p' = 1 was not considered. The cost of an adverse event was determined to be between €4124 and €6946 according to current literature, and a sensitivity analysis was performed by increasing the interval by 20% above and below. The cost of employing two part-time specialist pharmacists was estimated to be €59 142. Savings per medication error prevented were calculated as (€4124 OR €6946) × 'p'. Total savings were the sum of all costs associated with prevented medication errors. Patients on chronic medications who were in therapeutic groups with a 0.6 probability of an adverse event or who were in therapeutic groups responsible for 50% of the prevented adverse events were considered prioritisable. RESULTS 3105 patients attended the consultation and 1179 medication errors were prevented, corresponding to 300 adverse events. 42.2% of the errors had a 'p' of 0.4. The costs avoided by this consultation ranged from €1 237 200 to €2 083 800, while the cost of its implementation was €295 710. The cost-effectiveness ratio was between €4.2 and €7.0 saved per euro invested. In the sensitivity analysis, the ratios ranged from €3.3 to €8.5 per euro invested. Fifteen different therapeutic groups accounted for 90% of the medication errors prevented. The therapeutic groups 'Agents acting on the renin-angiotensin system', 'Antidiabetics, non-insulin (excluding SGLT2)' and 'Antithrombotics: low molecular weight heparins' were responsible for 56% of the prevented adverse events. The therapeutic groups 'Antidiabetics: rapid-acting insulin' and 'Antithrombotic agents: vitamin K antagonists, low-molecular-weight heparins, or direct oral anticoagulants' had a 'p' of 0.6. Therefore, patients in six therapeutic groups should be prioritised for preoperative pharmacy counselling. CONCLUSIONS The implementation of preoperative pharmaceutical care consultations in Spain has proven to be cost-effective. Incorporating the probability of a medication error causing an adverse event allowed the prioritisation of patients for these consultations. Patients taking anticoagulants, oral antidiabetics, rapid-acting insulins, and agents acting on the renin-angiotensin system benefited the most. This study could serve as a basis for implementing such consultations in other hospitals, as they are effective in reducing the cost of medication errors in surgical patients.
Collapse
Affiliation(s)
| | - Almudena Ribed
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - Ignacio Garutti
- Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Sergio Herrero
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Yeray Rioja
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Anais Carrillo
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Ana Herranz
- Pharmacy, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Bailly R, Wuyts S, Toelen L, Mets T, Van Hauwermeiren C, Scheerlinck T, Cortoos PJ, Lieten S. Introducing a pharmacist-led transmural care program to reduce drug-related problems in orthogeriatric patients: a prospective interventional study. BMC Geriatr 2024; 24:47. [PMID: 38212699 PMCID: PMC10782737 DOI: 10.1186/s12877-023-04591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Orthogeriatric patients have an increased risk for complications due to underlying comorbidities, chronic drug therapy and frequent treatment changes during hospitalization. The clinical pharmacist (CP) plays a key role in transmural communication concerning polypharmacy to improve continuity of care by the general practitioner (GP) after discharge. In this study, a pharmacist-led transmural care program, tailored to orthogeriatric patients, was evaluated to reduce drug related problems (DRPs) after discharge. METHODS An interventional study was performed (pre-period: 1/10/2021-31/12/2021; post-period: 1/01/2022-31/03/2022). Patients (≥ 65 years) from the orthopedic department were included. The pre-group received usual care, the post-group received the pharmacist-led transmural care program. The DRP reduction rate one month after discharge was calculated. Associated factors for the DRP reduction rate were determined in a multiple linear regression analysis. The GP acceptance rate was determined for the proposed interventions, as well as their clinical impact using the Clinical, Economic and Organizational (CLEO) tool. Readmissions one month after discharge were evaluated. RESULTS Overall, 127 patients were included (control n = 61, intervention n = 66). The DRP reduction rate was statistically significantly higher in the intervention group compared to the control group (p < 0.001). The pharmacist's intervention was associated with an increased DRP reduction rate (+ 1.750, 95% confidence interval 1.222-2.278). In total, 141 interventions were suggested by the CP, of which 71% were accepted one month after discharge. In both periods, four patients were readmitted one month after discharge. 58% of the interventions had a clinical impact (≥ 2 C level using the CLEO-tool) according to the geriatrician and for the CP it was 45%, indicating that they had the potential to avoid patient harm. CONCLUSIONS The pharmacist-led transmural care program significantly reduced DRPs in geriatric patients from the orthopedic department one month after discharge. The transmural communication with GPs resulted in a high acceptance rate of the proposed interventions.
Collapse
Affiliation(s)
- Rachel Bailly
- Departement of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | - Stephanie Wuyts
- Departement of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Clinical Pharmacology and Clinical Pharmacy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Loic Toelen
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tony Mets
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | - Thierry Scheerlinck
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Orthopedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Pieter-Jan Cortoos
- Departement of Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Siddhartha Lieten
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| |
Collapse
|
4
|
Abushanab D, Gulied A, Hamad A, Abu-Tineh M, Abdul Rouf PV, Al Hail M, El-Kassem W, El Hajj MS, Al-Badriyeh D. Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital. J Oncol Pharm Pract 2023; 29:1935-1943. [PMID: 36946146 DOI: 10.1177/10781552231160275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. METHODS The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results' robustness and increased generalizability. RESULTS A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of -QAR 645,174 (-USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. CONCLUSIONS The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.
Collapse
Affiliation(s)
- Dina Abushanab
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | - Amaal Gulied
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar
| | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar
| | - Mohammad Abu-Tineh
- Department of Medical Oncology-Hematology and Bone Marrow Transplantation Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Qatar
| | - Palli V Abdul Rouf
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | - Moza Al Hail
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | - Wessam El-Kassem
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Qatar
| | | | | |
Collapse
|
5
|
Fan X, Chen D, Bao S, Dong X, Fang F, Bai R, Zhang Y, Zhang X, Tang W, Ma Y, Zhai X. Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study. BMC Health Serv Res 2023; 23:1014. [PMID: 37730673 PMCID: PMC10512621 DOI: 10.1186/s12913-023-09931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.
Collapse
Affiliation(s)
- Xiucong Fan
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Danxia Chen
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Siwei Bao
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaohui Dong
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Fang Fang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Rong Bai
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yuyi Zhang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Xiaogang Zhang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Weijun Tang
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China
| | - Yabin Ma
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
| | - Xiaobo Zhai
- Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
| |
Collapse
|
6
|
Gomez Costas D, Sánchez AR, Manzorro AG, Martinez IG, Sanz Fernandez FJ, Sanz BT, Bermejo SH, Herranz-Alonso AM, Sanjurjo M. Impact of preoperative pharmaceutical care consultation on medication errors in surgical patients: a comprehensive analysis. Expert Opin Drug Saf 2023; 22:1301-1307. [PMID: 38063348 DOI: 10.1080/14740338.2023.2292710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Assessing the impact of introducing preoperative pharmaceutical care consultations by analyzing the severity of prevented medication errors (MEs) and their potential effects on the surgical process. METHODS Preoperative pharmaceutical care consultation was implemented in our hospital to assess the preoperative medication management of surgical patients between the pre-anesthesia consultation and the day of surgery. Pharmacists evaluated the appropriateness of medication management based on a consensus multidisciplinary institutional protocol. All errors identified between 2016 and 2020 were analyzed, and their severity and potential impact on surgery were standardized. A list of therapeutic groups was created to prioritize patients for consultations. RESULTS During the study period, 3,105 patients attended the consultations and 1,179 MEs were prevented. According to severity, 30.6% of MEs were classified as category E and 26.2% as D. The Number Needed to Treat to prevent a category E or higher ME (indicating potential harm to patients) was 5 patients. About 14.84% of MEs belonged to the prioritized drug groups. One hundred and thirteen errors would have resulted in a surgery delay of more than 24 h, and 175 errors were classified as G-H (irreversible damage). CONCLUSIONS This study highlights the effectiveness of pharmaceutical care consultations in preventing MEs and improving surgical outcomes.
Collapse
Affiliation(s)
- Daniel Gomez Costas
- Hospital General Universitario Gregorio Maranon, Hospital Pharmacy, Madrid, Spain
| | | | | | | | | | - Beatriz Torroba Sanz
- Hospital General Universitario Gregorio Maranon, Hospital Pharmacy, Madrid, Spain
| | | | | | - María Sanjurjo
- Hospital General Universitario Gregorio Maranon, Hospital Pharmacy, Madrid, Spain
| |
Collapse
|
7
|
Zerbit J, Kroemer M, Fuchs B, Detroit M, Decroocq J, Vignon M, Willems L, Deau‐Fischer B, Franchi P, Deschamps P, Contejean A, Grignano E, Fouquet G, Birsen R, Mondesir J, Rocquet M, Huon J, Batista R, Marty‐Reboul J, Bouscary D. Pharmaceutical cancer care for haematology patients on oral anticancer drugs: Findings from an economic, clinical and organisational analysis. Eur J Cancer Care (Engl) 2022; 31:e13753. [DOI: 10.1111/ecc.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremie Zerbit
- Pharmacy Department, Hospital at Home University Hospitals of Paris (AP‐HP) Paris France
| | - Marie Kroemer
- Pharmacy Department University Hospital of Besançon Besançon France
| | - Basile Fuchs
- Medical Information, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Marion Detroit
- Pharmacy Department University Hospital of Besançon Besançon France
| | - Justine Decroocq
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Marguerite Vignon
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Lise Willems
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | | | - Patricia Franchi
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Paul Deschamps
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | | | - Eric Grignano
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Guillemette Fouquet
- Hematology Department Centre Hospitalier Sud Francilien Corbeil‐Essonnes France
| | - Rudy Birsen
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Johanna Mondesir
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| | - Mathieu Rocquet
- Hematology Department Necker Hospital, University Hospitals of Paris (AP‐HP) Paris France
| | - Jean‐François Huon
- INSERM, UMR 1246‐SPHERE, MethodS in Patients‐Centered Outcomes and HEalth ResEarch Nantes France
- Clinical Pharmacy Unit Nantes University Hospital Nantes France
| | - Rui Batista
- Clinical Pharmacy, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Jeanne Marty‐Reboul
- Medical Information, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
| | - Didier Bouscary
- Clinical Hematology, Cochin Hospital University Hospitals of Paris (AP‐HP) Paris France
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016 Paris France
- Équipe Labellisée Ligue Nationale Contre le Cancer (LNCC) Paris France
| |
Collapse
|
8
|
Vallecillo T, Slimano F, Moussouni M, Ohl X, Bonnet M, Mensa C, Hettler D, Kanagaratnam L, Mongaret C. Development and validation of a ready-to-use score to prioritise medication reconciliation at patient admission in an orthopaedic and trauma department. Eur J Hosp Pharm 2022; 29:264-270. [PMID: 33293282 PMCID: PMC9660597 DOI: 10.1136/ejhpharm-2020-002283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/14/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Medication reconciliation (MR) is recognised as an important tool in preventing medication errors such as unintentional discrepancies (UDs). The aim of this study was to identify independent predictive factors of UDs during MR at patient admission to an orthopaedic and trauma department. The secondary objective was to build and validate a ready-to-use score to prioritise patients. METHOD A retrospective study was performed on 3.5 years of pharmacist-led MR in the orthopaedic and trauma department of a large university teaching hospital. Independent predictors of UD were identified by multivariable logistic regression. A priority score to identify patients at risk of at least one UD was constructed from the odds ratios of the risk factors, and validated in a separate cohort. Performance was assessed with sensitivity, specificity, C-statistic and Hosmer-Lemeshow goodness-of-fit. RESULTS In total, 888 patients were included and 387 UDs were identified, mainly drug omissions (65.1%). Five independent predictors of UD were identified: age >75 years (OR 2.05, 95% CI 1.41 to 3.00; p<0.001), admission during school holidays (OR 1.69, 95% CI 1.17 to 2.44; p=0.005), female gender (OR 2.20, 95% CI 1.53 to 3.16; p<0.001), emergency hospitalisation (OR 2.05, 95% CI 1.45 to 2.92; p<0.001), and ≥5 medications on the best possible medication history (BPMH) (OR 3.29, 95% CI 2.20 to 4.94; p<0.001). Based on these predictors, a priority score ranging from 0 to 10 was built and internally and externally validated (C statistic 0.72, 95% CI 0.67 to 0.76). CONCLUSIONS This study confirms the high prevalence of UD in patients admitted to orthopaedic and trauma surgery departments. Five independent predictive factors of UD during MR were identified (female gender, emergency hospitalisation, hospitalisation during school holidays, age ≥75 years, and ≥5 medicines on the BPMH). The developed risk score will help to prioritise MR among patients at risk of medication error and is ready-to-use in other orthopaedic and trauma departments.
Collapse
Affiliation(s)
| | - Florian Slimano
- Pharmacy, CHU Reims, Reims, France
- MEDyC UMR CNRS/URCA n°7369, Reims Champagne-Ardenne University Faculty of Pharmacy, Reims, France
| | | | - Xavier Ohl
- Orthopaedic Surgery, CHU Reims Pôle Locomoteur, Reims, France
- EA 4691, Reims Champagne-Ardenne University Faculty of Pharmacy, Reims, France
| | | | | | | | | | - Céline Mongaret
- Pharmacy, CHU Reims, Reims, France
- EA 4691, Reims Champagne-Ardenne University Faculty of Pharmacy, Reims, France
| |
Collapse
|
9
|
URBAŃCZYK K, WNĘK P, ROLEDER T, WITKIEWICZ W, MCCAGUE P, SCOTT M, WIELA-HOJEŃSKA A. Optimized and cost-effective pharmacotherapy of vascular surgery patients: evaluation of clinical pharmacy service. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.22.01534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
10
|
Martin J, Barral M, Janoly Dumenil A, Carre E, Poletto N, Goutelle S, Rioufol C, Novais T, Pivot C, Hoegy D, Mouchoux C. Implementation assessment of a patient personalized clinical pharmacy programme (5P project) into orthogeriatric care pathway. J Clin Pharm Ther 2022; 47:956-963. [PMID: 35218218 DOI: 10.1111/jcpt.13627] [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: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The orthogeriatric path (hip-fractured elderly patients) is composed of several transition points (emergency surgery, orthopaedic, geriatric and rehabilitation units). The intervention of clinical pharmacists can ensure the continuity of patients' drug management during their hospital stay. The aim of the study was to assess the implementation of clinical pharmacy activities in an orthogeriatric pathway, regarding its impact on medication error prevention, the healthcare professionals' and patients' satisfaction, and the estimated associated pharmaceutical workload. METHODS Participants were aged 75 or older and managed for proximal femoral fracture. Their admission prescription was reviewed. If they were evaluated at high risk of adverse event (AE), medication reconciliation (MedRec) and pharmaceutical interviews (admission, discharge, and targeted on oral anticoagulant) were added at different steps of their care pathway. The achievement and duration of each clinical pharmacy activity were recorded. The number of pharmaceutical interventions (PI) made during prescription review, and unintentional discrepancies (UID) identified during MedRec were collected. A satisfaction questionnaire was sent to patients and healthcare professionals. RESULTS AND DISCUSSION Among 455 included patients, 284 patients were considered at high risk of AE. Clinical pharmacy activity achievement rates varied between 12% and 98%. A total of 622 PI and 333 UID were identified. The overall patients' and healthcare professionals' satisfaction was rated from 63% to 100%. The total workload was estimated at 376 h: on average 16 min per prescription review, 43 min per admission MedRec, 26 min per discharge MedRec and 17 to 25 minutes per interview. CONCLUSION The implementation of the programme showed a high potential of drug management securing. To sustain it, additional pharmaceutical human resources and high-performance computing tools are needed.
Collapse
Affiliation(s)
- Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | | | - Audrey Janoly Dumenil
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Poletto
- Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Catherine Rioufol
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,EA3738, CICLY Centre pour l'innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Univ Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, INSERM U1028, CNRS, UMR5292, Lyon, France
| | | |
Collapse
|
11
|
Barral M, Martin J, Carre E, Janoly-Dumenil A, Ranchon F, Parat S, Rioufol C, Goutelle S, Bourguignon L, Novais T, Doh S, Malatray M, Chaudier P, Gauthier J, Pivot C, Mouchoux C, Hoegy D. How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)? Clin Interv Aging 2021; 16:1857-1867. [PMID: 34707352 PMCID: PMC8544550 DOI: 10.2147/cia.s325035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway. Objective To secure the therapeutic care of orthogeriatric patients. Design and Setting Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020. Subjects Patients aged ≥75 years admitted for hip fracture. Methods A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool. Results In the 455 patients included, 955 potential ME were detected, that is ≥1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null. Conclusion The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.
Collapse
Affiliation(s)
| | - Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Audrey Janoly-Dumenil
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Florence Ranchon
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Stéphanie Parat
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Rioufol
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Laurent Bourguignon
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Sebastien Doh
- Service de Gériatrie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Malatray
- Service de Chirurgie Orthopédique Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Philippe Chaudier
- Service de Chirurgie Orthopédique Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jerome Gauthier
- Service d'anesthésie et réanimation Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | | |
Collapse
|
12
|
Renaudin P, Coste A, Audurier Y, Berbis J, Canovas F, Lohan L, Dagneaux L, Loundou A, Boucekine M, Villiet M, Breuker C. Clinically significant medication errors in surgical units detected by clinical pharmacist: A real-life study. Basic Clin Pharmacol Toxicol 2021; 129:504-509. [PMID: 34553498 DOI: 10.1111/bcpt.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Pierre Renaudin
- Clinical Pharmacy Department, CHRU de Montpellier, Univ Montpellier, Montpellier, France.,EA 3279 - Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, Faculté de Médecine Timone, Aix-Marseille Université, Marseille, France.,Department of Traumatic and Orthopaedic Surgery, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Annabelle Coste
- Clinical Pharmacy Department, CHRU de Montpellier, Univ Montpellier, Montpellier, France
| | - Yohan Audurier
- Clinical Pharmacy Department, CHRU de Montpellier, Univ Montpellier, Montpellier, France
| | - Julie Berbis
- EA 3279 - Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, Faculté de Médecine Timone, Aix-Marseille Université, Marseille, France
| | - François Canovas
- Department of Traumatic and Orthopaedic Surgery, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Laura Lohan
- Clinical Pharmacy Department, CHRU de Montpellier, Univ Montpellier, Montpellier, France.,Inserm, CNRS, CHRU de Montpellier, Phymedexp, Université de Montpellier, Montpellier, France
| | - Louis Dagneaux
- Department of Traumatic and Orthopaedic Surgery, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Anderson Loundou
- EA 3279 - Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, Faculté de Médecine Timone, Aix-Marseille Université, Marseille, France
| | - Mohamed Boucekine
- EA 3279 - Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, Faculté de Médecine Timone, Aix-Marseille Université, Marseille, France
| | - Maxime Villiet
- Clinical Pharmacy Department, CHRU de Montpellier, Univ Montpellier, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, CHRU de Montpellier, Univ Montpellier, Montpellier, France.,Inserm, CNRS, CHRU de Montpellier, Phymedexp, Université de Montpellier, Montpellier, France
| |
Collapse
|
13
|
Delage C, Lelong H, Brion F, Blacher J. Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia. Eur J Hosp Pharm 2021; 28:e197-e202. [PMID: 34183458 DOI: 10.1136/ejhpharm-2021-002787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/15/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In recent years, hospital pharmacists have gained more importance in the clinical support of patients. However, most of the studies evaluating the impact of clinical pharmacy have only studied patients' adherence or satisfaction. The aim of this study was to evaluate the direct clinical outcomes of a pharmacist-led educational intervention in patients with chronic disease. METHODS We conducted a randomised, controlled, parallel, physician-blinded study in a day hospital and a consultation unit of a French teaching hospital over a 1-year period. Patients with hypertension, type 2 diabetes or hypercholesterolaemia who did not reach their therapeutic goals despite drug therapy were eligible. Patients in the intervention group received an intervention from a hospital pharmacist who provided patient education on pathology and drug management. The primary outcome was the proportion of patients reaching their therapeutic goals for blood pressure, glycated haemoglobin level or low-density lipoprotein cholesterol level at the 3-month follow-up consultation. RESULTS From January to December 2015, 89 patients were included and 73 completed the study. In the intervention group, 61.7% (21/34) of the patients reached their therapeutic goals compared with 33.3% (13/39) in the control group (p=0.015). The intervention was significantly more effective in polypharmacy patients (60.0% (12/20) vs 16.7% (4/24); p=0.005), in those aged >60 years (57.9% (11/19) vs 26.1% (6/23); p=0.037) and in patients with a high education level (68.8% (11/16) vs 29.4% (5/17); p=0.024). CONCLUSION A single pharmacist-led educational intervention has a clinical impact, doubling the proportion of patients reaching their therapeutic goals at 3 months, especially in polypharmacy patients and those aged >60 years. This study confirms the value of clinical involvement of hospital pharmacists in patient care in a consultation unit and day hospital.
Collapse
Affiliation(s)
- Clement Delage
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France .,Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France.,Université de Paris, Faculté de Médecine, Paris, Île-de-France, France
| | - Francoise Brion
- Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France.,Université de Paris, Faculté de Médecine, Paris, Île-de-France, France
| |
Collapse
|
14
|
Narayan SW, Abraham I, Erstad BL, Haas CE, Sanders A, Patanwala AE. Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review. Am J Health Syst Pharm 2021; 78:1576-1590. [PMID: 34003209 DOI: 10.1093/ajhp/zxab214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists' interventions in acute care settings. METHODS An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. RESULTS The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. CONCLUSION Cost-avoidance studies of pharmacists' interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.
Collapse
Affiliation(s)
- Sujita W Narayan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Ivo Abraham
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Brian L Erstad
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Curtis E Haas
- University of Rochester Medical Center, Rochester, NY, USA
| | - Arthur Sanders
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Australia, and Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
15
|
Guerin K, Quinlan P, Wessolock R, Goldberg S, Nguyen JT, Stone PW. Impact of a Unit-Based Clinical Pharmacist on Communication of Medication Information in an Orthopedic Hospital. HSS J 2020; 16:333-338. [PMID: 33380965 PMCID: PMC7749900 DOI: 10.1007/s11420-019-09739-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medication management, a complex yet essential part of patient care, requires that clinicians and patients understand indication, dosage, frequency, and adverse effects in order to maximize benefits and minimize errors, as well as to transition patients from hospital to home. Clinical pharmacists improve care transitions and safety by interacting with patients, prescribers, and nurses on medication management and self-care. However, little is known on the use of clinical pharmacists on interdisciplinary teams at the unit level within orthopedics. QUESTIONS/PURPOSES This study sought to measure the impact of unit-based clinical pharmacists on patient perceptions of communication specific to medication during hospitalization at an orthopedic specialty hospital and on the frequency of medication errors. METHODS A retrospective, quasi-experimental, two-group evaluative design with nonequivalent controls was used. Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data on six inpatient units was analyzed 6 months before and 6 months after assignment of clinical pharmacists to half these units. Data specific to questions that measure quality of communication as well as medication understanding were analyzed. Additionally, data on medication error frequency were collected and compared between units with and without clinical pharmacists. RESULTS A total of 2022 surveys were analyzed. The percentage of patients who reported receipt of medication information and medication understanding increased significantly after the implementation of unit-based clinical pharmacists. Comparison of intervention and non-intervention groups showed no statistically significant difference in the frequency of medication errors. CONCLUSION Results suggest that a clinical pharmacist assigned to an inpatient unit in orthopedics significantly influences patient perceptions of communication about and understanding of their medications.
Collapse
Affiliation(s)
- Kelly Guerin
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Patricia Quinlan
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Robert Wessolock
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Stephanie Goldberg
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Joseph T. Nguyen
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Patricia W. Stone
- Center for Health Policy, New York-Presbyterian/Columbia University Irving Medical Center, 617 W. 168th Street, New York, NY 10032 USA
| |
Collapse
|
16
|
Clinical Pharmacist Service Associated With Improved Outcomes and Cost Savings in Total Joint Arthroplasty. J Arthroplasty 2020; 35:2307-2317.e1. [PMID: 32389406 DOI: 10.1016/j.arth.2020.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Institutions providing total joint arthroplasty (TJA) procedures are subject to substantial outcomes reporting, including those influencing payment for services. Although clinical pharmacists are well-poised to add value, a comprehensive approach to optimizing pharmacotherapy across the care continuum for TJA patients has not been described. METHODS This prospective, interventional, sequential cohort study was approved by our Institutional Review Board. The objective was to assess the impact of an Orthopedic Clinical Pharmacist service on institutional TJA complication rates and costs. Outcomes were compared for a Baseline period of July 2015 to February 2016 and a Post-implementation period of September 2016 to February 2017, allowing for a 6-month run-in period. Additionally, we pursued a post-discharge, RN-administered patient survey and an exploratory economic assessment. RESULTS A total of 1715 TJA procedures were performed at the institution during the 20-month study timeframe. Postoperative readmission rate (1.3% vs 4.8%, P = .002) and complication rate (1.8% vs 3.4%, P = .760) were lower in the Post-implementation period. Postoperative VTE rate decreased to zero in the Post-implementation period (0.0% vs 0.6%, P = .13) and average hospital length of stay was unchanged (2.8 vs 2.9 days). Patient self-rated understanding of discharge medications was improved and satisfaction with pharmacist interaction was very high. The service conferred an estimated $73,410 net annual cost savings to the institution. CONCLUSION Integration of a clinical pharmacist service for TJA patients was associated with clinically meaningful improvements in institutional outcomes, likely conferring substantial cost-benefit.
Collapse
|
17
|
Audurier Y, Chapet N, Renaudin P, Bons C, Mathieu B, Theret S, de Barry G, Jalabert A, Breuker C, Leclercq F, Pasquie JL, Agullo A, Roubille F, Castet-Nicolas A. Collaboration between cardiologist and clinical pharmacist on prescription quality: What is the potential clinical impact for cardiology patients? Int J Clin Pract 2020; 74:e13531. [PMID: 32459398 DOI: 10.1111/ijcp.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the effect of pharmacists' interventions (PI) on the potential clinical impact of medication errors, including the lack of therapeutic optimisation of patients with cardiologic diseases, such as heart failure and acute coronary syndrome). METHODS This was an observational, prospective study conducted in the cardiology department of a French university hospital centre for a duration of 9 months. All prescriptions were analysed and PI were registered for clinical rating by pharmacists and cardiologist. RESULTS A total of 532 PI cases were recorded in 339 patients, with a mean of 1.57 (±1.04) PI. The PI acceptance rate was 98.1%. "Dose adjustment" and "introduction therapy" were the most common interventions and represented 38.0% and 32.9%, respectively, of all PI. Statins were the most frequently involved drugs (18.1%), followed by ACE (Angiotensin Converting Enzyme) inhibitors (10.9%) and antiplatelet agents (9.3%). Moreover, 13.8% of PI potentially avoided a severe or very severe clinical impact (n = 71) and 38.6% had a significant impact altering the quality of life (n = 198). There was no significant difference between the average score performed by the clinical pharmacist included in the cardiology team and the one obtained by the cardiologist (P = .797). In contrast, a significant difference was observed for the average score established by the pharmacist localised in central pharmacy versus the rating of the cardiologist (P < .001). CONCLUSIONS The collaboration between clinical pharmacists and cardiologists in the medical units seems to be beneficial to the quality of prescriptions, including the implementation of recommendations. The good rate of PI acceptance and the similar rating with the cardiologist show that there is a change in perspective of the pharmacist, being closer to the clinical reality.
Collapse
Affiliation(s)
- Yohan Audurier
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
| | - Nicolas Chapet
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Pierre Renaudin
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- Faculty of Medicine Timone, Center for Studies and Research on Health Services and Quality of Life, University of Aix-Marseille, EA 3279, Marseille, France
| | - Carole Bons
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Betty Mathieu
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Sarah Theret
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Gaëlle de Barry
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Florence Leclercq
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- Cardiology Department, University Hospital, Montpellier, France
| | - Jean-Luc Pasquie
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
- Cardiology Department, University Hospital, Montpellier, France
| | - Audrey Agullo
- Cardiology Department, University Hospital, Montpellier, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
- Cardiology Department, University Hospital, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- Clinical Pharmacy Laboratory, University of Montpellier, Montpellier, France
- Cancer Research Institute of Montpellier (IRCM), INSERM U1194, ICM, Montpellier, France
| |
Collapse
|
18
|
Baudouin A, Herledan C, Poletto N, Guillemin MD, Maison O, Garreau R, Chillotti L, Parat S, Ranchon F, Rioufol C. Economic impact of clinical pharmaceutical activities in hospital wards: A systematic review. Res Social Adm Pharm 2020; 17:497-505. [PMID: 32819880 DOI: 10.1016/j.sapharm.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The positive impact of clinical pharmacy services (CPS) in improving clinical outcomes such as reduction of drug related problems is well demonstrated. Despite these results, the deployment of these activities is not systematically observed in the hospital setting. OBJECTIVES This systematic review first aimed to describe existing evidence regarding economic evaluation of ward-based CPS focusing on the entire treatment of a patient in a hospital setting. Secondly, the quality of economic evaluations of existing evidence was assessed. METHODS A comprehensive literature search was performed in PubMed/Medline, Science Direct and the NHS Economic Evaluation databases from January 2000 to March 2019. English or French language articles describing an economic evaluation of ward-based CPS on inpatients in hospital settings were included. Articles not describing a single study, dealing with a CPS not considering the entire medication regimen of the patient or presenting both inpatient and outpatient CPS were excluded. Selected articles were analyzed according to Drummond's check-list for assessing economic evaluations. RESULTS Forty-one studies were included. About one third were American publications. CPS implemented in ICU represented about half of the selected articles. Pharmacist-to-bed ratios varied according to countries and care unit type with the most favorable ratios in ICU and in American studies. Cost-avoidance was mostly used to express economic impact and ranged from €1579 to €3,089 328. Studies yielding the greater economic impact were conducted in the USA with implementation of full-time equivalents pharmacists or establishing of collaborative practice agreements. Only 6 articles dealt correctly with at least 7 of the 10 Drummond's checklist assessment criteria. CONCLUSION This review suggests that the existing evidence is not sufficient to conclude to a positive economic impact of CPS conducted according to clinical pharmacy guidelines. Funding resources, remuneration of clinical pharmacy activities and provision of standardized national clinical and economic databases appear to be essential evolutions to improve CPS development.
Collapse
Affiliation(s)
- Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Nicolas Poletto
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Marie-Delphine Guillemin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Ophélie Maison
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Romain Garreau
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Louis Chillotti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France.
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France
| |
Collapse
|
19
|
de Grégori J, Pistre P, Boutet M, Porcher L, Devaux M, Pernot C, L Chrétien M, Rossi C, Manfredi S, Dalac S, Gueneau P, Boulin M. Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department. J Oncol Pharm Pract 2020; 26:1172-1179. [DOI: 10.1177/1078155220915763] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate clinical and financial impact of pharmacist interventions in an ambulatory adult hematology–oncology department. Methods All cancer patients receiving a first injectable immuno- and/or chemotherapy regimen were included in this prospective study over a one-year period. The clinical impact of pharmacist interventions made by two clinical pharmacists was rated using the Clinical Economic and Organizational tool. Financial impact was calculated through cost savings and cost avoidance. Main results: Five hundred and fifty-eight patients were included. A total of 1970 pharmacist interventions were performed corresponding to a mean number of 3.5 pharmacist interventions/patient. The clinical impact of pharmacist interventions was classified as negative, null, minor, moderate, major and lethal in 0, 84 (4%), 1353 (68%), 385 (20%), 148 (8%) and 0 cases, respectively. The overall cost savings were €175,563. One hundred and nine (6%) of all pharmacist interventions concerned immuno- or chemotherapy regimen for cost savings of €148,032 (84% of the total amount of cost savings). The cost avoidance was €390,480. Cost avoidance results were robust to sensitivity analyses with cost of preventable adverse drug event as main driver of the model. When the cost of employing a pharmacist was subtracted from the average yearly cost savings plus cost avoidance per pharmacist, this yielded a net benefit of €223,021. The cost–benefit ratio of the clinical pharmacist was €3.7 for every €1 invested. Principal conclusions: To have two full-time clinical pharmacists in a 55-bed ambulatory adult hematology–oncology department is both clinically and financially beneficial.
Collapse
Affiliation(s)
| | - Pauline Pistre
- Department of Pharmacy, University Hospital, Dijon, France
| | | | - Laura Porcher
- Department of Pharmacy, University Hospital, Dijon, France
| | | | - Corinne Pernot
- Department of Pharmacy, University Hospital, Dijon, France
| | - Marie L Chrétien
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comte, Dijon, France
| | - Cédric Rossi
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comte, Dijon, France
| | - Sylvain Manfredi
- Department of Hepatogastroenterology and Digestive Oncology, University Hospital and EPICAD LNC UMR 1231, University of Burgundy & Franche Comte, Dijon, France
| | - Sophie Dalac
- Department of Dermatology, University Hospital, Dijon, France
| | | | - Mathieu Boulin
- Department of Pharmacy, University Hospital and EPICAD LNC UMR 1231, University of Burgundy & Franche Comte, Dijon, France
| |
Collapse
|
20
|
Reinau D, Furrer C, Stämpfli D, Bornand D, Meier CR. Evaluation of drug-related problems and subsequent clinical pharmacists' interventions at a Swiss university hospital. J Clin Pharm Ther 2019; 44:924-931. [PMID: 31408206 DOI: 10.1111/jcpt.13017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/06/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The evaluation of clinical pharmacy services is essential for their further development and establishment. We analysed drug-related problems (DRPs) and subsequent clinical pharmacists' interventions (PIs) at a Swiss university hospital. METHOD We conducted a retrospective analysis of DRPs and subsequent PIs that were identified and implemented during interdisciplinary ward rounds in internal medicine at the University Hospital Basel, Switzerland, between 2015 and 2017. We estimated the potential clinical and economic impact of PIs using a validated evaluation tool (CLEOde ). RESULTS AND DISCUSSION Based on medication reviews of 5441 patients, clinical pharmacists identified 5024 DRPs, of which 2892 DRPs (57.6%) were followed by a PI that was directly accepted and implemented by the physician in charge and included in the present analysis. The leading cause and type of PIs were inappropriate dose and dose adjustment, respectively. Overall, 97.8% of DRPs were followed by PIs with an expected clinical benefit for the patients (major: 11.1%; moderate: 27.6%; minor: 59.1%). The drugs most often involved in PIs of major clinical impact were antithrombotics, acid blockers and cardiovascular drugs. With regard to the economic impact, 40.7% of DRPs implied PIs resulting in an increase of immediate therapy costs, whereas 39.3% implied PIs resulting in a decrease of immediate therapy costs. The remaining PIs were cost-neutral. WHAT IS NEW AND CONCLUSION This study emphasizes that clinical pharmacists may help improve the effectiveness and safety of pharmacotherapy on acute care medical wards.
Collapse
Affiliation(s)
- Daphne Reinau
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Chiara Furrer
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Dominik Stämpfli
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Delia Bornand
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
| |
Collapse
|