Clinical Pharmacy Interventions Research Articles

Clinical pharmacy interventions for critically ill patients

Clinical pharmacy interventions for critically ill patients

Peran Farmasi Klinis dalam Meningkatkan Keamanan Penggunaan Obat pada Pasien Geriatri : Tinjauan Literatur

With the aging population increasing worldwide, attention to the safety of drug use in geriatric patients is becoming increasingly important. Through a better understanding of the role of clinical pharmacy in this context, it is hoped that more effective strategies can be found to improve the quality of drug care for the geriatric population, thereby providing maximum benefits for patients' health and quality of life. Thus, the aim of this literature observation is to dig deeper into the role of clinical pharmacy in improving the safety of drug use in geriatric patients (Javier, 2023). The aim of exploring relevant literature, we can innovate approaches that have been proven effective, as well as identify challenges and opportunities in optimizing the role of clinical pharmacy in the care of geriatric patients (Annisa, 2012), adjusting doses based on physiological factors related to age, and providing education to patients and families about the correct use of drugs (Sari, 2015). Literature studies suggest that clinical pharmacy interventions, such as thorough medication review, drug counseling, and identification of potential drug interactions, can reduce the risk of side effects and increase patient compliance with drug therapy. Apart from that, health team collaboration between clinical pharmacists, doctors and nurses is also an important factor in ensuring the safe use of drugs in geriatric patients (Karnova, 2020).
 Keywords: Clinical Pharmacy, Safety of Drug Use, Geriatric Patients, Literature Review.

Clinical pharmacy interventions in an Austrian hospital: a report highlights the need for the implementation of clinical pharmacy services

BackgroundClinical pharmacy services face challenges in Austria due to limited implementation and acceptance, outdated legislation and a lack of guidelines and training, despite the evidence from global studies of the...

Education and clinical pharmacist-led management strategies for the risk and prophylaxis of venous thromboembolism in general surgery

BackgroundDespite the risks of venous thromboembolism (VTE) in surgical patients are well defined, primary thromboprophylaxis (TP) can be neglected. The aim of this study was to evaluate the risk of VTE and appropriateness of TP and to assess the effects of education and clinical pharmacy (CP) services.MethodsThis study was conducted in a total of 3 periods (n = 800): pre-education (n = 340), post-education (n = 269) and CP intervention period (n = 191) and the risk of VTE and the appropriateness of TP were evaluated. At the end of pre-education period, patients were re-evaluated after education was given about the guidelines on TP and an educative poster was posted in the services (post-education period). During the CP intervention period, the CP made recommendations in terms of optimal TP use to the physicians in charge.ResultsWhile there was no significant difference in the optimal TP rate administered to the patients before and after education (138/340, 40.6% vs. 122/269, 45.4%; p = 0.238); this rate was increased to 113/191 (59.2%) in the CP intervention period (p = 0.004). High-risk patients who received one type of TP constituted the majority of patients who did not receive optimal TP. While the ratio of high-risk patients undergoing a single type of TP in the pre- and post-education periods (104/340, 30.6% vs. 83/269, 30.9%), was similar (p = 0.819); with the CP interventions, this rate was reduced to 35/191 (18.3%) (p = 0.001).ConclusionEven though education has positive influence on surgeons, the implementation of CP practices is more effective especially in terms of maintaining optimal TP.

Adherence to epilepsy quality indicators in a tertiary referral center

BackgroundQuality indicators play an important role in healthcare quality and patient safety. The aim of this study is to identify specific clinical pharmacy interventions to improve adherence to quality indicators and minimize risks among patients with epilepsy. Material and methodsA prospective, two-phase, observational study was conducted in a neurology outpatient clinic of a tertiary university hospital. In the first phase of the study, the rate of adherence to the quality indicators was evaluated with a checklist containing the quality indicators. In the second phase of the study, an expert panel meeting was convened to identify clinical pharmacist interventions to reduce the risks associated with non-adherence. The Fine–Kinney method was used to prioritize risks, and adherence rates with each quality improvement indicator (QI) were calculated. ResultsThe study found that adherence rates were highest for QIs involving estimating the number and type of seizures, providing medical treatment or referring patients with evidence of mood disorders to mental healthcare, and co-managing prenatal care for women with epilepsy. The most non-adherence rates were found in QIs involving quality-of-life assessment, daily folate supplementation, and addressing the decreased effectiveness of oral contraception. The annual review of information about educational issues was also poorly provided. An expert panel decided to integrate a clinical pharmacist into the outpatient clinic to improve medication adherence, side-effect assessment, drug interaction assessment, patient education, lifestyle-modification education, depression/suicide-related behavior screening, quality-of-life assessment, and effectiveness evaluation of oral contraceptives for female patients using enzyme-inducing ASM. ConclusionThe study shows that medication adherence, assessment of side effects, drug interactions, and patient education are inadequately provided by neurologists in patients with epilepsy. Clinical pharmacists have a crucial role in reducing potential risks of non-adherence with quality indicators. By integrating clinical pharmacy services into routine epilepsy care processes, the quality of care can be improved. Future studies should focus on implementing these interventions and evaluating their impact on patient outcomes.

Doctor’s perception of clinical pharmacy services at Universitas Sumatera Utara Hospital

Clinical Pharmacy Services (CPS) play important roles in the clinical setting. This study aims to evaluate CPS based on Doctors’ perception at the Universitas Sumatera Utara Hospital, Medan, Indonesia. It was a mixed methods descriptive study that used the Importance–Performance Analysis (IPA). The quantitative and qualitative data were accessed simultaneously in a semi-structured interview using questionnaires as the guideline. The forty-three doctors as respondents were interviewed from October to December 2021. According to the findings, doctors have used the CPS in collaboration with clinical pharmacists in percentages ranging from 16% to 98%. Furthermore, information on drug regulatory aspects, reconciliation, and drug information services are in Quadrant II, which showed the CPS has performed well. Meanwhile, the information on pharmaceutical and clinical aspects, patient drug history, as well as recommendations and clinical pharmacy intervention, are in Quadrant III. This indicated the respondents did not consider this service to be important. Based on the interview note, increasing the capacity of CPS is important to be done.

Economic impact of clinical pharmacist interventions in a general tertiary hospital in Qatar.

With an increasingly strained health system budgets, healthcare services need to continually demonstrate evidence of economic benefits. This study sought to evaluate the economic impact of interventions initiated by clinical pharmacists in an adult general tertiary hospital. A retrospective review of clinical pharmacist interventions was carried out throughout follow-up durations in March 2018, July/August 2018, and January 2019 in Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) in Qatar. The study included clinical pharmacy interventions data of patients admitted to the internal medicine, critical care, and emergency wards. Included interventions were documented by clinical pharmacists or clinical pharmacy specialists, and approved by physicians. Interventions by non-clinical pharmacists or with missing data were excluded. Adopting the perspective of HMC, we calculated the total economic benefit, which is the sum of the cost savings and the cost avoidance associated with the interventions. Cost savings was defined as the reduced cost of therapy associated with therapy changes minus the cost of intervention and cost avoidance was the cost avoided by eliminating the occurrence of adverse drug events (ADEs). Sensitivity analyses were performed to assess the robustness of results against uncertainties. A total of 852 interventions, based on 340 patients, were included. The analysis projected an annual total benefit of QAR 2,267,036 (USD 621,106) based on a negative cost-savings of QAR-175,139 (USD-47,983) and a positive cost avoidance of QAR741,898 (USD203,260) over the 3-month follow-up period. The uncertainty analysis demonstrated the robustness of outcomes, including a 100% probability of positive economic benefit. The clinical pharmacist intervention was associated with an increased cost of resource use, which was overtaken by the cost avoidance generated. The pharmacy intervention, therefore, is an overall economically beneficial practice in HGH, reducing ADEs with considerable consequential positive economic savings.

Documenting Pharmacist Intervention: A Technology-Driven Solution to Overcome Challenges

Clinical pharmacist conducts multiple activities governed by the best evidence for disease management and safe medication practices. The ASHP highlighted the importance of documenting and recording clinical pharmacy interventions to prevent adverse drug events and reduce hospital length of stay. Our institution utilizes an in-house electronic documentation system (e-DS) to document clinical interventions. We aim to study the impact of enhancing the e-DS. This study is a retrospective single-center descriptive review post-implementation of in-house e-DS enhancements. Data were collected between September 2017 and December 2019 for documented interventions by clinical pharmacists for admitted patients. Fields for analysis include clinical interventions, expected outcomes of interventions, cycle time for documentation, and drug cost. Outcomes measures include several documented interventions, preventing medication errors/adverse drug events, time-saving and cost avoidance. Descriptive analysis will be performed for categorical variables. The study showed an increased number of documented interventions for preventing medication errors/adverse drug events, time-saving, and cost avoidance, with an average time-saving of 20 minutes per 10 interventions and estimated cost avoidance of 20 000 SAR per month. Study limitations include a lack of interface with EHR and non-feasibility to estimate indirect cost. Investment in documentation system optimization to reduce medication errors/adverse drug events, time-saving and cost avoidance.

Acceptance rate, cost avoidance of clinical pharmacy interventions: A follow up interventional study from palestine.

Acceptance rate, cost avoidance of clinical pharmacy interventions: A follow up interventional study from palestine.

An EHR-based method to structure, standardize, and automate clinical documentation tasks for pharmacists to generate extractable outcomes.

As the recognition of team-based care grows and pharmacists increase in patient care interventions, it is important that tools to track clinical services are easily accessible and well-integrated into workflow for all providers. We describe and discuss feasibility and implementation of data tools in an electronic health record to evaluate a pragmatic clinical pharmacy intervention focused on deprescribing in aged adults delivered at multiple clinical sites in a large academic health system. Of the data tools utilized, we were able to demonstrate clear documentation frequency of certain phrases during the intervention period for 574 patients receiving opioids and 537 patients receiving benzodiazepines. Although clinical decision support and documentation tools exist, they are underutilized or cumbersome to integrate into primary health care and strategies, such as employed, are a solution. This communication incorporates the importance of clinical pharmacy information systems in research design.

Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital.

The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results' robustness and increased generalizability. A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of -QAR 645,174 (-USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.

Perspectives of clinical pharmacists on the provision of pharmaceutical care through telepharmacy services during COVID-19 pandemic in Qatar: A focus group.

BackgroundCoronavirus disease 2019 (COVID-19) pandemic created unprecedented pressures on healthcare systems and led to the widespread adoption of telepharmacy services, a practice that was not previously established in the state of Qatar.ObjectiveThe -study aimed to explore clinical pharmacists’ (CPs) perspectives and experiences in utilizing telepharmacy for the provision of pharmaceutical care during the COVID-19 pandemic.MethodsA descriptive, qualitative approach using face-to-face focus group (FG) discussions was used. CPs across Hamad Medical Corporation (HMC) were purposively invited to participate in the study. FG discussions were audio-recorded, transcribed verbatim, and validated. Transcripts were analyzed using inductive thematic analysis. Recruitment continued until a saturation point was achieved.ResultsWe conducted five focus groups that included 23 CPs and led to seven themes. Overall, CPs reported inadequate preparedness for the practice of telepharmacy, which they perceived as challenging. The primary perceived benefits of telepharmacy were decreased infection exposure risk, improved quality of care, improved patients’ satisfaction, and enhanced workplace efficiency and productivity. The main highlighted risks of telepharmacy were related to threatened patient confidentiality, missed pharmaceutical care opportunities, and negatively impacted professional rapport with other healthcare providers; and the major perceived challenges were low digital health literacy, complex illnesses and medication regimens, lack of standardized protocols, and inadequacy of resources and cultural resistance for virtual care. Participants recommended standardization and training, resource allocation, and proper service promotion as potential facilitators of telepharmacy practice.ConclusionThe current study revealed that despite perceived barriers, pharmacists identified several benefits of telepharmacy and recommended potential facilitators that should be used to integrate and sustain the practice of telepharmacy in the future. Future studies should investigate the impact of telepharmacy on clinical pharmacy interventions and patient outcomes.

Medicatiefouten met methotrexaat: casuïstiek en opportuniteiten door de bril van de ziekenhuisapotheker

Medication errors with methotrexate: new insights into an old drug Methotrexate (MTX) was first used in 1948 to treat childhood leukaemia. Nowadays, it is used for the treatment of inflammatory diseases, such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis and inflammatory bowel disease. MTX is a folic acid antagonist that binds dihydrofolate reductase and thereby inhibits the synthesis of deoxyribonucleic acid (DNA), ribonucleic acid (RNA) and proteins. As an incontestable cornerstone in the treatment of RA, MTX should be started as soon as RA is diagnosed. The primary goal of the treatment is rapid and effective disease control to prevent long-term damage to the joints. For the treatment of patients with RA, the usual starting dose of MTX is 7.5-10 mg per week. Based on the clinical response, the dose could be increased to reach the optimal dose. The most common adverse drug events of MTX therapy are gastro-intestinal intolerance, haematological abnormalities, alopecia, hepatotoxicity and pulmonary toxicity. Overall, MTX is well tolerated. However, fatal cases of MTX intoxication have been reported in literature, mainly due to the daily intake and thus overdose of MTX. Despite the widespread experience with MTX, medication errors still occur with a risk of potentially severe adverse drug events. Clinical pharmacy interventions aim to detect these medication errors in inpatients. Based on a case series within a hospital population, the most common medication errors with MTX are presented. Subsequently, specific interventions to optimize medication safety with MTX therapy are described. The implementation of a specific chemotherapy module in the computerized physician order entry and clinical pharmacy interventions, such as medication reconciliation, the engagement of clinical pharmacists on hospital wards as part of the interdisciplinary team and prescription validation based on clinical rules, can contribute to a safer use of MTX.

The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial

BackgroundUnplanned rehospitalizations occur frequently in older patients. Drug-related problems constitute a major and largely preventable cause with inappropriate prescribing being a substantial culprit. Solutions are needed to reduce this risk by targeting pharmacotherapy both during and after hospital stay. Therefore, we aim to perform a randomized controlled trial in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health-related outcomes. Methods/designThe study concerns a monocenter, non-blinded, randomized controlled trial that will take place at the acute geriatric wards of a large academic hospital. Patients being in a palliative stage with active therapy withdrawal or patients discharged to another ward within the same hospital or another hospital are excluded. In total, 828 patients will be randomized (1:1) to the usual care or intervention group. The multifaceted clinical pharmacy intervention comprises medication reconciliation at admission and discharge, medication review, patient/caregiver education, intensified communication with primary care providers and post-discharge follow-up, which also includes a telepharmacology service. The primary endpoint is defined as the time to an all-cause, unplanned hospital revisit within six months after discharge. Other health-related outcomes such as drug-related readmissions, quality of life and number of potentially inappropriate medications will be analyzed as secondary endpoints. Patient inclusion started in February 2021. DiscussionThis study will provide useful insights regarding the impact of clinical pharmacy interventions on geriatric wards with the goal to optimize health-related outcomes such as hospital revisits.Trial registration:ClinicalTrials.gov Identifier: NCT04617340

HSD25 Impact of Clinical Pharmacy Interventions on Health and Economic Outcomes in Type 2 Diabetes: A Systematic Review and Meta-Analysis

There is lack of synthesized evidence on the effectiveness of clinical pharmacy interventions on clinical outcomes like adverse events (AEs) and mortality, and economic outcomes of diabetes at hospital settings. The aim of this study was to examine the effectiveness of clinical pharmacy interventions on health and economic outcomes of patients with type 2 diabetes in hospital settings.

Medications adherence in patients with osteoporosis after vertebroplasty or kyphoplasty at Hanoi Medical University Hospital

Poor adherence to medication therapy is currently one of the most critical obstacles facing osteoporosis care and it is one of the main barriers for optimal therapeutic osteoporosis management, especially after surgical intervention. This paper presents medication adherence and explores factors associated with medications non-adherence in patients with osteoporosis after vertebroplasty or kyphoplasty. This is a retrospective case series included osteoporosis patients underwent vertebroplasty or kyphoplasty at Hanoi Medical University Hospital in 2019. Medication adherence was assessed using the validated Osteoporosis specific Morisky Medication Adherence Scale. A total of 42 patients participated in the study. Level of osteoporosis medication adherence decreased gradually with time of using medication: high adherence level after 1 month with OS-MMAS score was 8. Mean score of medium and low adherence after 3 months and 6 months were 6.64 ± 1.19 and 4.64 ± 2.18, respectively . 57.14% of participants had low adherence (6 months). 73.81% patients forgot to take medication. The associated factors of medication adherence are residence area, occupation, education level, number of medication used, frequency of osteoporosis medication, failure to take medication and side effects. The current study reveals a low level of medication adherence and sheds the light on different causes of medication non-adherence among patients with osteoporosis after vertebroplasty or kyphoplasty. Identifying barriers for medication non-adherence is an important initial step for developing effective clinical pharmacy interventions for patients with osteoporosis.

Fully independent validation and updating of a clinical pharmacy prioritizing risk score in an infectious disease hospital ward.

The aim of this study was to validate and update the risk score originally developed at Hospital de Clínicas de Porto Alegre, verifying its performance in an infectious disease population. This is an observational study with consecutive selection of admission in a ward of participants with infectious diseases. Predictors were age, number of medications, intravenous drugs, potentially dangerous drugs, renal dysfunction, liver dysfunction, use of nasoenteral tube, nasogastric tube, gastrostomy feeding, jejunostomy feeding, oral enteral tube, total parenteral nutrition, cardiac or pulmonary dysfunction and immunosuppression. Outcome was defined as preventable prescription incidents by a clinical pharmacist. A GEE model was fit to make predictions each week. A total of 219 patients participated in the study, 79.25% of whom had prescription incidents in the first week of admission. Predictors of the updated model were number of drugs prescribed, number of intravenous drugs, use of tubes, truncated age at 36 years and week of hospitalization. The performance of the original model was poor. The updated model's discrimination and calibration were moderate (overall AUC 0.74). A calculator to apply the model is available at https://pedrobrasil.shinyapps.io/INDWELL/. The updated risk score enabled the user to make predictions at admission and throughout the weeks, allowing for a prioritized weekly update for clinical pharmacy intervention. The updated model has a moderate and satisfactory performance for infectious disease patients.

A randomised controlled trial of clinical pharmacy intervention versus standard care to improve medication adherence in outpatients with head and neck cancer receiving radiotherapy.

Patient understanding of medicines information and adherence to medication instructions are important variables for ensuring optimal cancer care. This randomised controlled trial (RCT) aimed to evaluate the impact of an outpatient clinical pharmacy service on medication adherence and symptom burden in cancer patients. In this single-centre RCT, 115 patients were randomised 1:1 to a pharmacist-led pharmaceutical care program (intervention, n = 59) versus standard of care (control, n = 56) within an outpatient multidisciplinary radiotherapy clinic. The primary endpoint was medication adherence as assessed by Medication Understanding and Use Self-Efficacy (MUSE) scale and Teach-Back assessment. Secondary endpoints were patient-reported symptom burden assessed by the Edmonton Symptom Assessment Scale (ESAS). Patients were assessed at baseline (weeks 1-2) and at discharge from radiotherapy (weeks 5-7). Polypharmacy (use of five or more medications) was observed in 26% of patients at baseline compared to 97% at discharge. Patient self-efficacy and medication adherence was higher in the intervention arm compared to the control arm, with a mean MUSE score difference of 2.70 (95% CI 1.24, 4.17) after adjustment for baseline, and a higher proportion of patients with average Teach-Back score of four or more (86% vs 14%; odds ratio (OR) 46.09, 95% CI 14.49, 146.56). The mean (SD) scores for aggregate ESAS (0-100) at discharge were 26.2 (14.0) in the intervention arm and 32.0 (15.8) in the control arm demonstrating lower overall symptom burden associated with the intervention (mean score difference adjusted for baseline - 0.52; 95% CI - 1.03, - 0.01). A structured outpatient clinic pharmacy service significantly improved medication adherence and reduced overall symptom burden in patients receiving radiotherapy.

Influence of Clinical Pharmacist's Interventions on Clinical Outcomes of Patients With Pneumonia in the Emergency Department of Tertiary Care Healthcare Setting

Abstract The aims of the study were to evaluate the services of emergency medicine pharmacists in patient care and to assess the need to implement clinical pharmacy practice in emergency department. This study analyzed English language articles, which were identified and studied according to the inclusion criteria. The articles were identified from different databases from 1982 to 2020. Two hundred fifty articles were primarily searched for inclusion criteria and a preferred reporting items for systematic reviews and meta-analyses diagram was created to describe qualitative analysis. Quality assessment of the studies was done using the strengthening the reporting of observational studies in epidemiology checklist. A total of 9 studies were quality assessed and included for evidence synthesis. Four studies showed a significant reduction in readmission rate P < 0.0001 with an odds ratio (OR) of 1.6341 for the patients with the pharmacist care group. Patient's in-hospital mortality and appropriateness of medications had an OR of 3.2196 (P = 0.0353) and 0.1444 (P = 0.0001), respectively. The pooled OR (n = 1026) in 4 studies was 1.4534 (95% confidence interval = 0.2844–0.7292) in antibiotic guidelines for pharmacist interventions. In addition, evidence showed a statistically significant reduction in hospital revisits (P < 0.00001, OR = 2.05, 95% confidence interval = 1.76–2.39) with the pharmacist in the emergency department compared with no pharmacist. The meta-analysis concluded that clinical pharmacy interventions in the ambulatory setting had a positive impact on clinical outcomes related to disease management, medication optimization, ensuring patient safety, and providing quality of care. Studies identified did not evaluate the impact of pharmacists on cost-effectiveness, which is a useful direction for future study.

Do clinical pharmacy activities have an impact on the rehospitalisation rate of elderly patients admitted to a MUPA unit for a fall?

to evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalisation rates of elderly people admitted following a fall to the emergency medical treatment for the elderly unit (médecine d'urgence de la personne âgée [MUPA]) in a teaching hospital. this was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the MUPA unit following a fall, who had at least two chronic diseases, and who were being treated with two or more medications were included between 1 February 2018 and 30 June 2018 and were followed for 90 days. The main outcomes were the unplanned rehospitalisation rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 h. The estimated cost-saving was also assessed. 252 patients were included. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction in the rate of unplanned rehospitalisations at 90 days (OR = 0.45 (0.26-0.79) P = 0.005). These results were also consistent at 30 days (P = 0.035) and 72 h (P = 0.041). We found a cost-saving of €37770 related to 21 avoided rehospitalisations. our results strongly emphasise the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalisations of elderly patients admitted following a fall.