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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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Nymoen LD, Pettersen JLS, Flatebø TE, Øie E, Viktil KK. Drug-related emergency department visits: external validation of an assessment tool in a general emergency department population. Int J Clin Pharm 2024:10.1007/s11096-024-01760-8. [PMID: 38958864 DOI: 10.1007/s11096-024-01760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The process of identifying drug-related hospitalisations is subjective and time-consuming. Assessment tool for identifying hospital admissions related to medications (AT-HARM10) was developed to simplify and objectify this process. AT-HARM10 has not previously been externally validated, thus the predictive precision of the tool is uncertain. AIM To externally validate AT-HARM10 in adult patients admitted to the emergency department (ED). METHOD This retrospective cross-sectional study investigated 402 patients admitted to the ED, Diakonhjemmet Hospital, Oslo, Norway. A trained 5th-year pharmacy student used AT-HARM10 to assess all patients and to classify their ED visits as possibly or unlikely drug-related. Assessment of the same patients by an interdisciplinary expert panel acted as the gold standard. The external validation was conducted by comparing AT-HARM10 classifications with the gold standard. RESULTS According to AT-HARM10 assessments, 169 (42%) patients had a possible drug-related ED visit. Calculated sensitivity and specificity values were 95% and 71%, respectively. Further, positive and negative predictive values were 46% and 98%, respectively. Adverse effects/over-treatment and suboptimal treatment were the issues most frequently overestimated by AT-HARM10 compared with the gold standard. CONCLUSION AT-HARM10 identifies drug-related ED visits with high sensitivity. However, the low positive predictive value indicates that further review of ED visits classified as possible drug-related by AT-HARM10 is necessary. AT-HARM10 can serve as a useful first-step screening that efficiently identifies unlikely drug-related ED visits, thus only a smaller proportion of the patients need to be reviewed by an interdisciplinary expert panel.
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Affiliation(s)
| | | | | | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten K Viktil
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway.
- Department of Pharmacy, University of Oslo, Oslo, Norway.
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Ruiz-Ramos J, Plaza-Diaz A, Roure-i-Nuez C, Fernández-Morató J, González-Bueno J, Barrera-Puigdollers MT, García-Peláez M, Rudi-Sola N, Blázquez-Andión M, San-Martin-Paniello C, Sampol-Mayol C, Juanes-Borrego A. Drug-Related Problems in Elderly Patients Attended to by Emergency Services. J Clin Med 2023; 13:3. [PMID: 38202010 PMCID: PMC10779430 DOI: 10.3390/jcm13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
The progressive aging and comorbidities of the population have led to an increase in the number of patients with polypharmacy attended to in the emergency department. Drug-related problems (DRPs) have become a major cause of admission to these units, as well as a high rate of short-term readmissions. Anticoagulants, antibiotics, antidiabetics, and opioids have been shown to be the most common drugs involved in this issue. Inappropriate polypharmacy has been pointed out as one of the major causes of these emergency visits. Different ways of conducting chronic medication reviews at discharge, primary care coordination, and phone contact with patients at discharge have been shown to reduce new hospitalizations and new emergency room visits due to DRPs, and they are key elements for improving the quality of care provided by emergency services.
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Affiliation(s)
- Jesús Ruiz-Ramos
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| | - Adrián Plaza-Diaz
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
| | - Cristina Roure-i-Nuez
- Pharmacy Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (C.R.-i.-N.); (J.F.-M.)
| | - Jordi Fernández-Morató
- Pharmacy Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (C.R.-i.-N.); (J.F.-M.)
| | - Javier González-Bueno
- Pharmacy Department, Hospital Dos de Maig Consorci Sanitari Integral, 08025 Barcelona, Spain; (J.G.-B.); (M.T.B.-P.)
- Central Catalonia Chronicity Research Group (C3RG), Universitat de Vic-Universitat Central de Catalunya, 08500 Vic, Spain
| | | | - Milagros García-Peláez
- Pharmacy Department, Hospital General de Granollers, 08402 Granollers, Spain; (M.G.-P.); (N.R.-S.)
| | - Nuria Rudi-Sola
- Pharmacy Department, Hospital General de Granollers, 08402 Granollers, Spain; (M.G.-P.); (N.R.-S.)
| | - Marta Blázquez-Andión
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
- Emergency Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Carla San-Martin-Paniello
- Strategy and Innovation Office (Més Sant Pau), Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.S.-M.-P.); (C.S.-M.)
| | - Caterina Sampol-Mayol
- Strategy and Innovation Office (Més Sant Pau), Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (C.S.-M.-P.); (C.S.-M.)
| | - Ana Juanes-Borrego
- Pharmacy Department, Hospital Santa Creu i Sant Pau, 08025 Barcelona, Spain; (A.P.-D.); (A.J.-B.)
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain;
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Dunn TE, Desai KJ, Krajewski MP, Jacobs DM, Lu CH, Paul S, Paladino JA. Pharmacists and transitions of care from emergency department to home. THE AMERICAN JOURNAL OF MANAGED CARE 2023; 29:715-719. [PMID: 38170487 PMCID: PMC10926005 DOI: 10.37765/ajmc.2023.89473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To determine the impact of a pharmacist-led telephone outreach program among patients discharged from the emergency department (ED) to home. STUDY DESIGN We conducted a randomized controlled study from February to November 2019 at a tertiary care academic medical center. METHODS At ED discharge, participants were randomly assigned to usual care (controls) or usual care plus the pharmacist's review (intervention group). Eligible individuals included those being discharged from the ED to home with 8 or more medications. A pharmacist telephoned patients in the intervention group within 48 to 96 hours after ED discharge. The medications in the patient's record from the ED were compared with what the patient was taking at home. Discrepancies were communicated to the primary provider via fax or telephone. The primary outcome was overall health care utilization including unplanned hospital readmissions or ED visits within 30 days of discharge. The effect of the intervention on the number of acute events was analyzed using a Poisson regression model adjusting for relevant baseline characteristics. RESULTS Of 90 eligible participants, 45 patients each were in the intervention and control groups. A total of 26 patients (58%) in the intervention group were reached, and 56 interventions were provided by the pharmacists. There was no significant difference between groups for overall health care utilization (adjusted risk ratio [aRR], 1.01; 95% CI, 0.50-2.06; P = .96), hospitalizations (aRR, 0.20; 95% CI, 0.02-2.18; P = .19), and ED visits (aRR, 1.24; 95% CI, 0.56-2.79; P = .59). CONCLUSIONS A pharmacist-led telephone outreach program conducted after ED discharge was not associated with a change in health care utilization.
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Affiliation(s)
| | | | | | | | - Chi-Hua Lu
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, 3435 Main St, 344 Abbott Hall, Buffalo, NY 14214. . ORCID: 0000-0001-9647-4363
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van Nuland M, Butterhoff M, Verwijmeren K, Berger F, Hogervorst VM, de Jonghe A, van der Linden PD. Assessment of drug-related problems at the emergency department in older patients living with frailty: pharmacist-led medication reviews within a geriatric care team. BMC Geriatr 2023; 23:215. [PMID: 37016324 PMCID: PMC10074685 DOI: 10.1186/s12877-023-03942-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Older patients are vulnerable to experiencing drug related problems (DRPs), which may result in emergency department (ED) visits. However, it is not standard practice to conduct medications reviews during ED visit. The aim of this study was to assess the number of DRPs in older patients living with frailty at the ED, identified through pharmacist-led medication reviews within a geriatric care team, and to determine the acceptance rate of pharmacists' recommendations among hospital physicians and general practitioners or elderly care specialists. METHODS A retrospective observational study was performed in patients ≥ 70 years living with frailty at the ED at Tergooi Medical Center. Pharmacist-led medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. The acceptance rate of given recommendations was determined during follow-up. RESULTS A total of 356 ED visits were included. The mean (standard deviation, SD) age of patients was 83 (6.8) years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP (SD 1.3) per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients. CONCLUSIONS Pharmacist-led medication reviews as part of a geriatric care team identified DRPs in 76% of older patients living with frailty at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients.
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Affiliation(s)
- Merel van Nuland
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands.
| | - Madelon Butterhoff
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Karin Verwijmeren
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Florine Berger
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | | | | | - Paul D van der Linden
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
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