Physicians’ acceptance of pharmacists’ interventions in daily hospital practice

Zaal, Rianne J.; Haak, Edwin W. den; Andrinopoulou, E.-R.; Gelder, Teun van; Vulto, Arnold G.; Bemt, Patricia M. L. A. van den

doi:10.1007/s11096-020-00970-0

Cited by 37 publications

(36 citation statements)

References 23 publications

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“…Previous works have suggested that the clinical impact on patient health of a PI facilitates its acceptance, but these studies had a small sample and did not use the CLEO scale ( Zaal et al, 2020 ). The fact that PIs are significantly more often accepted when they have a major clinical impact on patient health should support the medical attention they generate.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…17 Studies on the acceptance rates of pharmaceutical interventions demonstrate great variability of these numbers, with rates between 50% and 99.5% of the total interventions. [18][19][20] This study found an acceptance rate of 83.5% by the medical team in the total of interventions for medication discrepancies, and all the interventions related to unintentional discrepancies were accepted. The interventions that were not accepted were related to discrepancies in which there was no record in the medical chart of the clinical reason for their occurrence, which warns of the need for institutional initiatives to optimize the medical record of medication reconciliation, including continuing education actions.…”

Section: Resultsmentioning

confidence: 99%

Medication reconciliation in emergency department - the role of clinical pharmacist

Barbosa¹,

Szpak²,

Chrispim³

2021

Rev Bras Farm Hosp Serv Saude

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Objective: To classify the frequencies and types of pharmaceutical interventions related to medication reconciliation performed in the hospital emergency room. Methods: This is a retrospective sectional study of medication reconciliation carried out in the emergency department of a referral hospital in cardiology from June 11 to August 11, 2019. All patients admitted to the sector at the corresponding period and that have been reconciled were selected for the study. Patients’ home medications were classified according to the Anatomical Therapeutic Chemical Classification and as reconciled, not reconciled or reconciled after pharmaceutical intervention. Types of pharmaceutical interventions considered: suggestions for correcting the omission of patients’ home medications, dose or frequency. Interventions were classified as accepted or not accepted. The patients were divided into two groups: no discrepancies or intentional discrepancies (G1) and unintentional discrepancies (G2). The groups were compared using the Student’s T test (continuous data) and chi-square (x2) or Fisher’s exact test (categorical variables), considering statistical significance values of p <0.05. Results: 182 admissions were analyzed, with an average number of patient’s home medications use of 4.9 ± 3.6 drugs per patient. Of the 900 patients’ home medications, discrepancies were found in 227 medications on medical prescription of admission at the emergency room, being 48.9% intentional discrepancies and 51.1% unintentional discrepancies. Regarding unintentional discrepancies, 81% were due to the medication’s omission correction on the medical prescription; 9.5% were correction of divergent dose of patients’ home medications and frequency of administration respectively and all were adjusted after pharmaceutical intervention. 139 pharmaceutical interventions were performed to correct medication discrepancies, with 83.5% of acceptance by medical staff. Among all the analyzed medications, 51.8% had at least one registration failure by medical and/or nursing staff. Conclusion: The presence of the pharmacist in the emergency room reduced the incidence of unintentional discrepancies related to medication reconciliation, through interventions to correct medication omissions, dose and frequency, being an important element for patient safety.

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“…The overall acceptance rate in our observational study (74.3%) was comparable with previously reported values between 52% and 100% in studies assessing interventions proposed by pharmacists. Previous studies have already shown that verbally communicated recommendations are more likely to be accepted by physicians (Zaal et al., 2020). In the future, it might therefore be commendable to contact the physician by phone in case of non‐acceptance.…”

Section: Discussionmentioning

confidence: 97%

Impact of Check of Medication Appropriateness (CMA) in optimizing analgesic prescribing: An interrupted time series analysis

Quintens

Coster

Linden

et al. 2020

European Journal of Pain

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Background Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software‐supported ‘Check of Medication Appropriateness’ (CMA), which is a centralized pharmacist‐led service consisting of a clinical rule‐based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain‐related prescribing. Methods A quasi‐experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre‐implementation, patients were exposed to standard of care. Afterwards, a pain‐focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post‐implementation period. A regression model was used to assess the impact of the intervention on the number of pain‐related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post‐implementation period. Results At baseline, a median number of 13.1 (range: 9.5–15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0–9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain‐related residual PIPs. A significant decreasing time trend was observed during the post‐implementation period. Post‐implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%. Conclusions We proved that the CMA approach reduced the number of pain‐related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics. Significance Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule‐based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain‐related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.

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Physicians’ acceptance of pharmacists’ interventions in daily hospital practice

Cited by 37 publications

References 23 publications

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

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

Medication reconciliation in emergency department - the role of clinical pharmacist

Impact of Check of Medication Appropriateness (CMA) in optimizing analgesic prescribing: An interrupted time series analysis

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