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Rahman RN, Polinder S, Nikolik B, Hoek AE, Janssen MJA, Schuit SCE, van den Bemt PMLA, Karapinar-Çarkit F. Medication reviews by emergency department pharmacists in patients hospitalised for an adverse drug event: a cost study. BMC Health Serv Res 2024; 24:975. [PMID: 39180043 PMCID: PMC11344293 DOI: 10.1186/s12913-024-11346-9] [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: 08/09/2023] [Accepted: 07/23/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE To perform a cost study of pharmacist-led medication reviews in patients with an acute hospitalization for adverse drug events. METHOD Emergency department pharmacists performed medication reviews in patients hospitalized after visiting the emergency department for an adverse drug event (ADE). Control patients were hospitalized after an emergency department visit not related to an ADE and received usual care. The costs of the intervention were labour costs of the junior emergency department pharmacist and the cost savings consisted of costs of medication that was stopped or reduced during six months after the intervention. Sensitivity analyses were performed to evaluate different scenarios. RESULTS In the intervention group (n = 104) 113 medication changes led to stopping or reducing medication, accounting for averted costs of €22,850. In the control group (n = 112) 39 medication changes led to stopping or reducing medication, accounting for averted costs of €299. The mean labour costs of the intervention were €138 per patient, resulting in saved costs of €61 per patient per six months. Sensitivity analyses showed that if the intervention would be performed by a senior clinical pharmacist, there are no cost savings (€-21), if parts of the intervention would be executed by pharmacy technicians (e.g. administrative tasks), cost savings would be augmented to €87, if outliers in costs associated with medication reduction would be excluded, there are no cost savings (€-35) and if the costs of reduced medication were extrapolated to one year, cost savings would be €260. CONCLUSION In this study, medication reviews by junior emergency department pharmacists in patients hospitalized after an emergency department visit for an ADE lead to a cost reduction over a six month period. TRIAL REGISTRATION The main study is registered on the ISRCTN registry with trial ID ISRCTN12506329 on 06-03-2022.
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Affiliation(s)
- Rehana N Rahman
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bojan Nikolik
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Amber E Hoek
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjo J A Janssen
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Stephanie C E Schuit
- Board of Directors, University Medical Center Groningen, Groningen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Pharmacy, CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
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Hurley E, Byrne S, Walsh E, Foley T, Woods N, Dalton K. Cost avoidance of pharmacist-led deprescribing using STOPPFrail for older adults in nursing homes. Int J Clin Pharm 2024:10.1007/s11096-024-01749-3. [PMID: 38967733 DOI: 10.1007/s11096-024-01749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/02/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria aim to reduce inappropriate/unnecessary medications in frail older adults, which should minimise adverse drug events and additional healthcare expenditure. Little is known about the economic outcomes of applying these criteria as an intervention. AIM To evaluate cost avoidance of pharmacist-led application of STOPPFrail to frail older nursing home residents with limited life expectancy. METHOD Pharmacist-identified STOPPFrail-defined potentially inappropriate medications that were deprescribed by patients' general practitioners were assigned a rating by a multidisciplinary panel, i.e. the probability of an adverse drug event occurring if the medication was not deprescribed. The intervention's net cost benefit and cost-benefit ratio were then determined by factoring in adverse drug event cost avoidance (calculated from probability of adverse drug event ratings), direct cost savings (deprescribed medication costs/reimbursement fees), and healthcare professionals' salaries. RESULTS Of the 176 potentially inappropriate medications deprescribed across 69 patients, 65 (36.9%) were rated as having a medium or high probability of an adverse drug event occurring if not deprescribed. With €27,162 for direct cost savings, €61,336 for adverse drug event cost avoidance, and €2,589 for healthcare professionals' salary costs, there was a net cost benefit of €85,909 overall. The cost-benefit ratio was 33.2 and remained positive in all scenarios in sensitivity analyses. CONCLUSION Pharmacist-led application of STOPPFrail to frail older nursing home residents is associated with significant cost avoidance. Wider implementation of pharmacist interventions in frail older nursing home residents should be considered to reduce potentially inappropriate medications and patient harm, alongside substantial cost savings for healthcare systems.
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Affiliation(s)
- Eoin Hurley
- Pharmaceutical Care Research Group, University College Cork, Cork, Ireland.
| | - Stephen Byrne
- Pharmaceutical Care Research Group, University College Cork, Cork, Ireland
| | - Elaine Walsh
- Department of General Practice, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Noel Woods
- Centre for Policy Studies, University College Cork, Cork, Ireland
| | - Kieran Dalton
- Pharmaceutical Care Research Group, University College Cork, Cork, Ireland
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Loeffler M, Maas R, Neumann D, Scherag A. [INTERPOLAR-prospective, interventional studies as part of the Medical Informatics Initiative to improve medication therapy safety in healthcare]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:676-684. [PMID: 38750238 PMCID: PMC11166858 DOI: 10.1007/s00103-024-03890-w] [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: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 06/12/2024]
Abstract
Medication analyses by ward pharmacists are an important measure of drug therapy safety (DTS). Medication-related problems (MRPs) are identified and resolved with the attending clinicians. However, staff resources for extended medication analyses and complete documentation are often limited. Until now, data required for the identification of risk patients and for an extended medication analysis often had to be collected from various parts of the institution's internal electronic medical record (EMR). This error-prone and time-consuming process is to be improved in the INTERPOLAR (INTERventional POLypharmacy-Drug interActions-Risks) project using an IT tool provided by the data integration centers (DIC).INTERPOLAR is a use case of the Medical Informatics Initiative (MII) that focuses on the topic of DTS. The planning phase took place in 2023, with routine implementation planned from 2024. DTS-relevant data from the EMR is to be presented and the documentation of MRPs in routine care is to be facilitated. The prospective multicenter, cluster-randomized INTERPOLAR‑1 study serves to evaluate the benefits of IT support in routine care. The aim is to show that more MRPs can be detected and resolved with the help of IT support. For this purpose, six normal wards will be selected at each of eight university hospitals, so that 48 clusters (with a total of at least 70,000 cases) are available for randomization.
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Affiliation(s)
- Markus Loeffler
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Härtelstraße 16-18, 04103, Leipzig, Deutschland
| | - Renke Maas
- Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Pharmakologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Daniel Neumann
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Härtelstraße 16-18, 04103, Leipzig, Deutschland.
| | - André Scherag
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Jena, Deutschland
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Jermini M, Fonzo-Christe C, Blondon K, Milaire C, Stirnemann J, Bonnabry P, Guignard B. Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis. Int J Clin Pharm 2024; 46:496-505. [PMID: 38315303 PMCID: PMC10960916 DOI: 10.1007/s11096-023-01683-w] [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: 06/30/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adverse drug events contribute to rising health care costs. Clinical pharmacists can reduce their risks by identifying and solving drug-related problems (DRPs) through medication review. AIM To develop an economic model to determine whether medication reviews performed by clinical pharmacists could lead to a reduction in health care costs associated with the prevention of potential adverse drug events. METHOD Two pharmacists performed medication reviews during ward rounds in an internal medicine setting over one year. Avoided costs were estimated by monetizing five categories of DRPs (improper drug selection, drug interactions, untreated indications, inadequate dosages, and drug use without an indication). An expert panel assessed potential adverse drug events and their probabilities of occurrence for 20 randomly selected DRPs in each category. The costs of adverse drug events were extracted from internal hospital financial data. A partial economic study from a hospital perspective then estimated the annual costs avoided by resolving DRPs identified by 3 part-time clinical pharmacists (0.9 full-time equivalent) from 2019 to 2020. The return on investment (ROI) of medication review was calculated. RESULTS The estimated annual avoided costs associated with the potential adverse drug events induced by 676 DRPs detected was € 304,170. The cost of a 0.9 full-time equivalent clinical pharmacist was € 112,408. Extrapolated to 1 full-time equivalent, the annual net savings was € 213,069 or an ROI of 1-1.71. Sensitivity analyses showed that the economic model was robust. CONCLUSION This economic model revealed the positive financial impact and favorable return on investment of a medication review intervention performed by clinical pharmacists. These findings should encourage the future deployment of a pharmacist-led adverse drug events prevention program.
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Affiliation(s)
- Mégane Jermini
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - Caroline Fonzo-Christe
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
| | - Katherine Blondon
- Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Bertrand Guignard
- Pharmacy, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland
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5
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Yakti O, Al-Badriyeh D, Rijims M, Abdelaal M, Alsoukhni O, Al Hail M, Abdulrouf PV, El-Kassem W, Abounahia F, Kaddoura R, Abushanab D. Clinical pharmacists' interventions for preventing adverse events in critically ill neonates in Qatar: an economic impact analysis. J Pharm Policy Pract 2024; 17:170-190. [PMID: 38236554 PMCID: PMC10793632 DOI: 10.1080/20523211.2023.2291508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Objective This study aimed to assess the overall economic impact of clinical pharmacist interventions in the neonatal ICU (NICU) in Qatar. Methods A retrospective review of neonates' records was performed over a 3-month duration in the NICU of Qatar to determine the total economic benefit of clinical pharmacist interventions. The total benefit of interventions was calculated by considering the cost avoidance due to preventable adverse drug events (ADEs) and the cost savings associated with the revised resource use due to interventions. Sensitivity analyses were conducted to ensure the robustness and generalizability of the results. Results A total of 513 interventions were analyzed, involving 150 neonates. Most of the drug-related problems were related to therapy dosing, followed by drug choice appropriateness, the addition of prophylactic treatment, and administration frequency. The overall annual benefit was estimated at QAR 4,178,352 (1,147,584), which consisted of cost avoidance of QAR 1,050,680 (USD 288,648) and an overall cost saving of QAR -6091 (USD -1673). Conclusions While the clinical pharmacist interventions led to increased resource utilisation and associated costs, when considering the avoided costs of ADEs, the overall clinical pharmacist practices in the NICU setting were economically beneficial.
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Affiliation(s)
- Ola Yakti
- Pharmacy Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammed Rijims
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Omar Alsoukhni
- Pharmacy Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Moza Al Hail
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Wessam El-Kassem
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Fouad Abounahia
- Neonatal Intensive Care Unit, Hamad Medical Corporation, Doha, Qatar
| | - Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Pharmacy Department, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
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Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Cardiac intensive care unit: where we are in 2023. Front Cardiovasc Med 2023; 10:1201414. [PMID: 38075954 PMCID: PMC10704904 DOI: 10.3389/fcvm.2023.1201414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024] Open
Abstract
Cardiac intensive care has been a constantly evolving area of research and innovation since the beginning of the 21st century. The story began in 1961 with Desmond Julian's pioneering creation of a coronary intensive care unit to improve the prognosis of patients with myocardial infarction, considered the major cause of death in the world. These units have continued to progress over time, with the introduction of new therapeutic means such as fibrinolysis, invasive hemodynamic monitoring using the Swan-Ganz catheter, and mechanical circulatory assistance, with significant advances in percutaneous interventional coronary and structural procedures. Since acute cardiovascular disease is not limited to the management of acute coronary syndromes and includes other emergencies such as severe arrhythmias, acute heart failure, cardiogenic shock, high-risk pulmonary embolism, severe conduction disorders, and post-implantation monitoring of percutaneous valves, as well as other non-cardiac emergencies, such as septic shock, severe respiratory failure, severe renal failure and the management of cardiac arrest after resuscitation, the conversion of coronary intensive care units into cardiac intensive care units represented an important priority. Today, the cardiac intensive care units (CICU) concept is widely adopted by most healthcare systems, whatever the country's level of development. The main aim of these units remains to improve the overall morbidity and mortality of acute cardiovascular diseases, but also to manage other non-cardiac disorders, such as sepsis and respiratory failure. This diversity of tasks and responsibilities has enabled us to classify these CICUs according to several levels, depending on a variety of parameters, principally the level of care delivered, the staff assigned, the equipment and technologies available, the type of research projects carried out, and the type of connections and networking developed. The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have detailed this organization in guidelines published initially in 2005 and updated in 2018, with the aim of harmonizing the structure, organization, and care offered by the various CICUs. In this state-of-the-art report, we review the history of the CICUs from the creation of the very first unit in 1968 to the discussion of their current perspectives, with the main objective of knowing what the CICUs will have become by 2023.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
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Al-Badriyeh D, Kaddoura R, AlMaraghi F, Homosy A, Hail MA, El-Kassem W, Rouf PVA, Fadul A, Mahfouz A, Alyafei SA, Abushanab D. Impact of clinical pharmacist interventions on economic outcomes in a cardiology setting in Qatar. Curr Probl Cardiol 2023:101838. [PMID: 37244514 DOI: 10.1016/j.cpcardiol.2023.101838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
We sought to investigate the economic impact of preventing adverse events in a cardiology setting in Qatar as an effect of the clinical pharmacist as an intervention. This is a retrospective study of interventions by clinical pharmacists within an adult cardiology setting in a public healthcare setting (i.e Hamad Medical Corporation). The study included interventions that took place in March 2018, July 15, 2018-August 15, 2018, and January 2019. The economic impact was measured via calculating the total benefit, defined as the sum of the cost savings and the cost avoidance. Sensitivity analyses were adopted to confirm the robustness of the results. The pharmacist intervened in 262 patients, resulting in 845 interventions, with appropriate therapy (58.6%) and dosing/administration (30.2%) being the most frequent categories of reported interventions. Cost savings and cost avoidance resulted in QAR-11,536 (USD-3,169) and QAR1,607,484 (USD 441,616), respectively, yielding a total benefit of QAR1,595,948 (USD438,447) per three months and QAR6,383,792 (USD1,753,789) per a year.
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Affiliation(s)
| | - Rasha Kaddoura
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima AlMaraghi
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Homosy
- Department of Pharmacy, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al Hail
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Wessam El-Kassem
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdalla Fadul
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Dina Abushanab
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar.
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Samaan F, Aoike D, Pagrion-Neto R, Cesar Pons T, Bracci Lisboa R, Burdmann EA. Medical students’ and health professionals’ knowledge regarding acute kidney injury: a cross-sectional study in the city of São Paulo, Brazil. Ren Fail 2022; 44:1660-1668. [DOI: 10.1080/0886022x.2022.2131575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Farid Samaan
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
- LIM 12, Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, Brazil
| | - Danilo Aoike
- Disciplina de Nefrologia, Universidade Federal de São Paulo, Brazil
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9
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Houso A, Hamdan M, Falana H. Cost benefit analysis of clinical pharmacist interventions in medical intensive care unit in Palestine medical complex: Prospective interventional study. Saudi Pharm J 2022; 30:1718-1724. [PMID: 36601501 PMCID: PMC9805959 DOI: 10.1016/j.jsps.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background Clinical pharmacy services in the critical health care settings have expanded dramatically.Study problem.Clinical pharmacy services have limited implementation in Palestine. Many intensive care units (ICUs) patients do not get the intended beneficial effects of their treatment due to treatment related problems and their consequent cost burden. Aim To evaluate the impact of the clinical pharmacist interventions on costs of care and safety of patient by assessing treatment related problems among medical ICUs patients in Palestine. Methodology A prospective interventional study was conducted at medical ICU of the major public hospital in Ramallah city over a 4-month period (between September and December 2020). Patients were randomly assigned to either an intervention or a control group (With / without clinical pharmacist involvement). Treatment related problems were identified in both study groups by the clinical pharmacist, but interventions were only provided to the intervention group. The total economic benefit included both cost savings from intervention and cost avoidance from preventable adverse drug events (ADEs) resulted from CP interventions. The primary outcomes with the clinical pharmacist interventions were net benefit and benefit to cost ratio, which were calculated using previously published methodologies and adjusted to the Palestinian settings. The analysis of CP interventions acceptance by physicians was performed. Results During the 4-month study period, the 117 patients admitted to the ICU were included into the analysis; 66 patients in the intervention group and 51 in the control group. The interventions made by a clinical pharmacist resulted in direct cost saving of NIS8,990.05 ($2799.63) and cost avoidance of NIS22,087.5 ($ 6878.37). Translated into a net savings of NIS188.35 ($58.65) per intervention and NIS470 ($146.36) per patient. Comparison of benefits (NIS31,077.55) ($9678.00) and costs (NIS19,043.928) ($5930.55) indicate a net economic benefit to the institution of (NIS 12,033.623) ($3747.44) and a benefit cost ratio of 1.63. Conclusion Integrating a clinical pharmacist in the ICU team was investment that resulted in benefits in term of cost saving and cost avoidance.
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Affiliation(s)
- Aseel Houso
- Faculty of Public Health, Al-Quds University, Jerusalem, Palestine,Corresponding author.
| | - Motasem Hamdan
- Faculty of Public Health, Al-Quds University, Jerusalem, Palestine
| | - Hiba Falana
- Faculty of pharmacy, Birzait University Ramallah, Palestine
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Bochniarz M, Inglot-Brzęk E, Lewandowska A, Podgórska J. Directions of Changes in the Profession of Hospital Pharmacist in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14522. [PMID: 36361404 PMCID: PMC9658758 DOI: 10.3390/ijerph192114522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/30/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The Act on the Pharmacist Profession, adopted on 10 December 2020, is a breakthrough for the entire community of pharmacists in Poland. Due to the scope of the changes introduced in the Act, the question is whether pharmacists in Poland are suitably prepared for pharmaceutical care and clinical pharmacy services. The main aim of the study is to assess the readiness of hospital pharmacists to introduce changes in the way the profession functions. The result of the study is the presentation of the concept of a new model of pharmacist functioning in healthcare entities and the indication of actions necessary to carry out such a change. The questionnaire was addressed to all hospital pharmacists in Poland. Two hundred and seventy-seven hospital pharmacists were included in the research. The analysis of the data revealed that almost all (96.1%) respondents indicated the need to introduce changes to the model of functioning of pharmacists in medical entities. Two-thirds of pharmacists declared readiness to start work to introduce changes. Hospital pharmacists recognize the importance of clinical pharmacy in their current practice; however, the biggest barrier is the lack of financing, an insufficient number of staff, a lack of knowledge and skills, and a lack of tools to use the service.
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Affiliation(s)
- Marcin Bochniarz
- Specialist Hospital, Subcarpathian Oncology Centre, 36-200 Brzozów, Poland
| | | | - Anna Lewandowska
- Department of Management, University of Information Technology and Management, 35-225 Rzeszów, Poland
| | - Joanna Podgórska
- Department of Economics and Finance, University of Information Technology and Management, 35-225 Rzeszów, Poland
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11
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Al-Maqbali JS, Taqi A, Al-Ajmi S, Al-Hamadani B, Al-Hamadani F, Bahram F, Al-Balushi K, Gamal S, Al-Lawati E, Al Siyabi B, Al Siyabi E, Al-Sharji N, Al-Zakwani I. The Impacts of Clinical Pharmacists' Interventions on Clinical Significance and Cost Avoidance in a Tertiary Care University Hospital in Oman: A Retrospective Analysis. PHARMACY 2022; 10:pharmacy10050127. [PMID: 36287448 PMCID: PMC9611954 DOI: 10.3390/pharmacy10050127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Pharmaceutical interventions are implicit components of the enhanced role that clinical pharmacists provide in clinical settings. We aimed to study the clinical significance and analyze the presumed cost avoidance achieved by clinical pharmacists’ interventions. Methods: A retrospective study of documented clinical pharmacists’ interventions at a tertiary care hospital in Oman was conducted between January and March 2022. The interventions were electronically recorded in the patients’ medical records as routine practice by clinical pharmacists. Data on clinical outcomes were extracted and analyzed. Cost implications were cross checked by another clinical pharmacist, and then, cost avoidance was calculated using the Rx Medi-Trend system values. Results: A total of 2032 interventions were analyzed, and 97% of them were accepted by the treating physicians. Around 30% of the accepted interventions were for antimicrobials, and the most common type was dosage adjustment (30%). Treatment efficacy was enhanced in 60% and toxicity was avoided in 22% of the interventions. The presumed cost avoided during the study period was USD 110,000 with a projected annual cost avoidance of approximately USD 440,000. Conclusion: There was an overall positive clinical and financial impact of clinical pharmacists’ interventions. Most interventions have prevented moderate or major harm with a high physician acceptance rate. Optimal documentation of the interventions is crucial for emphasizing clinical pharmacists’ value in multi-specialty hospitals.
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Affiliation(s)
- Juhaina Salim Al-Maqbali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
- Correspondence: or
| | - Aqila Taqi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Samyia Al-Ajmi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | | | - Farhat Al-Hamadani
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Fatima Bahram
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Kifah Al-Balushi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Sarah Gamal
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Esra Al-Lawati
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Bushra Al Siyabi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Ekram Al Siyabi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Nashwa Al-Sharji
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat PC 123, Oman
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat PC 123, Oman
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Dong PTX, Pham VTT, Dinh CT, Le AV, Tran HTH, Nguyen HTL, Hua S, Li SC. Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting. Clin Interv Aging 2022; 17:1127-1138. [PMID: 35903286 PMCID: PMC9314755 DOI: 10.2147/cia.s368871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Geriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission. Patients and Methods The study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system. Results A total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians. Conclusion Improving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.
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Affiliation(s)
- Phuong Thi Xuan Dong
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Van Thi Thuy Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam.,Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Chi Thi Dinh
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Anh Van Le
- Department of Pharmacy, Friendship Hospital, Hanoi, Vietnam
| | - Ha Thi Hai Tran
- Department of Internal Cardiology, Friendship Hospital, Hanoi, Vietnam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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13
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Ó Ciardha D, Blake AM, Creane D, Callaghan MÓ, Darker C. Can a practice pharmacist improve prescribing safety and reduce costs in polypharmacy patients? A pilot study of an intervention in an Irish general practice setting. BMJ Open 2022; 12:e050261. [PMID: 35623753 PMCID: PMC9150158 DOI: 10.1136/bmjopen-2021-050261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs. SETTING Four-doctor suburban general practice. PARTICIPANTS Inclusion criteria: patients receiving 10+ repeat drugs per month. EXCLUSION CRITERIA deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study. INTERVENTION Pharmacist conducting holistic medication reviews in the study group over a 6-month period. PRIMARY OUTCOME MEASURES Anonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated. RESULTS In total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing. CONCLUSIONS This study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.
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Affiliation(s)
- Darach Ó Ciardha
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Anne-Marie Blake
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Dylan Creane
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Michael Ó Callaghan
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Catherine Darker
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
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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]
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15
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Ito K, George N, Wilson J, Bowman J, Aaronson E, Ouchi K. Primary palliative care recommendations for critical care clinicians. J Intensive Care 2022; 10:20. [PMID: 35428371 PMCID: PMC9013119 DOI: 10.1186/s40560-022-00612-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Palliative care is an interdisciplinary care to optimize physical, psychosocial, and spiritual symptoms of patients and their families whose quality of life is impaired by serious, life-limiting illness. In 2021, the importance of providing palliative care in the intensive care unit (ICU) is well recognized by various studies to alleviate physical symptoms due to invasive treatments, to set patient-centered goals of care, and to provide end-of-life care. This paper summarizes the evidence known to date on primary palliative care delivered in the ICU settings. We will then discuss the potential benefits and harms of primary palliative care so that critical care clinicians are better equipped to decide what services might best improve the palliative care needs in their ICUs.
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Mucalo I, Brajković A, Strgačić M, Ramalho-de-Oliveira D, Ribarić E, Bobinac A. Budget Impact Analysis of Pharmacist-Led Medication Management in Cardiovascular and Type 2 Diabetic Patients. Healthcare (Basel) 2022; 10:healthcare10040722. [PMID: 35455900 PMCID: PMC9027851 DOI: 10.3390/healthcare10040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
The paper aims to identify and measure the costs and savings associated with the delivery of Comprehensive Medication Management (CMM) services in Croatia in patients diagnosed with hypertension accompanied by at least one additional established cardiovascular disease (CVD) and/or type 2 diabetes mellitus (DMT2) who use five or more medicines daily. The budget impact analysis (BIA) employed in this study compares the total costs of CMM to the cost reductions expected from CMM. The cost reductions (or savings) are based on the reduced incidence of unwanted clinical events and healthcare service utilisation rates due to CMM. The BIA model is populated by data on medication therapy costs, labour, and training from the pilot CMM intervention introduced in Zagreb’s main Health Centre, while relevant international published sources were used to estimate the utilisation, incidence, and unwanted clinical events rates. Total direct costs, including pharmacists’ labour and training (EUR 2,667,098) and the increase in the cost of prescribed medication (EUR 5,182,864) amounted to EUR 7,849,962 for 3 years, rendering the cost per treated patient per year EUR 57. CMM is expected to reduce the utilisation rates of healthcare services and the incidence of unwanted clinical events, leading to a total 3-year reduction in healthcare costs of EUR 7,787,765. Given the total CMM costs of EUR 7,849,962, CMM’s 3-year budget impact equals EUR 92,869, rendering per treated patient an incremental cost of CMM EUR 0.67. Hence, CMM appears to be an affordable intervention for addressing medication mismanagement and irrational drug use.
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Affiliation(s)
- Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
- Correspondence: ; Tel.: +38-51-6394-802
| | - Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
| | - Marija Strgačić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
| | - Djenane Ramalho-de-Oliveira
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Elizabeta Ribarić
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia; (E.R.); (A.B.)
| | - Ana Bobinac
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia; (E.R.); (A.B.)
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Huntley M, McCall K, Stickney K, Gelinas A, Levesque E. Avoidance of drug interactions with hepatitis C treatment: evaluation of pharmacist interventions in the specialty setting. J Am Pharm Assoc (2003) 2022; 62:1671-1674. [DOI: 10.1016/j.japh.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/28/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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18
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Falconer N, Snoswell C, Morris C, Barras M. The right time and place: the need for seven‐day pharmacist service models. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nazanin Falconer
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Centaine Snoswell
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Christopher Morris
- Department of Internal Medicine Princess Alexandra Hospital Metro South Health Brisbane Australia
| | - Michael Barras
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
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Javor E, Allouch A, Osvaldić Galic J, Skelin M. The economic impact of a clinical pharmacist's involvement in the hospital medicines policy in a rural area. Int J Clin Pract 2021; 75:e14859. [PMID: 34516725 DOI: 10.1111/ijcp.14859] [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: 12/04/2020] [Accepted: 09/10/2021] [Indexed: 11/27/2022] Open
Abstract
AIM The evidence of the value of pharmaceutical care continues to grow, however, data on its effect in rural areas are still scarce. The aim of this article was to evaluate the economic impact of a clinical pharmacist's involvement in the hospital medicines policy design in a rural area, through the drug and therapeutics committee (DTC) and public procurement for medicines. METHODS An economic evaluation was conducted in the General Hospital Bjelovar which covers the Bjelovarsko-Bilogorska County in Croatia. It included costs from denial and approval decisions of the drug and therapeutics committee, during a 1-year period between June 1, 2019 and June 1, 2020, and costs for medicines in 2018 and 2019 that were intended for public procurement. The cost-benefit analysis and cost-minimisation analyses for the DTC and public procurement data have been conducted for the evaluation of the economic impact of a clinical pharmacist. RESULTS The involvement of a clinical pharmacist in the hospital medicines policy design through the DTC and public procurement for medicines provides an economic benefit. This resulted in a cost-benefit ratio of 14.18:1 and 18.31% and 17.58% savings through the DTC and public procurement process, respectively. To put in a different perspective, around 14 yearly gross salaries can be paid out from savings achieved by the clinical pharmacist through a 1-year period. CONCLUSION The involvement of a clinical pharmacist in the hospital medicines policy in a rural area hospital results with an optimisation of investment in medicines and leads to substantial cost savings for the healthcare system.
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Affiliation(s)
- Eugen Javor
- Pharmacy Department, General Hospital Bjelovar, Bjelovar, Croatia
| | - Ali Allouch
- General Surgery Department, General Hospital Bjelovar, Bjelovar, Croatia
| | - Josipa Osvaldić Galic
- Department for Public Procurement and Cooperation with EU Funds, General Hospital Bjelovar, Bjelovar, Croatia
| | - Marko Skelin
- Pharmacy Department, General Hospital Šibenik, Šibenik, Croatia
- Department of Basic and Clinical Pharmacology with Toxicology, University of Rijeka, Rijeka, Croatia
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20
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Rezazadeh A, Hajimiri SH, Kebriaeezadeh A, Gholami K, Hashemian F, Khoshnevisan A, Mohebbi N. Clinical and economic impact of comprehensive medication management implementation by clinical pharmacists in an intensive care unit: a cost–benefit analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
Critically ill patients are at risk of drug-related problems (DRPs) and healthcare-related cost. Clinical pharmacists are specifically trained in pharmacotherapy evaluation; they can identify and prevent DRPs. We aim to evaluate clinical and economic impact of clinical pharmacist by cost–benefit analysis in intensive care unit.
Methods
This was a prospective, interventional study from healthcare provider perspective which conducted over 6 months in a neurosurgery intensive care unit (ICU) of a university hospital on 162 patients. A clinical pharmacist was dedicated to implement comprehensive medication management. All pharmacotherapy problems were categorized and economic impact of clinical pharmacist’s interventions including cost–benefit ratio and net benefit in the ICU was assessed.
Key findings
A total of 1524 interventions were done. The top five pharmacotherapy-related problems were defined as, drug selection (33.3%), dose adjustment (17.32%), fluid and electrolyte management (12.99%), drug discontinuation (12.07%) and therapeutic drug monitoring (6.75%). The minimum and maximum benefit–cost ratio was 8.4:1 to 12.7:1 and net benefit was $169,205 to $266,633, respectively over the 6-month period.
Conclusions
The participation of a clinical pharmacist in a multidisciplinary ICU team by implementation of comprehensive medication management may reduce healthcare expenditures and improve drug safety.
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Affiliation(s)
- Amir Rezazadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Hajimiri
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical sciences, Tehran, Iran
- Pharmaceutical Management and Economics Research Center, Tehran University of Medical sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical sciences, Tehran, Iran
- Pharmaceutical Management and Economics Research Center, Tehran University of Medical sciences, Tehran, Iran
| | - Kheirollah Gholami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Hashemian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical sciences, Islamic Azad University, Tehran, Iran
| | - Alireza Khoshnevisan
- Department of neurosurgery, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niayesh Mohebbi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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21
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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.
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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
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22
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Bednall R, White S, Mills E, Thomson S. Validation of a hospital clinical pharmacy workforce calculator: A methodology for pharmacy? Int J Clin Pract 2021; 75:e13932. [PMID: 33305382 DOI: 10.1111/ijcp.13932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The benefits of clinical pharmacy services are established within hospital practice but staff numbers required for service delivery are not well described and staffing levels vary. The need for a consistent, objective method of determining staffing levels was recognised at a UK University Hospital and a Clinical Pharmacy Workforce Calculator (CPWC) was developed. OBJECTIVE To develop the Activity Standard (AS) for pharmaceutical care and establish the reliability of the CPWC across acute hospital settings in UK. SETTING Acute hospital in-patient clinical pharmacy services on medical and surgical wards. METHOD Using the World Health Organisation's Workload Indicators of Staffing Need (WISN) methodology, a two-round Delphi study was undertaken. This developed the Activity Standard for pharmaceutical care and identified the staff-time unavailable for clinical work. Consenting panel members then tested the CPWC, calculating the staff required for three scenarios to determine whether it could be reliably used by different operators. RESULTS Thirty-six participants consented to participate. Data were returned from 22 (61%) of whom 20 (56%) supplied analysable data. Consensus was achieved on the tasks required for pharmaceutical care delivery, the mean time each takes, how frequently they should be completed and the time unavailable for clinical work for each grade of staff. The CPWC calculates staffing requirements using these data. Eleven participants (55%) tested the CPWC and analysis of responses demonstrated that 30 of 33 (91%) calculations were accurately completed. DISCUSSION This study defined the WISN Activity Standard for UK pharmaceutical care delivery to hospital inpatients and showed content validity for the CPWC in acute medical and surgical hospital settings. Different operators used the CPWC reliably and applied it to local sites. CONCLUSION The CPWC offers hospital pharmacy managers a useful tool to negotiate adequate staffing to deliver pharmaceutical care. Its development methodology could be applied widely in pharmacy practice.
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Affiliation(s)
- Ruth Bednall
- Royal Stoke University Hospital, United Hospitals of North Midlands, Newcastle-under-Lyme, UK
| | - Simon White
- School of Pharmacy & Bioengineering, Keele University, Newcastle-under-Lyme, UK
| | | | - Susan Thomson
- Royal Stoke University Hospital, United Hospitals of North Midlands, Newcastle-under-Lyme, UK
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Alshakrah MA, Steinke DT, Tully MP, Abuzour AS, Williams SD, Lewis PJ. Development of the adult complexity tool for pharmaceutical care (ACTPC) in hospital: A modified Delphi study. Res Social Adm Pharm 2021; 17:1907-1922. [PMID: 33712369 DOI: 10.1016/j.sapharm.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hospital pharmacists play an essential role in patient care; however, a lack of resources means pharmacists are unable to review all patients daily. Consequently, there is a demand for reliable screening tools to allocate care to patients with urgent and/or complex pharmaceutical needs. Several tools have been developed, but no broad consensus exists on the design of a screening tool to be used in the adult hospital setting. OBJECTIVE To obtain expert consensus on the design of a pharmaceutical care complexity screening tool for use on admission to hospital. METHODS Two Delphi studies were conducted: the first sought to gain consensus from experts including pharmacists, academics and physicians on the components of a pharmaceutical complexity tool, the second to achieve consensus from UK chief pharmacists and clinical service pharmacy managers on the clinical appropriateness and practicality of the tool. Tool components and Delphi statements were identified and refined from our previous systematic review, UK survey and interview study of prioritisation tools. A valid definition for consensus was used. RESULTS Over 300 components were extracted from the interview data and systematic review and then refined for inclusion in the first Delphi study. Thirty-three experts completed Delphi One and consensus was reached on 92 components. Components were grouped into demographic, clinical and medication components and condensed to 33 items, which were included in the first draft of the Adult Complexity Tool for Pharmaceutical Care (ACTPC). The tool stratified patients into highly, moderately or least complex. Forty expert panellists completed Delphi Two and consensus was reached on review frequency and experience of pharmacy practitioner at each level. These decisions were incorporated into the final version of the ACTPC. CONCLUSIONS The ACTPC is the first systematically designed and internationally agreed tool for use on medical admission to hospital. It has potential to enable the delivery of targeted patient-centred pharmaceutical care.
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Affiliation(s)
- Meshal A Alshakrah
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Universityof Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom; King Abdulaziz Medical City, Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Douglas T Steinke
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Universityof Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Mary P Tully
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Universityof Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Aseel S Abuzour
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Universityof Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Steven D Williams
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Universityof Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom; Poole Bay and Bournemouth Primary Care Network, Dorset, England.
| | - Penny J Lewis
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Universityof Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
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Identification and management of contraindicated drug–drug interactions through pharmaceutical care programs: Experience in direct-acting antivirals therapy. J Formos Med Assoc 2021; 121:58-65. [DOI: 10.1016/j.jfma.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 12/21/2022] Open
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Yung E, McNicol M, Lewis D, Fischer J, Petkus K, Sebastian S, Abdel-Rasoul M, Schmuhl K, Wise K. Economic impact of pharmacist interventions in pediatric ambulatory care clinics. J Am Pharm Assoc (2003) 2020; 61:198-205.e1. [PMID: 33358098 DOI: 10.1016/j.japh.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Ambulatory care pharmacists have a unique opportunity to identify and prevent adverse drug events (ADEs) throughout a patient's treatment course. These interventions can reduce unexpected clinic visits or hospitalizations, which may lead to decreased health care costs. However, research on this topic has not been conducted in the pediatric population. This study explored the economic impact of pharmacist interventions related to ADEs in pediatric ambulatory care clinics. The primary objective was to determine the total cost avoidance of pharmacist interventions associated with the prevention or management of ADEs in pediatric ambulatory care clinics. The secondary objectives were to describe and quantify pharmacist interventions related to the prevention and management of ADEs in pediatric ambulatory care clinics. METHODS Pharmacist interventions from pediatric ambulatory care clinics were collected from an electronic health record. These interventions were categorized into 1 of 4 categories: Drug interaction, drug not indicated, prevent or manage ADE, or prevent or manage drug allergy. A review panel consisting of ambulatory care pharmacists reviewed the interventions. The expected probability of the event occurring was classified according to the Nesbit method (0-0.6), and the level of care necessary to treat the potential ADE was determined. The levels of care included hospitalization, ambulatory care, and self-care. The cost avoidance associated with each prevented ADE was calculated by multiplying the probability of the ADE occurring by the average charge of the expected level of care. RESULTS Of the 8755 interventions documented, 212 were included, leading to a total cost avoidance of $307,210 (range $76,802-$1,071,053). The estimated cost avoidance from each ADE subtype was $128,283 from drug interaction, $20,727 from drug not indicated, $157,993 from prevent or manage ADE, and $207 from prevent or manage drug allergy. CONCLUSION Pediatric ambulatory care pharmacists optimize health care cost savings through the prevention and management of ADEs as integrated members of the health care team.
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Ng TM, Teo CJ, Heng ST, Chen YR, Lim WP, Teng CB. Impact of
round‐the‐clock
pharmacist inpatient medication chart review on medication errors. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tat Ming Ng
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Chong Junn Teo
- Department of Pharmacy, Faculty of Science National University of Singapore Singapore Singapore
| | - Shi Thong Heng
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Yi Rong Chen
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Wan Peng Lim
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Christine B Teng
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
- Department of Pharmacy, Faculty of Science National University of Singapore Singapore Singapore
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Snoswell C, Jensen E, Wang N, Shah K, Currey E, Barras M. Transit Care Hub pharmacist: improving patient flow within the hospital. Int J Clin Pharm 2020; 42:1319-1325. [PMID: 32865678 DOI: 10.1007/s11096-020-01092-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
Background The Transit Care Hub (TCH) is an inpatient ward traditionally used as a waiting area for patients who require transport to return home. In July 2018, a six-month pilot of a TCH pharmacist was funded to improve the flow of patients through the hospital. Setting Major Australian teaching hospital. Objective(s) To determine the effect that the TCH pharmacist had on patient flow within the hospital and on the time saved for other clinical pharmacists, as well as estimating cost savings. Methods A service delivery framework for the TCH pharmacist was developed and tested. This involved a proactive approach to patient discharge with ward-based staff. Data were collected from July to November 2018, 20 weeks prior to and 20 weeks after the commencement of the pilot. Main outcome measure Measurements included the number of best possible medication histories (BPMHs) completed during admission, improvements in arrival time to TCH from inpatient wards and cost savings. Results During the pilot study period (20 weeks), 791 patients were discharged by the TCH pharmacist, arriving an average of 70 minutes earlier than other patients discharging through TCH. There was a 16% increase in patients discharging through TCH which released ward beds. The TCH pharmacist increased the number of BPMHs on day of admission by 14%. There was an estimated annual saving of AU$252,008 for the hospital. Conclusions The TCH pharmacist service enhanced patient flow by coordinating earlier discharges, increasing the timely completion of BPMHs, and saving ward pharmacist time. Significant cost savings supported a permanently funded position.
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Affiliation(s)
- Centaine Snoswell
- Pharmacy Department, Ground Floor, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.,School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Estelle Jensen
- Pharmacy Department, Ground Floor, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Nancy Wang
- Pharmacy Department, Ground Floor, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Krishna Shah
- Pharmacy Department, Ground Floor, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Elizabeth Currey
- Pharmacy Department, Ground Floor, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Michael Barras
- Pharmacy Department, Ground Floor, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.,School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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Njuguna B, Berhane H, Ndemo FA, Opanga S. Scaling up clinical pharmacy practice in Africa: Current challenges and the future. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Benson Njuguna
- Department of Pharmacy & Department of Cardiology Moi Teaching & Referral Hospital Eldoret Kenya
| | - Haftay Berhane
- Mekelle University College of Health Sciences and Ayder Comprehensive Specialized Hospital Mekelle Ethiopia
| | - Francis Abuga Ndemo
- School of Pharmacy and Health Sciences, United States International University Nairobi Kenya
| | - Sylvia Opanga
- Division of Clinical Pharmacy, School of Pharmacy University of Nairobi Nairobi Kenya
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29
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Muñoz‐Pichuante D, Villa‐Zapata L. Benefit of Incorporating Clinical Pharmacists in an Adult Intensive Care Unit: A Cost‐saving Study. J Clin Pharm Ther 2020; 45:1127-1133. [DOI: 10.1111/jcpt.13195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel Muñoz‐Pichuante
- Facultad de Ciencias Instituto de Farmacia Universidad Austral de Chile Valdivia Chile
- Unidad de Cuidados Intensivos Hospital Base de Valdivia Valdivia Chile
| | - Lorenzo Villa‐Zapata
- Center for Pharmaceutical Outcomes Research Skaggs School of Pharmacy & Pharmaceutical Sciences University of Colorado Denver CO USA
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30
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Fares M, Khachman D, Salameh P, Lahoud N. Evaluation of discharge instructions among hospitalized Lebanese patients. Pharm Pract (Granada) 2020; 18:1-9. [PMID: 32206139 PMCID: PMC7075427 DOI: 10.18549/pharmpract.2020.1.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge. Objectives: Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors. Methods: Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to “instructions given” and “instructions appropriate” to later conduct bivariate analysis. Results: We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of “appropriate instructions”. In fact, our study showed that despite being capable of giving good medication advice, nurses’ instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions. Conclusions: In conclusion, our observational study showed that in a Lebanese university hospital, patients’ understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions’ quality.
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Affiliation(s)
- Mirella Fares
- PharmD. Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
| | - Dalia Khachman
- PharmD, PhD. Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
| | - Pascale Salameh
- PharmD, PhD. National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB), Faculty of Public Health, Lebanese University, Fanar (Lebanon).
| | - Nathalie Lahoud
- PharmD, PhD. National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB), Faculty of Public Health, Lebanese University, Fanar (Lebanon).
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31
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Hammond DA, Rech MA. Cautions heeded: A call to action for evaluating pharmacists' direct and indirect patient care activities. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Drayton A. Hammond
- Department of Pharmacy; Rush University Medical Center; Chicago Illinois
- Department of Internal Medicine; Rush Medical College; Chicago Illinois
| | - Megan A. Rech
- Department of Pharmacy; Loyola University Medical Center; Maywood Illinois
- Department of Emergency Medicine; Loyola University Medical Center; Maywood Illinois
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32
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Zecchini C, Vo TH, Chanoine S, Lepelley M, Laramas M, Lemoigne A, Allenet B, Federspiel I, Bedouch P. Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study. BMC Health Serv Res 2020; 20:113. [PMID: 32050957 PMCID: PMC7017539 DOI: 10.1186/s12913-020-4963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit. Methods A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers’ perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.
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Affiliation(s)
- Céline Zecchini
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.
| | - Thi-Ha Vo
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,Pham Ngoc Thạch University of Medicine, Hochiminh, V-70000, Vietnam
| | - Sébastien Chanoine
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Marion Lepelley
- Centre Régional de Pharmacovigilance, F-38000, Grenoble, France
| | - Mathieu Laramas
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Cancer et maladies du sang, F-38000, Grenoble, France
| | - Aude Lemoigne
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Benoît Allenet
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Isabelle Federspiel
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Pierrick Bedouch
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
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Al-Qudah RA, Al-Badriyeh D, Al-Ali FM, Altawalbeh SM, Basheti IA. Cost-benefit analysis of clinical pharmacist intervention in preventing adverse drug events in the general chronic diseases outpatients. J Eval Clin Pract 2020; 26:115-124. [PMID: 31234234 DOI: 10.1111/jep.13209] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Clinical pharmacy services are vital in the prevention of adverse drug events (ADEs) in clinical practice, extending beyond the hospital to chronic disease management in outpatient settings. This study sought to evaluate the cost benefit of a clinical pharmacy intervention in resolving treatment-related problems (TRPs) among hospital outpatients with chronic diseases. METHODS From the hospital system perspective, the cost-benefit analysis was based on a randomized clinical trial in the general outpatients of the major hospital in Jordan. Eligible patients were randomly assigned to either an intervention or a control group. TRPs were identified in both study groups, but interventions were delivered only to the intervention group via a home medication management review (HMMR) by a clinical pharmacist. A follow-up in both groups took place 3 months after recruitment. The total economic benefit was the sum of (a) cost savings due to intervention and (b) cost avoidance associated with preventable ADEs. The primary outcome measures were the net benefit and benefit-to-cost ratio with the clinical pharmacist-based HMMR. RESULTS In both groups, 158 TRPs were identified, and 79 interventions were provided in the study group. The monthly cost of intervention was JD764 (US $1078), and the total monthly benefit was JD4570 (US $6444), leading to a benefit-to-cost ratio of 5.98 and an annual net benefit of JD45 669 (US $64 393). Sensitivity analyses confirmed the robustness of results. CONCLUSION The RCT-based cost-benefit evaluation provided evidence-based insight into the economic benefit of a clinical pharmacist-provided HMMR for preventing ADEs in the general chronic diseases outpatients. This intervention method against the TRPs among outpatients is cost beneficial and offers substantial cost savings to the health care hospital payer in Jordan.
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Affiliation(s)
- Rajaa A Al-Qudah
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Daoud Al-Badriyeh
- College of Pharmacy, QU Health Cluster, Qatar University, Doha, Qatar
| | - Farah M Al-Ali
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Iman A Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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The Role of the Clinical Pharmacist in an Irish University Teaching Hospital: A Mixed-Methods Study. PHARMACY 2020; 8:pharmacy8010014. [PMID: 32019094 PMCID: PMC7151682 DOI: 10.3390/pharmacy8010014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 01/27/2023] Open
Abstract
Medication review (MR) is a vital part of the pharmacist’s role in hospital. However, in the South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland, this has not been fully implemented due to resource issues. In addition, the cost of providing this service has not been evaluated. Moreover, it is not clear how other members of the multidisciplinary team e.g., Nurses, value any interventions made as a result of the MR. This mixed methods study assessed the impact of MR in terms of (i) potential clinical harm, (ii) cost avoidance and (iii) the views of nursing staff on the role of the pharmacist. The setting is a 192-bed, voluntary, acute hospital, in the Munster region of Ireland. Study I: The pharmacist provided MR to patients conventionally once a week. Any interventions were then assessed for potential clinical harm and to calculate cost avoidance. Study II: Semi-structured interviews, guided by a topic guide were completed with 12 nurses (11 female). Thematic analysis was used to code the main themes. Main outcome measure: To estimate the cost, cost avoidance, and the net cost benefit ratio of MR provided by pharmacists. Study I: Of 128 patients who received the MR, 113 interventions were made. The estimated cost of providing the MR was €2559 (senior pharmacist). Using €1084 as the cost of an adverse drug event (ADE), the cost avoidance was calculated at €42,330. This led to a net cost benefit of €39,771 (senior pharmacist) which equated to a net cost benefit ratio of 16.5:1. Study II: The main themes were (i) perceptions of pharmacy services, (ii) the role of the pharmacist—past, present and future, and (iii) teamwork and communication. Nurses expressed a desire to have more pharmacists present on the wards.
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Jacob S, Britt RB, Bryan WE, Hashem MG, Hale JC, Brown JN. Economic Outcomes Associated with Safety Interventions by a Pharmacist-Adjudicated Prior Authorization Consult Service. J Manag Care Spec Pharm 2019; 25:411-416. [PMID: 30816815 PMCID: PMC10397701 DOI: 10.18553/jmcp.2019.25.3.411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The establishment of a formulary management system ensures that health care professionals work together in an integrated patient care process to promote clinically sound, safe, and cost-effective medication therapy. Pharmacists have a foundational role within this system. A pharmacist-adjudicated prior authorization drug request (PADR) consult service has the potential to optimize drug therapy by decreasing medication misuse, minimizing adverse drug events (ADEs), and preventing medication errors. OBJECTIVES To (a) determine cost avoidance associated with pharmacist-adjudicated PADR safety interventions within the Durham Veterans Affairs Health Care System and (b) evaluate cost savings associated with pharmacist-adjudicated PADRs not approved due to a safety intervention, evaluate cost avoidance and direct cost savings based on clinical specialty of pharmacist adjudicating PADR, and characterize severity of avoided ADEs. METHODS Pharmacist-adjudicated PADRs not approved between July 1, 2016, and June 30, 2017, because of safety interventions were retrospectively reviewed. Cost avoidance was determined by multiplying the probability of ADE occurrence in the absence of PADR safety intervention by the estimated cost avoided based on the type of intervention. Direct cost savings was calculated by totaling the cost of requested medications not approved for each PADR and subtracting the cost of recommended alternative therapies and cost of pharmacist PADR review. All potential ADEs avoided were reviewed by a panel of 3 clinical pharmacists to validate ADE classification and ADE probability and severity scores. Descriptive statistics were used for all analyses. RESULTS Of the 910 PADRs that were not approved during the study period, 96 met inclusion criteria. Pharmacist-adjudicated PADR safety interventions resulted in a total cost avoidance of $24,485.34 (mean = $255.06) and a direct cost savings of $288,695.63 (mean = $3,007.25). The practice settings of anticoagulation and infectious diseases PADRs resulted in the largest contribution to cost avoidance and direct cost savings, respectively. Prevented ADEs were classified as major for 64.6% of the PADRs. CONCLUSIONS Pharmacist-adjudicated PADR safety reviews resulted in substantial economic benefit and prevention of major ADEs. This analysis supports the pharmacist's role in a formulary management system to optimize medication therapy. DISCLOSURES This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors. The authors have nothing to disclose.
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Affiliation(s)
- Sherin Jacob
- 1 Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Rachel B Britt
- 1 Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - William E Bryan
- 1 Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Mohamed G Hashem
- 1 Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jonathan C Hale
- 1 Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jamie N Brown
- 1 Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina
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Mestres C, Hernandez M, Agustí A, Puerta L, Llagostera B, Amorós P. Development of a pharmaceutical care program in progressive stages in geriatric institutions. BMC Geriatr 2018; 18:316. [PMID: 30567496 PMCID: PMC6300022 DOI: 10.1186/s12877-018-1002-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To introduce and manage a Pharmaceutical care programs in geriatric care institutions presents difficulties such as reduced pharmacy service staff, complexity of the patients or lack of integration of the pharmacist in the health care team. This work describes the evolution of the implementations of a program of pharmaceutical care centered in drug related problems (DRP) in a group of geriatric institutions of different levels of complexity. METHODS Setting: Long-term and subacute care hospitals (HSS) and Health care teams attending nursing homes (EARs). PARTICIPANTS Patients attended in HSS and EARs during different periods between 2010 and 2016. INTERVENTIONS The program was developed in different stages, in which pharmacists made interventions of increasing complexity. RESULTS Between 2010 and 2013, the approach was only to improve the prescription of non-appropriate drugs for the elderly, which was reduced from 19 to 14.5%. Subsequent steps included detection of drug-related problems (DRP), systematization of treatment revisions, recording of pharmacist interventions, improvements in the classification of interventions and the creation of a web-based database for recording in a more efficient way. During these years, there was an increase in the number of patients included in pharmaceutical care activities and thus the number of pharmacist interventions (3872 in 2014 vs 5903 in 2016). In 2016, mean age in 2016: 83.2 years old. Mean number of medicines/patient: 8.4 ± 3.3, and mean interventions/patient: 1.62. Degree of acceptance of the interventions by physicians improved (68.6% in 2016 vs 45.5% in 2012), even though there is still much work to do. The Medication Appropriateness Index (MAI) showed that when the interventions were accepted, there was an important improvement. HSS mean MAI values pre-intervention: 2.52, post-intervention 0.80. In EARs: 5 pre and 1.39 post. In both cases p < 0.0001. CONCLUSIONS Approaching the deployment of activities in a progressive way has made us more efficient and able to confront and solve the problems that have arisen. Even though there has been a very restricted increase in the staff and budget, we are able to implement a DRP detection programme with guaranties of quality.
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Affiliation(s)
- Conxita Mestres
- School of Health Sciences Blanquerna, University Ramon Llull, Padilla 326, 08025 Barcelona, Spain
| | | | - Anna Agustí
- Pharmacy Department, HSS Mutuam Girona, Girona, Spain
| | - Laura Puerta
- Pharmacy Department, HSS Mutuam Güell, Barcelona, Spain
| | | | - Patricia Amorós
- Pharmacy Department, Centre Residencial La Creueta, Sabadell, Spain
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Convertino I, Salvadori S, Pecori A, Galiulo MT, Ferraro S, Parrilli M, Corona T, Turchetti G, Blandizzi C, Tuccori M. Potential Direct Costs of Adverse Drug Events and Possible Cost Savings Achievable by their Prevention in Tuscany, Italy: A Model-Based Analysis. Drug Saf 2018; 42:427-444. [PMID: 30276630 DOI: 10.1007/s40264-018-0737-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adverse drug events (ADEs) may represent an important item of expenditure for healthcare systems and their prevention could be associated with a relevant cost saving. OBJECTIVE The objective of this study was to simulate the annual economic burden for ADEs in Tuscany (Italy) and the potential cost savings related to avoidable ADEs. METHODS A systematic review was performed, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statements, on observational studies published from 2006 to 2016 in MEDLINE and EMBASE, focusing on direct costs of ADEs in the inpatient setting from high-income countries. The mean probability of preventable ADEs was estimated over the included studies. The mean ADE cost was calculated by means of Monte Carlo simulation. We then extrapolated the spontaneous reports of ADEs in Tuscany, Italy in 2016 from the Italian National Pharmacovigilance Network (Rete Nazionale di Farmacovigilanza), and we assumed the same costs and preventability probability for these as obtained in the systematic review. Finally, we simulated the possible costs of ADEs and preventable ADEs in Tuscany. Three sensitivity analyses were also performed to test the robustness of the results. RESULTS Of 11,936 articles initially selected, 12 observational studies were included. The estimated mean [± standard deviation (SD)] ADE cost was €2471.46 (± €1214.13). The mean (± SD) probability of preventable ADEs was 45% (± 21). The Tuscan expenditure for ADEs was €3,406,280.63 per million inhabitants (95% confidence interval (CI) 1,732,910.44-5,079,664.61) and the potential cost saving was €1,532,760.25 per million inhabitants (95% CI 779,776.1-2,285,750.60). Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS The present simulation showed that ADEs could have a relevant economic impact on the Tuscan healthcare system. In this setting, the prevention of ADEs would result in important cost savings. These results could be likely extended to other healthcare systems.
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Affiliation(s)
- Irma Convertino
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessandro Pecori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Maria Teresa Galiulo
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Parrilli
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Tiberio Corona
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Giuseppe Turchetti
- Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Corrado Blandizzi
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.,Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, via Roma 55, Pisa, 56126, Italy
| | - Marco Tuccori
- Division of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. .,Tuscan Regional Centre of Pharmacovigilance, Florence, Italy. .,Unit of Adverse Drug Reactions Monitoring, University Hospital of Pisa, via Roma 55, Pisa, 56126, Italy.
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O’Brien GL, O’Mahony D, Gillespie P, Mulcahy M, Walshe V, O’Connor MN, O’Sullivan D, Gallagher J, Byrne S. Cost-Effectiveness Analysis of a Physician-Implemented Medication Screening Tool in Older Hospitalised Patients in Ireland. Drugs Aging 2018; 35:751-762. [DOI: 10.1007/s40266-018-0564-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lenssen R, Schmitz K, Griesel C, Heidenreich A, Schulz JB, Trautwein C, Marx N, Fitzner C, Jaehde U, Eisert A. Comprehensive pharmaceutical care to prevent drug-related readmissions of dependent-living elderly patients: a randomized controlled trial. BMC Geriatr 2018; 18:135. [PMID: 29898670 PMCID: PMC6000946 DOI: 10.1186/s12877-018-0814-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. METHODS A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis. RESULTS Sixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors 'age' or 'length of stay on the ward' were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward). CONCLUSIONS Our findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01578525 , prospectively registered April 13, 2012.
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Affiliation(s)
- R Lenssen
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany.,Present address: Hospital Pharmacy, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Schmitz
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - C Griesel
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany
| | - A Heidenreich
- Department of Urology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Present address: Department of Urology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - J B Schulz
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - C Trautwein
- Department of Internal Medicine III, Gastroenterology, Metabolic Disorders and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - N Marx
- Department of Internal Medicine I, Cardiology, Pneumology, Angiology and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - C Fitzner
- Department of Medical Statistics, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - U Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - A Eisert
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.
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Sjölander M, Lindholm L, Pfister B, Jonsson J, Schneede J, Lövheim H, Gustafsson M. Impact of clinical pharmacist engagement in ward teams on the number of drug-related readmissions among older patients with dementia or cognitive impairment: An economic evaluation. Res Social Adm Pharm 2018; 15:287-291. [PMID: 29778344 DOI: 10.1016/j.sapharm.2018.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far. OBJECTIVES To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments. METHODS Economic evaluation of a randomised controlled trial conducted in two hospitals in Northern Sweden between January 2012 and December 2014. Participants included 460 hospital-admitted older patients with dementia or cognitive impairments. Patients were randomly assigned to usual care, or usual care with pharmacist intervention; the intervention consisted of medication reconciliation, medication review, and participation in ward rounds. The outcomes were measured as drug-related readmissions to hospital as assessed by a group of external experts, 180 and 30 days after discharge. Costs included pharmacists' direct labour costs for the interventions, average costs for drug-related readmissions, and from this the total cost per person was calculated. RESULTS The effect of the intervention on drug-related readmissions within 180 days was significant in patients without heart failure (subgroup analysis), and the intervention resulted in cost savings of €950 per person in this subgroup. Drug-related readmissions within 30 days were reduced in the total sample (post-hoc analysis), and the cost-savings in this intervention group were €460 per person. CONCLUSIONS Post-hoc and subgroup analyses indicate that engagement of pharmacists in hospital ward teams reduced the number of drug-related readmissions, and that the cost per person was lower in the intervention group compared to the control group. Including clinical pharmacists created savings in the subgroups of older patients with dementia or cognitive impairments.
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Affiliation(s)
- Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bettina Pfister
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Jeanette Jonsson
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology, Umeå University, Umeå, Sweden.
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Maaskant JM, Tio MA, van Hest RM, Vermeulen H, Geukers VG. Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis. Health Sci Rep 2018; 1:e23. [PMID: 30623062 PMCID: PMC6200092 DOI: 10.1002/hsr2.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children. METHOD We performed an interrupted time series analysis with 6 preintervention and 6 postintervention data collection points, in a tertiary pediatric intensive care unit. We included intensive care patients admitted during July to December 2013 (preintervention) and July to December 2014 (postintervention). The primary endpoint was the prevalence of MEs per 100 prescriptions. We reviewed the clinical records of the patients and the incident reporting system for MEs. If an ME was suspected, a pediatrician-intensivist and a clinical pharmacist determined causality and preventability. They classified MEs as harmful according to the National Coordinating Council for Medication Error Reporting and Prevention categories. RESULTS We included 254 patients in the preintervention period and 230 patients in the postintervention period. We identified 153 MEs in the preintervention period, corresponding with 2.27 per 100 prescriptions, and 90 MEs in the postintervention period, corresponding with 1.71 per 100 prescriptions. Autoregressive integrated moving average analyses revealed a significant change in slopes between the preintervention and postintervention periods (β = -.21; 95% CI, -0.41 to -0.02; P = .04). We did not observe a significant decrease immediately after the start of the intervention (β = -.61; 95% CI, -1.31 to 0.08; P = .07). CONCLUSION The implementation of a structured medication audit, followed by feedback by a clinical pharmacist as part of the multidisciplinary team, resulted in a significant reduction of MEs in a tertiary pediatric intensive care unit.
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Affiliation(s)
- Jolanda M. Maaskant
- Department of Pediatric Intensive Care, Emma Children's HospitalAcademic Medical CenterAmsterdamThe Netherlands
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Medical FacultyAcademic Medical Center and University of AmsterdamAmsterdamThe Netherlands
- ACHIEVE Centre of Applied Research, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - Marieke A. Tio
- Department of Hospital PharmacyAcademic Medical CenterAmsterdamThe Netherlands
| | - Reinier M. van Hest
- Department of Hospital PharmacyAcademic Medical CenterAmsterdamThe Netherlands
| | - Hester Vermeulen
- ACHIEVE Centre of Applied Research, Faculty of HealthAmsterdam University of Applied SciencesAmsterdamThe Netherlands
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare)Radboud University Medical CenterNijmegenThe Netherlands
| | - Vincent G.M. Geukers
- Department of Pediatric Intensive Care, Emma Children's HospitalAcademic Medical CenterAmsterdamThe Netherlands
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42
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Declaye C, Sennesael AL, Larock AS, Spinewine A, Krug B. Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital. Eur J Hosp Pharm 2018; 25:e66-e69. [PMID: 31157070 PMCID: PMC6457152 DOI: 10.1136/ejhpharm-2016-001024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Potential inappropriate use of direct oral anticoagulants (DOACs) increases the risk of thromboembolic and haemorrhagic events. PURPOSE To determine the net cost benefit of clinical pharmacy interventions on the prescription of DOACs. METHOD We constructed a decision tree model using a public payer perspective. The appropriateness of the prescription was assessed using the Medication Appropriateness Index. The theoretical risks were collected from the literature and the individual potential risks were calculated using the Nesbit risk assignment conducted by two independent clinical pharmacists. Different costs were included based on diagnosis-related group coding and data in the literature. A univariate sensitivity analysis was performed. RESULTS Thirty-six of 75 patients had an inappropriate prescription of DOACs. The saved difference between avoided costs (7954€) and annualised medication costs and pharmacist cost (4323€) was 3631€ for 75 patients. CONCLUSIONS In addition to the enhancement of the quality of the prescription, our results indicate that pharmacist interventions provide a positive net cost benefit.
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Affiliation(s)
- C Declaye
- Department of Pharmacy, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - A L Sennesael
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
- Namur Thrombosis and Hemostasis Center (NTHC), Universite de Namur, Namur, Belgium
| | - A S Larock
- Department of Pharmacy, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Namur Thrombosis and Hemostasis Center (NTHC), Universite de Namur, Namur, Belgium
| | - A Spinewine
- Department of Pharmacy, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
- Namur Thrombosis and Hemostasis Center (NTHC), Universite de Namur, Namur, Belgium
| | - B Krug
- Quality and Safety Officer, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Bayoud T, Waheedi M, Lemay J, Awad A. Drug therapy problems identification by clinical pharmacists in a private hospital in Kuwait. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:210-217. [PMID: 29475557 DOI: 10.1016/j.pharma.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To report the types and frequency of drug therapy problems (DTPs) identified and the physician acceptance of the clinical pharmacist interventions in a private hospital in Kuwait. METHODS A retrospective cross-sectional study was conducted on 3500 patients admitted to the hospital between December 2010 and April 2013. A structured approach was used to identify DTPs and recommend interventions. Data were analyzed using MAXQDA version 11. KEY FINDINGS A total of 670 DTPs were identified and recommendations were proposed to treating physicians for each DTP. Overdosage was the most frequently identified drug therapy problem (30.8%), followed by low dosage (17.6%), unnecessary drug therapy (17.3%), need for additional drug therapy (11.6%), and need for different drug product (11.6%). The drug classes most frequently involved were anti-infectives (36.9%), analgesics (25.2%), and gastrointestinal agents (15.5%). More than two-third of the interventions (67.5%) were accepted and implemented by physicians. The most frequently accepted interventions were related to nonadherence, adverse drug reaction, monitoring parameters, inappropriate dosage, and need for additional drug therapy. CONCLUSION The current findings expand the existing body of data by reporting on pharmacist recommendations of identified DTPs and importantly, their high rate of acceptance and implementation by the treating physician. These results could serve as a springboard to support further development and implementation of clinical pharmacy services in other healthcare settings in Kuwait.
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Affiliation(s)
- T Bayoud
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
| | - M Waheedi
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| | - J Lemay
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
| | - A Awad
- Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
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44
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Bosma LBE, Hunfeld NGM, Quax RAM, Meuwese E, Melief PHGJ, van Bommel J, Tan S, van Kranenburg MJ, van den Bemt PMLA. The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design. Ann Intensive Care 2018; 8:19. [PMID: 29417295 PMCID: PMC5803169 DOI: 10.1186/s13613-018-0361-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/23/2018] [Indexed: 02/06/2023] Open
Abstract
Background Medication errors occur frequently in the intensive care unit (ICU) and during care transitions. Chronic medication is often temporarily stopped at the ICU. Unfortunately, when the patient improves, the restart of this medication is easily forgotten. Moreover, temporal ICU medication is often unintentionally continued after ICU discharge. Medication reconciliation could be useful to prevent such errors. Therefore, the aim of this study was to determine the effect of medication reconciliation at the ICU. Methods This prospective 8-month study with a pre- and post-design was carried out in two ICU settings in the Netherlands. Patients were included when they used ≥ 1 chronic medicine and when the ICU stay exceeded 24 h. The intervention consisted of medication reconciliation by pharmacists at the moment of ICU admission and prior to ICU discharge. Medication transfer errors (MTEs) were collected and the severity of potential harm of these MTEs was measured, based on a potential adverse drug event score (pADE = 0; 0.01; 0.1; 0.4; 0.6). Primary outcome measures were the proportions of patients with ≥ 1 MTE at ICU admission and after discharge. Secondary outcome measures were the proportions of patients with a pADE score ≥ 0.01 due to these MTEs, the severity of the pADEs and the associated costs. Odds ratio and 95% confidence intervals were calculated, by using a multivariate logistic regression analysis. Results In the pre-intervention phase, 266 patients were included and 212 in the post-intervention phase. The proportion of patients with ≥ 1 MTE at ICU admission was reduced from 45.1 to 14.6% (ORadj 0.18 [95% CI 0.11–0.30]) and after discharge from 73.9 to 41.2% (ORadj 0.24 [95% CI 0.15–0.37]). The proportion of patients with a pADE ≥ 0.01 at ICU admission was reduced from 34.8 to 8.0% (ORadj 0.13 [95% CI 0.07–0.24]) and after discharge from 69.5 to 36.2% (ORadj 0.26 [95% CI 0.17–0.40]). The pADE reduction resulted in a potential net cost–benefit of € 103 per patient. Conclusions Medication reconciliation by pharmacists at ICU transfers is an effective safety intervention, leading to a significant decrease in the number of MTE and a cost-effective reduction in potential harm. Trial registration Dutch trial register: NTR4159, 5 September 2013, retrospectively registered
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Affiliation(s)
- Liesbeth B E Bosma
- Department of Pharmacy, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands. .,Apotheek Haagse Ziekenhuizen, PO Box 43100, 2504 AC, The Hague, The Netherlands. .,Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Nicole G M Hunfeld
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Rogier A M Quax
- Department of Intensive Care, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Maasstad Teaching Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Edmé Meuwese
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Piet H G J Melief
- Department of Intensive Care, Haga Teaching Hospital, PO Box 43100, 2504 AC, The Hague, The Netherlands
| | - Jasper van Bommel
- Department of Intensive Care, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - SiokSwan Tan
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maaike J van Kranenburg
- Department of Hospital Pharmacy, Gelre Hospitals, PO Box 9014, 7300 DS, Apeldoorn, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Dastan F, Jamaati H, Emami H, Haghgoo R, Eskandari R, Hashemifard SS, Khoddami F, Mirshafiei Langari Z. Reducing Inappropriate Utilization of Albumin: The Value of Pharmacist-led Intervention Model. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2018; 17:1125-1129. [PMID: 30127835 PMCID: PMC6094441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Albumin is known as a human blood product, with high cost and limited availability. Several studies have demonstrated the extent in which albumin is being utilized in controversial indications not supported or weakly supported by the available literature. To rationalize the use of albumin and to decrease the inappropriate cost of this expensive drug` a two phase study, with equal length of 66-days, comprising an observational drug utilization evaluation and a pharmacist-led audit and feedback interventional study, was conducted in a tertiary referral hospital in Tehran, Iran. The results of the interventional phase including the introduction of evidence-base guideline for albumin via a pharmacist-led audit and feedback intervention was compared to the ones from the observational phase. A total of 90 and 45 patients were included in the phase one and phase two of the study respectively. During the initial phase, 1870 albumin vials were used, of which 1467 (78.4%) vials were prescribed inappropriately. Inappropriate use of albumin was decreased significantly by 79.3% (p < 0.001) through the interventional phase, leading to 38,800 USD reduction in inappropriate costs of albumin. Introduction of evidence based guideline in conjugation with pharmacist-led audit and feedback can significantly decrease the inappropriate use of albumin. These results also demonstrate shifting towards a more evidence-based practice, which can increase patient's safety and enhance quality of care.
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Affiliation(s)
- Farzaneh Dastan
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Chronic Respiratory Diseases Research Center (CRDRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center (CRDRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences ,Tehran, Iran.
| | - Rodabeh Haghgoo
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Raha Eskandari
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Fatemeh Khoddami
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Mirshafiei Langari
- Pharmacovigilance Department, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kearney A, Walsh EK, Kirby A, Halleran C, Byrne D, Haugh J, Sahm LJ. A budget impact analysis of a clinical medication review of patients in an Irish university teaching hospital. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2018. [DOI: 10.1177/2284240318807726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alan Kearney
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Elaine K Walsh
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Ann Kirby
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Ciaran Halleran
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Derina Byrne
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Jennifer Haugh
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura J Sahm
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
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47
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Malet-Larrea A, Goyenechea E, Gastelurrutia MA, Calvo B, García-Cárdenas V, Cabases JM, Noain A, Martínez-Martínez F, Sabater-Hernández D, Benrimoj SI. Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:1069-1078. [PMID: 27913940 DOI: 10.1007/s10198-016-0853-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Drug related problems have a significant clinical and economic burden on patients and the healthcare system. Medication review with follow-up (MRF) is a professional pharmacy service aimed at improving patient's health outcomes through an optimization of the medication. OBJECTIVE To ascertain the economic impact of the MRF service provided in community pharmacies to aged polypharmacy patients comparing MRF with usual care, by undertaking a cost analysis and a cost-benefit analysis. METHODS The economic evaluation was based on a cluster randomized controlled trial. Patients in the intervention group (IG) received the MRF service and the comparison group (CG) received usual care. The analysis was conducted from the national health system (NHS) perspective over 6 months. Direct medical costs were included and expressed in euros at 2014 prices. Health benefits were estimated by assigning a monetary value to the quality-adjusted life years. One-way deterministic sensitivity analysis was undertaken in order to analyse the uncertainty. RESULTS The analysis included 1403 patients (IG: n = 688 vs CG: n = 715). The cost analysis showed that the MRF saved 97 € per patient in 6 months. Extrapolating data to 1 year and assuming a fee for service of 22 € per patient-month, the estimated savings were 273 € per patient-year. The cost-benefit ratio revealed that for every 1 € invested in MRF, a benefit of 3.3 € to 6.2 € was obtained. CONCLUSION The MRF provided health benefits to patients and substantial cost savings to the NHS. Investment in this service would represent an efficient use of healthcare resources.
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Affiliation(s)
- Amaia Malet-Larrea
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain.
| | - Estíbaliz Goyenechea
- Official Pharmacist Association of Guipúzcoa, Prim 2, 20006, San Sebastián, Spain
| | - Miguel A Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain
| | - Victoria García-Cárdenas
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Juan M Cabases
- Department of Economics, Public University of Navarra, Campus Arrosadía, 31006, Pamplona, Spain
| | - Aránzazu Noain
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Daniel Sabater-Hernández
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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48
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Rhalimi M, Rauss A, Housieaux E. Drug-related problems identified during geriatric medication review in the community pharmacy. Int J Clin Pharm 2017; 40:109-118. [PMID: 29188412 DOI: 10.1007/s11096-017-0571-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 11/23/2017] [Indexed: 01/14/2023]
Abstract
Background In line with the changing role of community pharmacists, we describe here a standardised procedure for detecting DRPs in elderly patients for use in community pharmacies. Objectives The primary aim was to describe the number and type of DRPs identified by community pharmacists in elderly patients. Secondary aims were to determine the number and type of associated pharmacist interventions (PIs) that were transmitted to the prescribers, and to identify risk factors associated with the occurrence of a PI. Setting Community pharmacies. Methods In this prospective, multicentre study, pharmacists received patients aged 65 and over. During a 30-min interview with patients who agreed to participate, patient characteristics were recorded such as age, weight, height, frailty (using the Short Emergency Geriatric Assessment grid), estimated renal function and compliance with treatment assessed by the Girerd scale. Main outcome measure DRPs characteristics. Results A total of 892 patients agreed to participate in 55 pharmacies. Among them 334 DRPs were identified and were associated with 259 PIs. Eighty-nine PIs of 259 were sent to the prescribing physicians; 70 (78%) were implemented by the general practitioner. Factors associated with the occurrence of a DRP are compliance problems [odds ratio (OR) = 1.8, 95% confidence interval (CI) (1.26-2.58)], frailty [OR = 1.3, 95% CI (1.01-1.66)], number of prescribed drugs per day [OR = 1.46, 95% CI (1.02-2.07)] and GFR < 60 mL/min [OR = 1.49, 95% CI (1.01-2.2)]. Conclusion This is the first standardised pharmaceutical assessment dedicated to the elderly carried out by community pharmacists in France. If implemented, it could help to find drug-related problems, identify frail elderly patients and ultimately decrease their exposure to iatrogenic medication errors.
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Affiliation(s)
- Mounir Rhalimi
- Centre Hospitalier Bertinot Juël, Service Pharmacie, 34 bis rue Pierre BUDIN, 60240, Chaumont en Vexin, France. .,INSERM U1088, Université de Picardie Jules Verne, Amiens, France.
| | - Alain Rauss
- ARCOSA, 94450, Limeil-Brévannes, Val de Marne, France
| | - Eric Housieaux
- Faculté de Pharmacie, 1 rue des Louvels, 80037, Amiens Cedex 1, France
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Medication Reviews by a Clinical Pharmacist at an Irish University Teaching Hospital. PHARMACY 2017; 5:pharmacy5040060. [PMID: 29077019 PMCID: PMC5748541 DOI: 10.3390/pharmacy5040060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose: Pharmacist-led medication reviews in hospitals have shown improvement in patient outcomes. The aim of this study is to describe the prevalence and nature of pharmacist interventions (PIs) following a medication review in an Irish teaching hospital. Methods: PIs were recorded over a six-month period in 2015. PIs were assessed by a panel of healthcare professionals (n = 5) to estimate the potential of adverse drug events (ADEs). Descriptive statistics were used for the variables and the chi square test for independence was used to analyse for any association between the variables. Results: Of the 1216 patients (55.8% female; median age 68 years (interquartile range 24 years)) who received a medication review, 313 interventions were identified in 213 patients. 412 medicines were associated with PIs, of which drugs for obstructive airway disease (n = 82), analgesics (n = 56), and antibacterial products for systemic use (n = 50) were the most prevalent. A statistically significant association was found between PI and patient’s age ≥65 years (p = 0.000), as well as female gender (p = 0.037). A total of 60.7% of the PIs had a medium or high likelihood of causing an ADE. Conclusion: Pharmacist-led medication review in a hospital setting prevented ADEs. Patients ≥65 years of age and female patients benefited the most from the interventions.
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Gregorová J, Rychlíčková J, Šaloun J. Standardization of clinical pharmacist's activities: Methodology. Saudi Pharm J 2017; 25:927-933. [PMID: 28951680 PMCID: PMC5605896 DOI: 10.1016/j.jsps.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 12/28/2016] [Accepted: 02/11/2017] [Indexed: 11/18/2022] Open
Abstract
Study objectives Establishing standardized and controlled system of work at a clinical pharmacy department and establishing effective recording of activities of a group of four clinical pharmacist when providing clinical pharmaceutical care (CPC) in a hospital. Methods The duration of evaluated period is 5.5 years. The first part was defining the purpose, methods and activities of clinical pharmaceutical care, the next part was designing the software for recording patient’s data and CPC activities. To verify the functionality of our system the third part was conducted (from January 1, 2015 to June 30, 2015). Results CPC activities were defined precisely. During the 6 months period, 3946 patients were reviewed (17% of patients admitted), in this group, 41% patients was labeled as risk (these patients had one or more risk factor). 1722 repeated reviews were performed, 884 drug therapy recommendations were recorded. The calculated average time necessary for one CPC activity is 28 min. Conclusion During the 5 year period, standardized system of work in clinical pharmacy department was established. This system is based on clearly defined activities and it enables external control. Our results supply data for negotiations with health insurance companies.
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Affiliation(s)
- Jana Gregorová
- Department of Clinical Pharmacy, Hospital Na Bulovce, Budinova 67/2, Prague 180 81, Czech Republic.,Department of Applied Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho tr. 1946/1, Brno 612 42, Czech Republic
| | - Jitka Rychlíčková
- Department of Clinical Pharmacy, Hospital Na Bulovce, Budinova 67/2, Prague 180 81, Czech Republic.,Department of Applied Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho tr. 1946/1, Brno 612 42, Czech Republic
| | - Jan Šaloun
- Department of Applied Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho tr. 1946/1, Brno 612 42, Czech Republic
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