Acceptance Factors for In-Hospital Pharmacist Interventions in Daily Practice: A Retrospective Study

Abstract

Introduction: Performing pharmacist interventions (PIs) during the medication review helps to improve the quality of care. The acceptance by the physician of these PIs is a good indicator of the quality of this clinical pharmacy activity. The objective of this study was to determine, in the Amiens-Picardie teaching hospital (France), factors of acceptance in a variable environment of activity (central pharmacy, in the care units, computer assisted).Methods: All PIs transcribed by pharmacists on the Act-IP© site between November 2018 and April 2019 were analyzed using a complementary search in patient records. The environment, type, and clinical impact on patient health of each PI was collected. Linear mixed-effects models with a random pharmacist intercept were used to investigate the relationship between PI modalities and their chance of being accepted.Results: A total of 3,100 PIs were traced, of which 2,930 had been followed over time. Of these, 2,930 PIs, 1,504 (51.3%) were performed by a postgraduate pharmacist and 1,426 (48.7%) by a pharmacy resident, 1,623 (55.4%) were performed by verbal exchange, 455 (15.5%) by telephone, 846 (28.9%) by computer software, and 6 (0.2%) by paper. The clinical impact on patient health was major for 976 PIs (33.3%) and vital for 26 PIs (0.9%). According to the Anatomical Therapeutic Chemical Classification (ATC), they were mainly related to anti-infectives (30.3%), the nervous system (18.7%), and blood and blood-forming organs (17.3%). In total, 2,415 PIs (82.4%) were accepted. According to the multivariate model, a PI was more often accepted when it was transmitted orally rather than by software (+27.7%, 95% CI: +23.2 to +32.1%) and when it was transmitted to a medical resident rather than a postgraduate physician (+4.4%, 95% CI: 1.2–7.6%). In these cases, there was a major rather than a moderate clinical impact on patient health (+4.3%, 95% CI: +1.1–+7.6%).Conclusion: This study highlights the importance of the quality of the exchange with the prescriber and the prioritization of high-risk interventions as key points of medication review to improve rate of pharmacist interventions accepted by physician.

Telephone versus In-Person Pharmacist-Led Medication Reviews in Home Dialysis Patients: Evaluating Quality of Care and Patient Satisfaction

“…We hypothesize that the loss of opportunity for in-person discussions following adoption of a virtual clinic model led to a lower physician acceptance of pharmacist recommendations. This is supported by the findings of a retrospective study of acceptance factors for hospital pharmacist interventions [ 17 ]. Pharmacist recommendations were accepted more often when communicated verbally to physicians (either in-person or by phone) rather than by text through a hospital software system (+27.7%, 95% CI: +23.2 to +32.1%) [ 17 ].…”

“…This is supported by the findings of a retrospective study of acceptance factors for hospital pharmacist interventions [ 17 ]. Pharmacist recommendations were accepted more often when communicated verbally to physicians (either in-person or by phone) rather than by text through a hospital software system (+27.7%, 95% CI: +23.2 to +32.1%) [ 17 ]. Alternatively, in a study by Bruns et al investigating the control of blood pressure, all recommendations made, regardless of appointment type, were accepted by the care team [ 8 ].…”

The impact of pharmacists’ interventions within the Closed Loop Medication Management process on medication safety: An analysis in a German university hospital

“…The overall acceptance rate of PIs in our data was high with 91.9% and is comparable with those of the MEDAP study (89%). In a retrospective study from Durand et al ( Durand et al, 2022b ), they analyzed 2,930 PIs transcribed of CPs over a 6-months period in a French online database (Standardisation et Valorisation des Activités de Pharmacie Clinique, Act-IP © ). The reported acceptance rate of PIs for all methods of contact was lower with 82.4%, but for PIs submitted verbal or via phone call, acceptance rates were higher than 90%.…”

“…An observational study by Bedouch et al evaluated PIs documented on this site during a 30-month period to describe the nature of PIs made across all medical specialties and ward types ( Bedouch et al, 2015 ). While nationwide analyses focusing on the relevance of PIs are rare in literature, there are more published single center analyses ( Bosma et al, 2008 ; Zhang et al, 2012 ; Zaal et al, 2020 ; Durand et al, 2022 ). However, international comparison of studies is difficult because of different settings and a lack of standardization in terms of definitions and methods.…”

Desprescrição de medicamento em unidade de terapia intensiva de um hospital universitário do Ceará

“…44 Além disso, estudos apontam que as recomendações farmacêuticas transmitidas a médicos residentes estão associadas a uma maior taxa de aceitação, provavelmente devido a sua maior disponibilidade e abertura a discussões, fator importante em um hospital universitário, como o deste estudo. 45 Nossos achados indicam que a prescrição de medicamentos não necessários (sem indicação e/ou sem evidência científica de benefício terapêutico) foi o motivo mais prevalente das recomendações de desprescrição. Embora seja limitados, uma revisão sistemática mostra que o uso de medicamentos desnecessários em idosos, população de idade similar a deste estudo, varia de 40 a 50% e que este pode causar danos irreversíveis ao paciente, como o declínio cognitivo morte prematura.…”