Implementation of Ward-Based Clinical Pharmacy Services in Belgium—Description of the Impact on a Geriatric Unit

Abstract

Background: Patient-centered clinical pharmacy services are still poorly developed in Europe, despite their demonstrated advantages in North America and the UK. Reporting European pilot experiences is, therefore, important to assess the usefulness of clinical pharmacy services in this specific context. Objective: To report the results of the first implementation of Belgian clinical pharmacy services targeting patients at high risk of drug-related problems. Methods: An intervention study was conducted by a trained clinical pharmacist providing pharmaceutical care to 101 patients (mean age 82.2 y; mean ± SD number of prescribed drugs 7.8 ± 3.5) admitted to an acute geriatric unit, over a 7 month period. All interventions to optimize prescribing, and their acceptance, were recorded. An external panel (2 geriatricians, 1 clinical pharmacist) assessed the interventions' clinical significance. Persistence of interventions after discharge was assessed through telephone calls. Results: A total of 1066 interventions were made over the 7 month period. The most frequent drug-related problems underlying interventions were: underuse (15.9%), wrong dose (11.9%), inappropriate duration of therapy (9.7%), and inappropriate choice of medicine (9.6%). The most prevalent consequences were to discontinue a drug (24.5%), add a drug (18.6%), and change dosage (13.7%). Acceptance rate by physicians was 87.8%. Among interventions with clinical impact, 68.3% and 28.6% had moderate and major clinical significance, respectively. Persistence of chronic treatment changes 3 months after discharge was 84%. Conclusions: Involving a trained clinical pharmacist in a geriatric team led to clinically relevant and well-accepted optimization of medicine use. This initiative may be a springboard for further development of clinical pharmacy services.

Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial

“…Fourth, whether the intervention improved compliance and quality of life and decreased adverse drug events was not evaluated (although an analysis of all interventions made by the clinical pharmacist suggests that this might have been the case). 18 Further work on the pharmacoeconomic benefit of the intervention is also needed.…”

“…18 Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient. 19 Briefly, the pharmacist was present on the unit 4 days per week, participated in medical and multidisciplinary rounds, had direct contact with patients and caregivers, and had access to patient medical records.…”

Electronic screening of medical records to detect inpatients at risk of drug-related problems

“…Approaches to detect and decrease DRPs are of great interest for hospitals. Clinical pharmacy services can have a positive impact on DRPs and so optimize medication use [3]. I In Swiss hospitals, drug orders are not systematically validated by a pharmacist, but as the clinical pharmacists (CPs) in our institution carry out different ward rounds, weekly or bimonthly, they can make recommendations in the patient's treatment.…”

Segurança do paciente no uso de medicamentos após a alta hospitalar: estudo exploratório1

“…Barriers for implanting and developing activities related to patient discharge care were also pointed out in studies conducted in other countries (Griffith et al, 1998;Alibhai et al, 1999;ASHP, 2005;Spinewine et al, 2006;Pedersen et al, 2007;Barnsteiner, 2008), showing that this is a common problem. Among the barriers mentioned were: lack of support by administration leadership, inadequate staff (insuficient or no specific training), lack of a systematized program, lack of previous notification on the discharge plan, lack of time and the need to use IT in an integrated way.…”