How effective are pharmacists who work with medical practitioners? A study of interventions intended to influence prescribing

The impact of pharmacist intervention on the use of activated vitamin D in a tertiary referral hospital in Malaysia

Objectives

In recent years, the usage of activated vitamin D (α-calcidol and calcitriol) in the University Malaya Medical Centre (UMMC) has escalated and this has put unnecessary burden on the hospital's limited health care budget. The main aim of this study was to determine the effects of a clinical pharmacist's intervention in reducing the inappropriate use of activated vitamin D.

Methods

Data were collected retrospectively. Pre-intervention data were obtained from records of the previous year's use of activated vitamin D. An intervention screening form was developed based on a new guideline which was produced by the UMMC Osteoporosis Committee. Use of activated vitamin D from August 2006 to July 2007 was reviewed by a clinical pharmacist using the screening form.

Key findings

Of the 557 requests screened, 44.5% were identified as unnecessary prescriptions. The main indications recommended for prescribing activated vitamin D were long-term glucocorticoid treatment (38.8%) and abone mineral density T-score of less than −2.5 for patients aged 60 years and above (22.4%). As a result of the intervention, the number of patients on activated vitamin D decreased from 4095 to 2338, which led to a significant reduction in expenditure from RM798 400.60 (US$221 777.90) to RM397 783.80 ($110 495.50) (P = 0.002). The main reasons for the approval of activated vitamin D use were impaired renal function (46.6%) and long-term glucocorticoid use (38.5%).

Conclusions

Pharmacist intervention on the use of activated vitamin D was effective and resulted in a cost saving of up to RM400 616.80 ($111 282.40) annually. Prescribers in the UMMC are now aware of the guidelines and justifications for the use of activated vitamin D. Therefore, the implementation of the guidelines to reduce the inappropriate use of medications is a multidisciplinary effort between pharmacists and prescribers.

Drug-related problems in general practice: results from a development project in Denmark

OBJECTIVE

The objective of the study is identify and document drug-related problems and other possible quality problems in primary care through a pharmacist-run medication review and screening service. GPs' acceptance and implementation rates of the pharmacist's recommendations are evaluated.

METHOD

A community pharmacist worked 20 h per week for 18 months in a GP practice with three GPs.

RESULTS

The pharmacist completed 40 reviews and identified 103 drug-related problems. GPs had a high rate of acceptance of the pharmacist's suggested interventions (83%), and 77% of the recommendations had been implemented. 765 (12.5%) possible quality problems were identified after screening 6094 medical records. The physicians accepted 86% of the recommendations to initiate low dosage ASA and treatment was implemented for 63% of the patients. 76% of the recommendations to initiate Statin treatment were agreed on and 56% were implemented.

CONCLUSIONS

The pharmacist was able to identify drug-related problems and other possible quality problems with regard to quality assurance of individual patient's drug treatment. The GPs accepted and implemented the pharmacist's recommendations. It was feasible to implement the services and to establish well-functioning co-operation between the pharmacist and the GPs.