A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older

Gillespie, Ulrika; Alassaad, Anna; Henrohn, Dan; Garmo, Hans; Hammarlund‐Udenaes, Margareta; Toss, Henrik; Kettis-Lindblad, Åsa; Melhus, Håkan; Mörlin, Claes

doi:10.1001/archinternmed.2009.71

Cited by 495 publications

(683 citation statements)

References 34 publications

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“…Gillespie et al identified 2.6 DRPs per patient, all of which were put forward and the physicians made adjustments for 69% of the DRPs while 23% of the suggestions were rejected (16). Blix et al identified 3.2 DRPs per patient and 74% of the identified DRPs were put 11 forward (26).…”

Section: Discussionmentioning

confidence: 99%

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The process of identifying, solving and preventing drug related problems in the LIMM-study

et al. 2011

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Objective To avoid negative effects of drug treatment and need for additional medical care, drug treatment must be individualised. Our research group has developed a model for clinical pharmacy which improves several aspects of the patient's drug treatment. This study describes the process behind these improvements, i.e. drug related problems identified by pharmacists within a clinical pharmacy service.Setting Three wards at a department of internal medicine.Method Pharmacists performed systematic interventions during the patient's hospital stay, aiming to identify, solve and prevent drug related problems in the elderly. Identified drug related problems were put forward to the health care team and discussed. Information on identified problems, and their outcomes was collected and analysed. A questionnaire was used to evaluate the health care personnel's attitudes towards the process. Main outcome measureThe number of drug related problems identified by the clinical pharmacists, the proportion of problems discussed with the physicians, the proportion of problems adjusted by the physicians and whether pharmacists and physicians prioritised any subgroup of drug related problems when choosing which problems to address. Finally, we wanted to evaluate the health care personnel's attitudes towards the model. ResultsIn total, 1227 problem were identified in 190 patients. The pharmacists discussed 685 (55.8%) of the identified problems with the physicians who accepted 438 (63.9%) of the suggestions. There was no significant difference in which subgroup to put forward and which to adjust. There was a high response rate (84%) to the questionnaire, and the health care personnel estimated the benefits to be very high, both for the patients and for themselves. ConclusionThe process for identifying, solving and preventing drug related problems was good and the different types of problems were considered equally important. The addition of a clinical pharmacy service was considered very useful. This suggests that the addition of our clinical pharmacy service to the hospital setting add skills of great importance. KeywordsClinical pharmacy service, Drug related problem (DRP), elderly, inpatients, LIMM-study,

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Section: Discussionmentioning

confidence: 99%

“…An increase in staffing of clinical pharmacist at United States hospitals reduced hospital drug costs (15). In Sweden, a clinical pharmacy service resulted in a decrease in drug related hospital readmissions and health care costs (16).…”

Section: The Process Of Identifying Solving and Preventing Drug Relamentioning

confidence: 99%

The process of identifying, solving and preventing drug related problems in the LIMM-study

et al. 2011

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“…[6][7][8][9][10][11][12][13][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Twenty-one studies applied to general populations, largely older adults and together included 10 445 patients. 1,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] Four studies applied to unique populations. 2,3,75,76 Twenty-nine studies were based in the United States, while the rest were in other nations.…”

Section: Population and Contextmentioning

confidence: 99%

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission

et al. 2017

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IMPORTANCE Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. OBJECTIVE To systematically review economic evaluations of QI interventions designed to reduce readmissions. DATA SOURCES Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat (January 2004 to July 2016).STUDY SELECTION Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs.DATA EXTRACTION AND SYNTHESIS Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs. We calculated the risk difference and net costs to the health system in 2015 US dollars. Weighted least-squares regression analyses tested predictors of the risk difference and net costs. MAIN OUTCOMES AND MEASURESMain outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTSOf 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95% CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3% among general populations (95% CI, 4.

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“…The clinical pharmacy process involves identifying potential and actual DRPs, resolving actual DRPs and preventing potential DRPs. Previous studies have demonstrated that clinical pharmacy services for in-patients reduce the number of drug-related problems [12], the length of stay [13][14][15][16], costs [13,[16][17], adverse drug reactions [18], rates of readmission [14][15] and rates of drug-related readmission [19].…”

Section: Introductionmentioning

confidence: 99%

In-hospital medication reviews reduce unidentified drug-related problems

Bondesson

Eriksson

Kragh

et al. 2012

Eur J Clin Pharmacol

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A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older

Abstract: If implemented on a population basis, the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs.

Cited by 495 publications

References 34 publications

The process of identifying, solving and preventing drug related problems in the LIMM-study

The process of identifying, solving and preventing drug related problems in the LIMM-study

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission

In-hospital medication reviews reduce unidentified drug-related problems

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