An evaluation of clinical pharmacist service on a neurology care unit

Zhang, Yi; Sun, Shusen; Li, Xiao-Xiao; Lu, Ming; Zhai, Suodi

doi:10.1007/s11096-015-0224-y

Cited by 15 publications

(13 citation statements)

References 7 publications

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“…It was reported that the incidence of PIMs was significantly reduced after pharmacists' assessment and intervention, 4 which indicated the importance of clinical pharmacist involvement in detecting and solving PIMs. However, in China, clinical pharmacy services only began in 2005 after the China Ministry of Health issued a series of documentations regarding clinical pharmacists 19 . Over the last few years, pharmacists are actively engaged in pharmaceutical care.…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications and potentially prescribing omissions in Chinese older patients: Comparison of two versions of STOPP/START

Tong

Zhang

2020

J Clin Pharm Ther

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What is known and objective The aim of this study was to compare the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in elderly Chinese patients identified by the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) version 2 (v2) and version 1 (v1). The secondary objective was to analyse the risk factors associated with the PIMs/PPOs. Methods This was a retrospective cross‐sectional study, and all patients were aged ≥65 years and discharged from internal medical wards of Beijing Chaoyang Hospital in December 2018. STOPP/START v2 and STOPP/START v1 were used to detect PIMs/PPOs. The concordance between the two versions was calculated using kappa tests. A logistic regression analysis was carried out to determine variables independently associated with PIM/PPO use. Results and discussion In the 662 patients included, the median age was 73 years and 361 were male (54.53%). PIMs were present in 36.1% and 47.7% of participants according to the STOPP v1 and STOPP v2, respectively. The prevalence of PPOs was 42.0% and 64.2% according to the START v1 and START v2, respectively. Drug prescribed without indication was the most common item in PIMs, whereas ACEIs were the drugs most frequently involved with PPOs according to the STOPP/START v2. Two versions of the STOPP criteria indicated a moderate coherence, whereas two versions of the START criteria showed poor accordance. Age (OR 1.029, 1.004‐1.054), gender (OR 1.536, 1.103‐2.138) and the number of prescribed medications (<5: OR 1; 5‐9: OR 2.503, 1.173‐5.342; ≥10: OR 4.324, 2.204‐9.235) were associated factors with PIMs identified by the STOPP v2, whereas PPOs identified by the START v2 were independently associated with age (OR 1.039, 1.012‐1.066), activities of daily living (ADL) score (OR 2.713, 1.818‐4.048), the number of prescribed medications (<5: OR 1; 5‐9: OR 2.704, 1.524‐4.795; ≥10: OR 3.075, 1.704‐5.549) and Charlson Comorbidity Index (OR 1.302, 1.110‐1.529). What is new and conclusion This study showed a high prevalence of PIMs/PPOs in aged internal medical ward inpatients in China, which was associated with various correlates. The STOPP/START v2 had a higher detection rate than v1.

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Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications and potentially prescribing omissions in Chinese older patients: Comparison of two versions of STOPP/START

Tong

Zhang

2020

J Clin Pharm Ther

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“…The management of pharmacotherapy through pharmacists' interventions, which is difficult and complex when involving inpatients with neurological diseases, specially older ones 2 , 26 , 27 , can seem costly in a simple direct cost analysis. For instance, in this study the prevalence of medicine addition was higher than withdrawal, which certainly reflected on direct hospital costs.…”

Section: Discussionmentioning

confidence: 99%

“…The most prevalent neurological diseases, especially if considered in more advanced stages, generally require pharmacological treatments, whose use is characterized by complex dosage, potential for interaction with other medication and/or the occurrence of important adverse reactions 1 , 2 .…”

Section: Introductionmentioning

confidence: 99%

Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

et al. 2020

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OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI -31,850 – -10,610), -US$27,112 (95%CI -33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95%CI 27,645–75,716) and, 4.6 (95%CI 2.24–10.05), US$91,496 (95%CI 34,700–168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.

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“…Recommendations to optimize pharmacotherapy may then be proposed to the prescriber. The acceptance rate of these interventions has been shown to vary between 52 and 100% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This variation can be explained by differences in, among other things, the prescribing process (computerized or handwritten), the identification of potential drug-related problems (using CDSS or medication review), the medical ward (medical, surgical or intensive care unit) and the way of communicating the intervention (over the telephone, during ward rounds and/or electronically).…”

Section: Introductionmentioning

confidence: 99%

Physicians’ acceptance of pharmacists’ interventions in daily hospital practice

et al. 2020

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Background The physicians' acceptance rate of pharmacists' interventions to improve pharmacotherapy can vary depending on the setting. The acceptance rate of interventions proposed by pharmacists located in the hospital pharmacy over the telephone and factors associated with acceptance are largely unknown. Objective To determine the physicians' acceptance rate of pharmacists' interventions proposed over the telephone in daily hospital practice and to identify factors associated with acceptance. Setting A retrospective case-control study was performed concerning adult patients admitted to a university hospital in the Netherlands. Method Pharmacists' interventions, based on alerts for drug-drug interactions and drug dosing in patients with renal impairment, recorded between January 2012 and June 2013 that were communicated over the telephone were included. Factors associated with physicians' acceptance were identified with the use of a mixed-effects logistic model. Main outcome measure The primary outcome was the proportion of accepted interventions. Results A total of 841 interventions were included. Physicians accepted 599 interventions, resulting in an acceptance rate of 71.2%. The mixed-effects logistic model showed that acceptance was significantly associated with the number of prescribed drugs (16 to ≤ 20 drugs OR adj 1.88; 95% CI 1.05-3.35, > 20 drugs OR adj 2.90; 95% CI 1.41-5.96, compared to ≤ 10 drugs) and the severity of the drug-related problem (problem without potential harm OR adj 6.36; 95% CI 1.89-21.38; problem with potential harm OR 6.78; 95% CI 2.09-21.99, compared to clinically irrelevant problems), and inversely associated with continuation of pre-admission treatment (OR adj 0.55; 95% CI 0.35-0.87). Conclusion Over the study period, the majority of pharmacists' interventions proposed over the telephone were accepted by physicians. The probability for acceptance increased for patients with an increasing number of medication orders, for clinically relevant problems and for problems related to treatment initiated during admission.

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An evaluation of clinical pharmacist service on a neurology care unit

Abstract: Presence of clinical pharmacists at the neurology unit may help in early detection of prescribing errors with increased patient safety.

Cited by 15 publications

References 7 publications

Potentially inappropriate medications and potentially prescribing omissions in Chinese older patients: Comparison of two versions of STOPP/START

Potentially inappropriate medications and potentially prescribing omissions in Chinese older patients: Comparison of two versions of STOPP/START

Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

Physicians’ acceptance of pharmacists’ interventions in daily hospital practice

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