Drug Utilization Review Research Articles

Developing supervisory and precepting skills through simulation: Near peer teaching in a skills laboratory

Background and purposeNear-peer teaching is an innovative approach to teaching the skills of supervising and precepting while benefiting students with different levels of experience and academic training. This study describes near-peer activities in skills-based laboratory courses that provided opportunities for one-on-one teaching to benefit learners in the introductory lab courses while simultaneously training more advanced students for future supervisory and precepting roles. Educational activity & settingThree community pharmacy near-peer teaching simulations were designed and implemented: 1) Patient Counseling and Medication Adherence, 2) Dispensing and Patient Counseling, and 3) Drug Utilization Review and Prescriber Calls. These activities took place over two semesters of a pharmacy skills lab with all first- and third-year Doctor of Pharmacy students. FindingsIn Autumn 2019, 80% (111/139) of P1s and 67% (80/119) of P3s responded to the course evaluation survey. In Spring 2020, 73% (100/137) of P1s and 68% (80/118) of P3s responded to the course evaluation survey. The P3s reported increased confidence in their ability to provide meaningful feedback, while P1s reported increased confidence in communicating with patients and healthcare providers. Performance data revealed that most P1s and P3s completed dispensing and communication activities accurately using a near-peer approach. Overall, the P1s and P3s felt the activities were valuable learning experiences. SummaryThe near-peer activities described in this study fill a gap in the training of pharmacy graduates for future precepting and supervisory roles. Evaluation of these near-peer activities suggest that both junior and senior learners benefit from simulated preceptor-intern interactions, supporting this innovative approach to address supervisory and precepting responsibilities.

Role of clinical pharmacist in drug utilization evaluation, medication adherence and pharmacovigilance

A series of systematic, criterion-based drug evaluation known as Drug utilization review are conducted on a regular basis to ensure that medication is utilized appropriately. It’s a mean of learning more about the issues brought on by drug usage, if done properly, may help to solve the issues. Medication adherence generally refers to a patient’s ability to take prescription drugs as directed and their continued use of those drugs. The increasing body of research linking medication non adherence to unfavorable outcomes and increased healthcare cost has raised concerns among clinicians, healthcare institutions, and other stakeholders. Pharmacovigilance, in which the procedures keeping an eye on the assessing adverse medication reactions, is essential to clinical practice, public health and efficient drug regulating system. Aim of the study was wo study about the role of pharmacist in drug utilization review, medication adherence and pharmacovigilance.

The impact of a multidisciplinary team intervention on medication prescription in nursing homes in Catalonia.

In response to the rising population of nursing home residents with frailty and multimorbidity, optimizing medication safety through drug utilization review and addressing medication-related problems (MRPs) is imperative. Clinical decision support systems help reduce medication errors and detect potential MRPs, as well as medication reviews performed by a multidisciplinary team, but these combined assessments are not commonly performed. The objective of this study was to evaluate the impact on medication plans of a multidisciplinary team intervention in nursing homes, by analyzing the medication plan before and after the intervention and assessing whether the recommendations given had been implemented. A multicenter before-after study, involving five nursing homes, assessed the impact of a multidisciplinary team intervention, to estimate effectiveness related to the review of the prescribed medications. The follow-up period for each patient was 12months or until death if prior, from July 2020 to February 2022, and involved 483 patients. The clinical pharmacologist coordinated the intervention and reviewed all the prescribed medications to make recommendations, focused on the completion of absent data, withdrawal of a drug, verification of whether a drug was adequate, the substitution of a drug, and the addition of drugs. Since the intervention was performed during the COVID-19 pandemic, optimization of psychotropic drugs and absorbent pads were limited. The intervention had an impact with recommendations given for 398 (82.4%) of the patients and which were followed by 58.5% of them. At least one drug was withdrawn in 293 (60.7%) of the patients, with a mean of 2.3 (SD 1.7). As for the total of 1,097 recommendations given, 355 (32.4%) were followed. From the intervention, antipsychotics, antidepressants, benzodiazepines, statins, and diuretics were the most frequently withdrawn. The findings underscore the impact of targeted interventions to reduce inappropriate medications and enhance medication safety in nursing homes. The proposed recommendations given and followed show the importance of a multidisciplinary team, coordinated by a clinical pharmacologist, for a patient-centered approach to make medication reviews regularly, with the help of clinical decision support systems, to help reduce potential MRPs and polypharmacy.

Potential drug–drug interaction and its determinants among patients with cancer receiving chemotherapy in oncology centres of Northwest Ethiopia: an institutional-based cross-sectional study

ObjectiveThe study was conducted to assess potential drug–drug interactions (PDDIs) and its determinants among patients with cancer receiving chemotherapy.Design and settingAn institutional-based cross-sectional study was used. This study was conducted...

Analysis of the prescription trends of potentially inappropriate medications in Korean older outpatients by sex: A retrospective study using data from the health insurance review and assessment service.

This study aimed to determine the policy implications for drug management by identifying the prescription trends of potentially inappropriate medications (PIMs) in older outpatients. Considering the Drug Utilization Review and Korean version of the standards for PIMs based on the Beers Criteria, 141 ingredients were selected that spanned over 7 years of health insurance claims data analysis. During the study period, the number of patients and claims related to PIMs increased. Although the number of health insurance claims decreased in 2020 owing to coronavirus disease (COVID-19), it increased again in 2021. Tamsulosin was the most frequently prescribed drug for male patients, followed by alprazolam and zolpidem. For female patients, eperisone was the most frequently prescribed drug, followed by alprazolam, zolpidem, and etizolam. In Korea, health insurance claims for PIMs decreased in 2020 owing to the COVID-19 pandemic. However, an overall increasing trend was observed from 2015 to 2021. Moreover, during this period, the prescription trend of benzodiazepine-type drugs and zolpidem increased in both male and female patients. Therefore, management policies regarding PIMs and drug ingredients, such as benzodiazepines and zolpidem, are required.

Potential drug-drug interactions with phentermine among long-term phentermine consumers: A retrospective analysis.

Phentermine is an internationally recognised amphetamine derivative with significant appetite-suppressing properties. The drug is indicated for the short-term management of obesity, as the long-term (LT) use of phentermine may potentially be associated with severe cardiovascular side-effects, abuse and dependence. The LT use hereinafter describes periods exceeding 12consecutive weeks. This use may also be associated with potential drug-drug interactions (PDDIs), which may result in adverse drug reactions (ADRs). The literature reports that phentermine is often prescribed LT and for several other off-label indications, increasing the risk for individuals to experience adverse drug events (ADEs) and drug-drug interactions (DDIs). There are, to our knowledge, no South African (SA) studies investigating the prevalence of co-prescribing LT phentermine with drugs that may potentially cause DDIs. To determine the prevalence of mild, moderate and severe DDIs with phentermine use when the duration of therapy in private healthcare exceeded 12consecutive weeks. A cross-sectional drug utilisation review (DUR) was done by using data obtained from a SA pharmacy benefit management (PBM) company's database. Retrospective data of medicine claims for phentermine, from 1 January 2015 to 31 December 2019, were extracted for analysis. The number of days phentermine was supplied was used to identify the study population, in other words, those patients who received the drug LT. A drug interaction checker (Drugs.com) was used to identify potential mild, moderate and severe DDIs when using phentermine and co-prescribed drugs concurrently. A total of 889 patients received phentermine LT. The top 20 drugs identified as being frequently co-prescribed in this study population demonstrated no mild PDDI, 15 (75%) moderate PDDIs and 5 (25%) severe PDDIs. The most common co-prescribed drug in the moderate group was dextromethorphan (n=282, 31.72%) and the least co-prescribed was formoterol (n=52, 5.85%). Among the drug group 'severe PDDIs', tramadol (n=416, 46.79%) was most frequently prescribed, whereas phenylpropanolamine (n=69, 7.76%) was the least prescribed to patients in this group. There are patients who receive LT phentermine therapy despite the potential severe consequences that may result. These patients may receive concomitant therapy with phentermine and other pharmaceutical constituents, which may potentially cause DDIs, more specifically, moderate and severe DDIs. As such, these patients are not only confronted with the consequences of DDIs but are also at risk to experience ADRs as the residual effect of PDDIs.

Pharmacists' Perceptions on Safety Alerts of the Drug Utilization Review (DUR) in Electronic Health Records in a Tertiary Healthcare Hospital.

Electronic Drug Alarms and Drug Utilization Reviews (DURs) are crucial in improving patient safety by reducing the dispensing of contraindicated medications and minimizing adverse drug events. The DUR system often generates low-level alerts, making it challenging for pharmacists and doctors to discern more critical alerts. This can result in alert fatigue, causing burnout and jeopardizing patient safety. A cross-sectional study was conducted in a tertiary hospital to explore pharmacists' perspectives and experience with the DUR system. This study aimed to identify their responses to alerts indicating a need to change the original prescription and the difficulties encountered. Out of all the participants, 85% had prior experience with DUR alerts. However, 40% of them expressed dissatisfaction with the alerts. Moreover, 88% of the participants received highly frequent DUR alerts, but only 40% believed that DUR alerts could identify rare adverse drug reactions. Additionally, only 27% of the participants altered their prescriptions based on alerts for the MAOI/serotonin modulator. The survey showed that 66% of participants believe improvements are necessary for the DUR system. Specifically, 77% of participants felt that more information is needed on overlapping prescriptions, 82% on patients with chronic diseases, and 82% on potential reactions caused by co-administration. At the same time, 75% raised concern about the need for backup for any server breakdown. Positive perceptions about DUR lead to changing the prescription in response to an alert. Therefore, improving the DUR system is crucial to prevent pharmacists from missing important alerts and to increase their awareness of clinically significant alarm signals. By doing so, we can optimize patient safety and contribute to providing high-quality healthcare services.

Teaching Independent Decision-Making Through a Computer-Based Drug Utilization Review Simulation.

Background: Drug utilization review (DUR) skills are important for pharmacists across all settings. Computer-based DUR simulations to teach student pharmacists are currently scarce. This article describes a computer-based DUR simulation that required limited faculty and financial resources and was implemented in collaboration among 3 institutions. Objective: To describe the innovation of a computer-based DUR simulation and its impact on pharmacy students' knowledge and confidence of DUR skills. Methods: This pre-post educational study assessed a computer-based DUR simulation that replicated the DUR process in dispensing systems. First- and third-year pharmacy students at 3 institutions were guided through simulated patient cases with various medication-related problems. The self-paced activity provided students with immediate, formative feedback and rationale for each option after an attempt was made in lieu of faculty intervention. Students completed pre-and post-assessments to evaluate changes in knowledge and confidence. Knowledge was assessed by comparing results of multiple choice and matching questions on the pre- and post-assessments. Confidence was assessed by the change in self-reported confidence scale measurements. Results: Students at all institutions (N = 405) had nonsignificant changes in knowledge scores from the pre-assessment to the post-assessment, with the exception of 1 question. All confidence survey questions significantly improved from pre- to post-assessment. Conclusion: The DUR educational innovation had a nonsignificant overall impact on students' knowledge but significantly improved confidence in their abilities. Skills-based instruction provides additional practice to increase student confidence.

Drug Utilisation Review among Geriatric Patients with Noncommunicable Diseases in a Primary Care Setting in Malaysia.

A prospective cross-sectional study was conducted to analyse the drugs prescribed to the elderly population with noncommunicable diseases and to determine the polypharmacy at a primary care clinic in Negeri Sembilan, Malaysia. The study was conducted for 6 months at the primary care clinic of Gemas. Geriatric patients above the age of 65 and diagnosed with noncommunicable diseases were included upon providing written informed consent. The majority of the geriatric patients were between 65 and 69 years (mean: 69.72 ± 2.85) and prescribed 4 or more medications (mean: 5.18 ± 0.64, p = 0.007). More than 95% (n = 295) of the geriatrics were found to have multimorbidity, in which around 45% (n = 139) had type-2 diabetes together with hypertension and dyslipidaemia. Combination therapy was prescribed to more than 97% (n = 302) of the elderly, whereas cardiovascular and endocrine medications were the most commonly prescribed. Ten prescriptions were found to have drug-related problems, prescribing cascade (80%), lack of medicine optimisation (10%), and inappropriate prescription (10%). In this study, the majority of the elderly had multimorbidity; polypharmacy was commonly seen among geriatric patients. Polypharmacy is the biggest threat to the elderly population, as it increases the chances of falls and fall-related injuries. Medicine optimisation and deprescribing will reduce the chances of drug-related problems and morbidity and mortality associated with polypharmacy and over-consumption of medications. Hence, the study recommends the health fraternity look for medication optimisation and deprescribing to reduce the future complications associated with polypharmacy.

HSD20 The Changes of Prescription Patterns after Providing Therapeutic Duplication Dur(DRUG UTILIZATION REVIEW) Information in Outpatient Veterans at Vhs Medical Center

Therapeutic duplication (TD) information is one of the drug utilization review (DUR) system provided by Health Insurance Review and Assessment Service (HIRA). TD provides information about duplicated agents in same therapeutic group used together in one patient over the same period. It cannot expect any additional medical effect and the risk of adverse effects could be increased. We figure out the changes in TD prescribing pattern through DUR in VHS medical center.

A DRUG UTILIZATION STUDY OF ANTIMICROBIAL DRUGS AT TERTIARY CARE HOSPITAL SOUTHERN RAJASTHAN

Background: Irrational usage and higher utilization of antimicrobial agents has become a major problem in all health care facilities all over the world, further give rise to antimicrobial resistance. Inappropriate use of antibacterial drugs may result in increased adverse drug reaction and also increase cost of treatment. The aim of the study was to evaluate and study drug utilization or drug distribution pattern of antimicrobial drugs. The objective of the study was to determine the average number of antibiotics prescribed per prescription, to evaluate the prescribing pattern and frequency, and to determine the most commonly prescribed antibiotic. Method: The present study was a prospective study done in general medicine ward of tertiary care teaching hospital to evaluate the utilization pattern of antibiotics. A total number of 208 patients were included in the study. Results: The ratio of male population is more as compared to females and most of the patients were in the age group of (61-70) years. The study report shows that most common class of antibiotics prescribed were cephalosporin (45.01%) followed by penicillin (14.74%), quinolones(13.94%), macrolides (7.56%), tetracyclines (4.38%). Study reports shows that (40.23%) of the prescription were prescribed with ceftriaxone (monocef). Conclusion: In this study maximum number of prescription had prescribed only one antibiotic as per W.H.O. A strict protocol for prescriber is now at utmost requirement to promote safe and rational use of antibiotic. KEYWORDS: Antimicrobial resistance, drug utilization evaluation, rational use, prescribing pattern, drug utilization review

Prevalence of cardiovascular diseases and drug utilization review at secondary care hospital in South India

Background: To study prevalence of cardiovascular diseases and drug utilization review in patients with cardiovascular diseases. Methods: This was a cross-sectional study conducted for about 6 months from December 2021 to February 2021 in a Secondary care hospital. Prescriptions of 167 patients with cardiovascular diseases were analysed. Patient Case files were used for extracting necessary data. Results: The collected data was analyzed by MS-Excel (Counts and Percentages).Cardiovascular diseases were most common in the age group of 31-40 years (27.55%) followed by 51-60 years (24.49%) among male patients and in female patients, it was more common in the age group of 41-50 years (23.19%) followed by 51-60 years (21.74%). Most prevalent cardiovascular disease was found to be Hypertension (31%), followed by coronary artery disease (21%) and acute coronary syndrome (19%). Diabetes Mellitus (39%) and Hematological disorders (20%) are the most found co-morbidities along with cardiovascular diseases. Antiplatelet and antihypertensive were the most prescribed category of drugs. Of all Cardiovascular drugs, Aspirin (115 prescriptions) followed by Clopidogrel (100 prescriptions), Atorvastatin (73 prescriptions), Olmesartan (54 prescriptions) and Metoprolol (49 cases) were mostly prescribed. Common combinations of drugs prescribed are Aspirin + Clopidogrel + Atorvastatin (25%) followed by Aspirin + Clopidogrel (24%). Out of the total 658 drugs prescribed, 15.95% (105) were from Essential Drug List of India (2011). Of the total drugs prescribed, 15.95% (105) were from Essential Drug List of India. Conclusions: The present study concluded that most of the drugs were prescribed rationally according to current guidelines. Combination therapy found to have an implication for the good cardiovascular outcome on long term follow-up.

DRUG UTILIZATION REVIEW OF FLUOROQUINOLONES AMONG THE OUT-PATIENTS IN A PUBLIC SECTOR HOSPITAL, PAKISTAN

Background: The increase in antibiotic resistance is a challenging threat to the healthcare system. Irrational drug use, polypharmacy and the current epidemic of bacterial resistance is attributed to the over use of anti-microbial drugs. Objectives: The aim of the current study is to evaluate the utilization pattern of fluoroquinolones, to find significant difference between defined daily dose and prescribed daily dose of such antibiotics. Methodology: Quantitative observational, retrospective study was performed to measure the use of antibiotics, specifically Fluoroquinolones in the northern region of Punjab, Gujranwala District, Pakistan. Total 300 patients were enrolled in this study. Data was collected from the patients of all age regardless of their gender, by prescription review. Results: Total 300 prescriptions were reviewed to evaluate the prescription pattern of fluoroquinolones in outpatients. Out of 300 prescriptions, the average number of drugs per prescription was 4.5, maximum number of drugs per prescription was 8 and minimum one drug was prescribed in 28 (9.3) prescriptions. The number of prescriptions that contains the drugs without generic names were 71 (23.7) and which contains one drug with generic names were 203 (67.7). Encounter with antibiotic and injection prescribed were 79.3% and 5.3%, respectively. The most commonly prescribed anti-biotic was ciprofloxacin followed by levofloxacin (maximum defined daily dose). Conclusion: In this study we observed the drug utilization review of fluoroquinolones antibiotics by evaluating the prescribing patterns among the outpatients. All the study drugs were prescribed by their brand names rather than generic names which is not a rational prescribing and utilization pattern, leading to the enforcement of antibiotic stewardship program.

Retrospective drug utilization review of antibiotics used in a government hospital in Kedah, Malaysia

Retrospective drug utilization review of antibiotics used in a government hospital in Kedah, Malaysia

Impact of an Educational Intervention on Hospital Pharmacists' Knowledge and Application of Substance Withdrawal Management.

Patients with substance use disorders are often encountered in an acute care setting and withdrawal management is important. Available literature reveals inadequate acute management of substance withdrawal due to lack of experience and knowledge of medications. A quality improvement project was implemented to improve hospital pharmacists' knowledge, application, and practice of inpatient opioid and alcohol withdrawal management through provision of didactic and case-based education and implementation of practice based prospective drug utilization review (PDUR). Pharmacists' knowledge of the management of alcohol and opioid withdrawal was assessed by a 10-item survey pre-and post-intervention. Twenty-one pharmacists completed the education and pre- and post-surveys. Scores for the 21 pharmacists improved significantly, with pre- and post-intervention scores of 7.33 ± 1.98 and 8.86 ± 0.91, respectively (P = .0035). Most pharmacists completed their required PDUR submission, and several pharmacist interventions were made and accepted post-education. Pharmacists indicated that the education increased their confidence and enabled them to learn new information that could be directly applied to their pharmacy practice. Providing education and requiring a PDUR improved pharmacists' knowledge, application, and practice of inpatient opioid and alcohol withdrawal management. Re-education or expanded education may be warranted to further increase pharmacists' competence.

Effectiveness of Paxlovid, an Oral Antiviral Drug, Against the Omicron BA.5 Variant in Korea: Severe Progression and Death Between July and November 2022.

Paxlovid is an oral antiviral drug that received emergency use authorization in South Korea for the treatment of patients with mild-to-moderate coronavirus disease 2019 (COVID-19) on January 14, 2022. Since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic, the virus has continued to evolve. The emergence of new variants has raised concerns about possible reductions in the effectiveness of vaccines and drugs. The effectiveness of Paxlovid in patients infected with the omicron variant and subvariants has not yet been determined. This study assessed the effectiveness of Paxlovid at reducing the risk of severe/critical illness or death and death in patients with mild-to-moderate COVID-19 caused by omicron subvariant BA.5. In this nationwide retrospective cohort study, data on 8,902,726 patients were collected from four sources (the Drug Utilization Review database, COVID-19 Patient Information Management System, confirmed patient information, and basic epidemiological investigation data) between July 1 and November 30, 2022. Multivariable logistic regression analysis was conducted, with adjustment for age, sex, severe acute respiratory syndrome coronavirus 2 immunity (vaccination), and comorbidities. A total of 1,936,925 patients with COVID-19 were included in the analysis, including 420,996 patients treated with Paxlovid, and 1,515,959 patients not treated with Paxlovid. Paxlovid treatment in patients aged ≥ 60 years of age was associated with significantly reduced risk of severe/critical illness or death (46.0%), and death rate (32.5%), and its effectiveness was high, regardless of vaccination status. Paxlovid is effective at reducing the risk of death due to COVID-19 in patients with omicron BA.5 infection, especially in older patients, regardless of vaccination status. This suggests that older patients with COVID-19-related symptoms should be administered Paxlovid, regardless of their vaccination status, to reduce severity and risk of death.

Drug Utilization Review of Monitored Parenteral Antimicrobials in a Tertiary Care Private Hospital in Cebu City

Drug Utilization Review of Monitored Parenteral Antimicrobials in a Tertiary Care Private Hospital in Cebu City

Antibiotic Prescribing Patterns for Outpatient Pediatrics at a Private Hospital in Abu Dhabi: A Clinical Audit Study.

Antibiotics are commonly used in pediatrics. The aim and objectives were to evaluate the antibiotic prescribing patterns of pediatric outpatients at a private hospital in Abu Dhabi, UAE. A retrospective drug utilization review was conducted for pediatric patients aged 1-18 between June and December 2018. The prescriptions with inclusion criteria were reviewed and evaluated by using the WHO indicators. 419 encounters included were female (50.1%). Most pediatrics were aged 4-6 years (35.3%). The average number of drugs per prescription were 4.9 drugs. The percentage of parenteral medication prescriptions was 16.9%, and with antibiotic prescriptions was 43.0%, where cefaclor was the most prescribed antibiotic (31.1%). The average consultation time was 14 min, while the average dispensing time was 9.6 min. The most common diagnosis where antibiotics were prescribed was acute pharyngitis (33.4%). There were about 60.6% with lab investigation. As per the WHO indicators, the pediatric outpatient department has a high rate of antibiotic use and polypharmacy, but adherence to the drug formulary and prescribing medicines using generic names was appropriate. The average time for consultation and dispensing were suitable. Irrational antibiotic use for inappropriate diagnoses such as acute otitis media and bronchiolitis were found.

Impact of an inpatient order verification simulation on student perceived preparedness and confidence

Background and purposeThe ability to effectively and efficiently navigate an electronic health record (EHR) to complete an inpatient prospective drug review is a vital skill that entry level practitioners must possess. The purpose of this study was to evaluate the impact of an EHR-based inpatient order verification simulation on students' perceived preparedness and confidence when reviewing the accuracy of an inpatient medication order and providing a verbal recommendation to a health care prescriber. This was evaluated by comparing survey scores pre- and post-simulation. Educational activity and settingAn educational series utilizing EHR technology was designed to simulate the sequence of tasks an inpatient pharmacist completes when processing an inpatient mediation order. This includes performing a prospective drug utilization review to identify medication-related problems, forming alternative recommendations, and verbalizing recommendations to prescriber. FindingsA total of 89 students across two cohorts (99%) completed the pre-survey; 31 students (34%) completed the post-survey. Comparison of pre- and post-survey scores resulted in significant findings for all categories: increased perceived preparedness, efficiency, and accuracy when processing or reviewing a medication order (P < .001); increased confidence when efficiently and effectively utilizing EHR technology (P < .001); increased confidence when efficiently (P < .001) and effectively (P < .001) providing a verbal recommendation to a health care prescriber. SummaryIncorporating a series of EHR-based activities simulating medication order verification and prescriber communication into the doctor of pharmacy curriculum positively impacts student perceived preparedness and confidence.

Description and financial impact of ambulatory care pharmacy team interventions within an underserved patient population.

The purpose of this study was to characterize and quantify the types of interventions made by an ambulatory care pharmacy team (ACPT), evaluate the financial impact of such interventions, and create a cost template for the interventions using the health system's intervention documentation system. We conducted a retrospective, single-center cohort study covering the period from July 1, 2018, to June 30, 2020. Eligible participants included patients aged 18 years or older who had an appointment at the ambulatory care clinic and received a pharmacy consult. Most patients were uninsured. Data collected included intervention types, specific interventions, the economic impact per intervention, the average cost avoidance per intervention, the total economic impact, and the total cost avoidance. The ACPT documented a total of 1,334 interventions during the 2-year study period. The 4 major categories of interventions included patient counseling, drug utilization review, medication therapy management, and drug information. Each category was further subdivided into subcategories, for a total of 18 distinct subcategories. The economic impact per intervention was approximately $30. The average cost avoidance was estimated to be $357.62 per intervention, with a total economic impact of $40,020 and cost avoidance of $477,065 for the study period. Pharmacist interventions resulted in a significant amount of economic impact and cost avoidance for the health system. Using the data from the study, we created a cost estimate to indicate the value of each ambulatory care intervention by using the health system's intervention documentation system.