Impact of pharmacist interventions on clinical outcome and cost avoidance in a university teaching hospital

Jourdan, Jean‐Pierre; Muzard, Alexandra; Goyer, Isabelle; Ollivier, Yann; Oulkhouir, Youssef; Henri, Patrick; Parienti, Jean‐Jacques; Breuil, Cécile

doi:10.1007/s11096-018-0733-6

Cited by 47 publications

(50 citation statements)

References 22 publications

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“…The most significant reduction of inappropriate prescribing in patients with RI has indeed been observed when physicians received immediate feedback from pharmacists [12]. Prescription review followed by recommendations by a pharmacist has been shown to positively influence clinical outcome and even reduce costs of hospital stay [37]. In our study, for manifest and potential rDRP, the three most often recommended interventions to the physician on ward would have been monitoring, change of dosage and change or discontinuation of a drug.…”

Section: Discussionmentioning

confidence: 67%

Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission

Seiberth

Bauer

Schönermarck

et al. 2020

Eur J Clin Pharmacol

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Purpose Two to seven percent of the German adult population has a renal impairment (RI) with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m 2. This often remains unrecognized and adjustment of drug therapy is lacking. To determine renal function in clinical routine, the CKD-EPI equation is used to calculate an indexed eGFR (ml/min/1.73m 2). For drug dosing, it has to be individualized to a non-indexed eGFR (ml/min) by the patient's body surface area. Here, we investigated the number of patients admitted to urological wards of a teaching hospital with RI between July and December 2016. Additionally, we correctly used the eGFR non-indexed for drug and dosage adjustments and to analyse the use of renal risk drugs (RRD) and renal drug-related problems (rDRP). Methods In a retrospective observational study, urological patients with pharmacist-led medication reconciliation at hospital admission and eGFR indexed (CKD-EPI) of 15-59 ml/min/1.73m 2 were identified. Indexed eGFR (ml/min/1.73m 2) was recalculated with body surface area to non-indexed eGFR (ml/min) for correct drug dosing. Medication at admission was reviewed for RRD and based on the eGFR non-indexed for rDRP, e.g. inappropriate dose or contraindication. Results Of 1320 screened patients, 270 (20.5%) presented with an eGFR indexed of 15-59 ml/min/1.73m 2. After readjustment, 203 (15.4%) patients had an eGFR non-indexed of 15-59 ml/min. Of these, 190 (93.6%) used ≥ 1 drugs at admission with 660 of 1209 (54.7%) drugs classified as RRD. At least one rDRP was identified in 115 (60.5%) patients concerning 264 (21.8%) drugs. Conclusion Renal impairment is a common risk factor for medication safety in urologic patients admitted to a hospital. Considerable shifts were seen in eGFR-categories when correctly calculating eGFR non-indexed for drug dosing purposes. The fact that more than half of the study patients showed rDRP at hospital admission underlines the need to consider this risk factor appropriately.

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Section: Discussionmentioning

confidence: 67%

Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission

Seiberth

Bauer

Schönermarck

et al. 2020

Eur J Clin Pharmacol

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“…Other pharmacist impact studies mostly focused on cost avoidance, for example in surgery, 9,13 psychiatry 19 or medical wards. 20,21 Surprisingly, there are few data on pharmacist impact in the oncology setting. A recent American study set in an ambulatory oncology unit only evaluated PI cost avoidance.…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Grégori

Pistre

Boutet

et al. 2020

J Oncol Pharm Pract

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Objectives To evaluate clinical and financial impact of pharmacist interventions in an ambulatory adult hematology–oncology department. Methods All cancer patients receiving a first injectable immuno- and/or chemotherapy regimen were included in this prospective study over a one-year period. The clinical impact of pharmacist interventions made by two clinical pharmacists was rated using the Clinical Economic and Organizational tool. Financial impact was calculated through cost savings and cost avoidance. Main results: Five hundred and fifty-eight patients were included. A total of 1970 pharmacist interventions were performed corresponding to a mean number of 3.5 pharmacist interventions/patient. The clinical impact of pharmacist interventions was classified as negative, null, minor, moderate, major and lethal in 0, 84 (4%), 1353 (68%), 385 (20%), 148 (8%) and 0 cases, respectively. The overall cost savings were €175,563. One hundred and nine (6%) of all pharmacist interventions concerned immuno- or chemotherapy regimen for cost savings of €148,032 (84% of the total amount of cost savings). The cost avoidance was €390,480. Cost avoidance results were robust to sensitivity analyses with cost of preventable adverse drug event as main driver of the model. When the cost of employing a pharmacist was subtracted from the average yearly cost savings plus cost avoidance per pharmacist, this yielded a net benefit of €223,021. The cost–benefit ratio of the clinical pharmacist was €3.7 for every €1 invested. Principal conclusions: To have two full-time clinical pharmacists in a 55-bed ambulatory adult hematology–oncology department is both clinically and financially beneficial.

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“…7 This high incidence of DRP negatively affects the quality of life of the patient and increases the economic and social burden of illnesses. 5 Many of the admissions to emergency departments, 10 11 many causes of extended hospital stays 12 or of patient re-admissions, 13 and even of deaths, are due to a DRP. It has been reported that these negative outcomes are proportional to the complexity of the drug use process, 14 with some of the described risk factors being polypharmacy, hepatopathies, nephropathies and the use of high-risk medicines.…”

Section: Introductionmentioning

confidence: 99%

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

et al. 2020

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ObjectivesTo evaluate the incidence and types of drug-related problems (DRP) in a general teaching hospital and to evaluate the acceptability of pharmaceutical interventions by the medical team.DesignProspective cohort study during 2 years.SettingConducted in a Brazilian University Hospital.ParticipantsThe patient cohort consisted of 9303 patients with a total of 12 286 hospitalisation episodes.Primary outcome measuresDRP detected by pharmacists’ review of 100% medication orders using Pharmaceutical Care Network Europe 6.2 classification.ResultsPatients with a mean age of 52.6±17.7 years and 50.9% females. A total of 3373 DRP in 1903 hospital episodes were identified, corresponding to a cumulative incidence of 15.5%. ‘Treatment ineffectiveness’ (11.5%) and ‘Treatment costs’ (5.90%) were the most common DRP and ‘Drug use process’ (18.4%) and ‘Treatment duration’ (31.0%) the main causes of DRP. The medicines involved most often involved in DRP were anti-infectives (36.0%), mainly cephalosporins (20.2%), antiulcer (38.6%), analgesics/antipyretics (61.2%), propulsives (51.2%), opioids (38.5%) and antiemetics (57.4%). From 1939 pharmaceutical interventions, at least, 21.4% were not approved by the medical team.ConclusionDRP detected by 100% medication order review by hospital pharmacists occur in a significant proportion of hospital episodes, the most frequent being related to treatment effectiveness and treatment costs. The medications mostly involved were cephalosporins, penicillins, antidyspeptics, analgesics, antipyretics, opioids and antiemetics. Pharmaceutical interventions had low acceptability by the medical staff.

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Impact of pharmacist interventions on clinical outcome and cost avoidance in a university teaching hospital

Cited by 47 publications

References 22 publications

Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission

Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission

Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

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