The economics of medicines optimization: policy developments, remaining challenges and research priorities

Faria, Rita; Barbieri, Marco; Light, Kate; Elliott, Rachel A.; Sculpher, Mark

doi:10.1093/bmb/ldu021

Cited by 12 publications

(11 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many of the aims of medicines optimisation mirror those of medication reviews. Faria et al 38 reviewed the evidence on the effectiveness of medicines optimisation. They concluded that more research on outcomes and which pharmacist duties are most beneficial to patients is needed.…”

Section: Introductionmentioning

confidence: 99%

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

et al. 2017

View full text Add to dashboard Cite

Objectives: The role of clinical pharmacists in hospitals has evolved and continues to expand.In the UK, outside a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to 1) highlight the need to identify and prioritise specific clinical pharmacy roles, responsibilities and practices that will bring the greatest benefit to patients and health-systems and 2) describe systemic weaknesses in current research methodologies for evaluating clinical pharmacy services and propose a different approach Method: Published reviews of CP services are discussed using the economic, clinical and humanistic outcomes (ECHO) framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP.Results: Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of clinical pharmacy often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding clinical pharmacy's definitive contribution to patient outcomes.Conclusion: There is a need for more research work in NHS hospitals, employing a different paradigm to address some of the weaknesses of existing research on clinical pharmacy practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital clinical pharmacy activities to patient care and the NHS. 4 Key MessagesWhat is already known on this subject• Clinical Pharmacy is a diverse, complex discipline and clinical pharmacy activities are not easily defined or described • It is important to robustly show the benefits of clinical pharmacy, in order to justify resource use and to prioritise and measure activities • Studies purporting to demonstrate the outcomes of clinical pharmacy activities are often criticized due to methodological flaws, poor intervention descriptions and weak conclusionsWhat this study adds• The current positivist mindset is weakening the case for clinical pharmacy. There is a need for a new research approach for studying and evaluating clinical pharmacy interventions • Mixed-methods studies, incorporating quantitative and qualitative methodologies are more appropriate for evaluating the outcomes of clinical pharmacy • Cost-consequence analyses are more suitable for evaluating the economic outcomes of clinical pharmacy 5

show abstract

Section: Introductionmentioning

confidence: 99%

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

et al. 2017

View full text Add to dashboard Cite

show abstract

“…In these terms, our findings support calls for more attention to be paid to economic evaluation of medication review. 57 , 58 …”

Section: Discussionmentioning

confidence: 99%

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

et al. 2018

View full text Add to dashboard Cite

Importance Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed. Objective To synthesize evidence for focused psychotropic medication review in medication optimization. Data Sources Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms “drug utilization review” and “psychotropic drugs” and synonyms. Additional articles were retrieved using citation tracking and reference checking. Study Selection Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently. Data Extraction and Synthesis Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted. Main Outcomes and Measures Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected. Results A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias. Conclusions and Relevance Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.

show abstract

“…These results therefore suggest that having high levels of evidence‐based resources to reduce medication errors enables advanced‐level critical care pharmacists to focus on medicines optimisations, with the potential for important patient and health economic outcomes . Moreover, the resources identified provide a methodological basis for further research in this area designed to specifically investigate the related healthcare economics required to support wider application …”

Section: Discussionmentioning

confidence: 99%

Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation

Bourne

Shulman

Jennings

2018

International Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

The economics of medicines optimization: policy developments, remaining challenges and research priorities

Cited by 12 publications

References 88 publications

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation

Contact Info

Product

Resources

About