Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis

Abstract

BackgroundPharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. ObjectiveTo systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. MethodsThe protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched.Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. ResultsEighteen RCTs and 7 economic studies were included. The RCTs were from USA (n=3), Sweden (n=2), Netherlands. The economic studies were from UK (n=2), Sweden (n=2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean= -1.74 days [95% CI: -2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) =1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) =£632/ QALY-gained). No evidence was found for 7-day pharmacist presence. Conclusions M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTPharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is costeffective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective. KEY WORDSClinical pharmacy, Systematic review, Meta-analysis, Cost effectiveness, acute medicine Adverse drug events (ADEs) are common in clinical settings, with a reported incidence from 2.3% in paediatric 2 inpatients to 27.4% in adult outpatients. 1 2 In adult inpatients, the reported incidence is 6.5%. 3 These ADEs are 3 direct causes of patient harm, dissatisfaction, prolonged hospital stay and increased costs. Pharmacists are 4 considered the medication experts in the health care team. Their extensive training in and knowledge of 5 pharmacology and therapeutics have placed them in the best position to undertake this role and to advise other 6 health care professionals on matters relating to appropriate prescribing and safe use of medicines. 4 7The pharmacist role in the hospital setting has evolved over the years, moving from a wholly dispensary-based 8 role to a more clinically-focused one based on the ward. 5 In fact, the presence of a ward-based p...

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