Evaluation Of Clinical Pharmacy Services Research Articles

Infringement of clinical pharmacist's authority.

Clinical pharmacists are healthcare practitioners who have advanced education and training in comprehensive medication management. Clinical pharmacists work with other members of the healthcare team to manage particular medications or disease states. Even though clinical pharmacists are members of healthcare teams, there are still many cases of challenge in the interprofessional relationship with other healthcare team members, especially related to drug management. Increasing interprofessional communication between physicians and clinical pharmacists within the healthcare system could enhance the role of clinical pharmacists. Earlier studies reported that physicians were comfortable with pharmacists detecting and preventing prescription errors, but were uncomfortable with them recommending drug therapy to patients. Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services. The role of clinical pharmacists could be improved by increasing interprofessional communication between doctors and clinical pharmacists in the healthcare system.

Improving the quality of economic evaluations of clinical pharmacy services

Improving the quality of economic evaluations of clinical pharmacy services

Implementation and Evaluation of Clinical Pharmacy Services on Improving Quality of Prescribing in Geriatric Inpatients in Vietnam: An Example in a Low-Resources Setting.

PurposeGeriatric inpatients generally have a high risk of drug-related problems (DRP) in prescribing following hospital admission, which are likely to cause negative clinical consequences. This is particularly evident in developing countries such as Vietnam. Therefore, clinical pharmacy service (CPS) aims to identify and resolve these DRPs to improve the quality use of medicines in the older population following hospital admission.Patients and MethodsThe study was conducted as a prospective, single-center study implemented at a general public hospital in Hanoi. Patients aged ≥60 years with at least three chronic diseases admitted to the Internal Medicine Department between August 2020 and December 2020 were eligible to be enrolled. A well-trained clinical pharmacist provided a structured CPS to identify any DRP in prescribing for each patient in the study. Clinical pharmacist interventions were then proposed to the attending physicians and documented in the DRP reporting system.ResultsA total of 255 DRP were identified in 185 patients during the study period. The most frequent types of DRP were underuse (21.2%), dose too high (12.2%), and contraindication (11.8%). There was a very high rate of approval and uptake by the physicians regarding the interventions proposed by the clinical pharmacist (82.4% fully accepted and 12.5% partially accepted). Of the interventions, 73.4% were clinically relevant (pADE score ≥0.1). In general, 9 out of 10 physicians agreed that CPS has significant benefits for both patients and physicians.ConclusionImproving clinical pharmacy services can potentially have a positive impact on the quality of prescribing in elderly inpatients. These services should officially be implemented to optimize the quality use of medicines in this population group in Vietnam.

Evaluation of clinical pharmacy services in community health centres to support Indonesian health programme in West Java Indonesia

Background: The implementation of clinical pharmacy services is critical in Indonesia's community health centres (CHCs). However, there is a paucity of studies evaluating the implementation of such services. This study aimed to evaluate clinical pharmacy services by CHCs in West Java, Indonesia. Methods: This cross-sectional study used a self-completed questionnaire, including several indicators of the standard pharmacy services, to evaluate the implementation of clinical pharmacy services by CHCs in West Java, Indonesia. Results: In total, 39 CHCs participated in this study. The home visits, drug therapy and adverse monitoring, counselling services, and drug use evaluation were not well performed as determined. In contrast, drug information services, rational use of medicine, and prescription have been well performed. There was no app or IoT (internet of things) system to support the clinical pharmacy services in Indonesia’s CHCs. Conclusions: The performance of the clinical pharmacy services of accredited CHCs should be improved to support Community Health Centers in Indonesia.

Evaluation of Clinical Pharmacy Services Offered for Palliative Care Patients in Chennai

Palliative care is an emerging concept in developing countries like India. North region is having more illiterate people comparing to southern part of India and shows poor palliative care services offered in those regions. Clinical pharmacy services are in developing stages in those regions. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from a period of three months (September to November, 2020) and were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient was calculated. A total of 98 interventions were documented, giving 2 interventions per patient and an acceptance rate of 62%. Discontinuing therapy (35%), initiating therapy (22%), and provision of education/counseling (8%) were most common Interventions. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. The major conclusions from this study are that clinical pharmacy services are being offered for palliative care patients in chennai, with an emphasis on initiating and discontinuing through clinical pharmacist is effective.
 Keywords: Clinical pharmacy; hospice; palliative care; pharmacy; pharmacy education

Implementation and evaluation of clinical pharmacy services through quality improvement in a Tertiary Hospital in Malawi

AbstractBackgroundClinical pharmacy services have been shown to improve patient outcomes, cost savings, and rational use of medications, yet there has been a slow transition from product‐focused to patient‐focused pharmacy practice in many low‐income countries.ObjectiveThe purpose of this study was to describe the implementation of a ward‐based clinical pharmacy program using quality improvement methods in a 1000‐bed tertiary hospital in Malawi and measure its associated impact on prescribing practices.MethodsThis was a post‐test only design with a nonequivalent control group evaluating the impact of a ward‐based clinical pharmacy program. The program was implemented in the female adult medical ward using 1‐month Plan‐Do‐Study‐Act cycles. Data were collected on the number of clinical pharmacy recommendations and acceptance rate. Outcome measures were collected in the intervention ward and a corresponding control ward and evaluated changes in prescribing habits across rational prescribing and antimicrobial prescribing. Data were collected over time and plotted on run charts. Logistic regression was used to examine differences in the trend in probability of rational prescribing and antimicrobial prescribing.ResultsOver 5 months, 321 clinical pharmacy recommendations were made and 67% were adopted by the medical team for implementation. For the intervention ward compared with the control ward, there was a significantly greater increase in probability of rational prescribing (P = .04), but no significant differences in antimicrobial prescribing (P = .48).ConclusionsThis study demonstrated a positive impact on rational prescribing as a result of ward‐based clinical pharmacy services in a low‐income country. This study can be used to inform development or improvement of clinical pharmacy services in other low‐income settings.

Implementation and Evaluation of Clinical Pharmacy Services on Diabetes Care in an Endocrinology Clinic

Purpose Diabetes impacts a significant population in the United States, with uncontrolled diabetes leading to serious adverse health effects and substantial cost to the healthcare system. Diabetes management by clinical pharmacy services (CPS) demonstrating positive clinical outcomes has been well-established in the primary care setting. However, there is little data evaluating the impact of CPS in specialty clinics such as endocrinology, which may provide additional opportunities for pharmacists to improve outcomes in a complex patient population. The purpose of this study is to describe the implementation of CPS in an ambulatory endocrinology clinic and to evaluate the impact of pharmacist care on diabetes management. Methods This was a retrospective, pre- post- descriptive study. Patients were enrolled into the study during a 6-month period and followed for a minimum of 6 months. The primary endpoint was mean change in hemoglobin A1c (HbA1c) between the pre- and post- pharmacist intervention phase. Secondary endpoints included blood pressure outcomes, statin appropriateness, rates of hospital and Emergency Department (ED) admissions due to severe hyper- or hypo- glycemia, and rates of retinal screening exams. Results A total of 101 patients were included in the study population. The mean baseline HbA1c was 9.11% and at six months 8.27%, with mean change of 0.84% (p-value <0.01). Descriptive statistics showed that blood pressure control, as well as statin and retinal screening rates, were high at baseline, with CPS making limited interventions in these areas. Conclusion This study demonstrated that pharmacist interventions in diabetes care is associated with improved HbA1c for a complex patient population in an endocrinology clinic.

Economic evaluations of clinical pharmacy services: What's next?

Economic evaluations of clinical pharmacy services: What's next?

Economic evaluations of clinical pharmacy services in China: a systematic review

ObjectiveThis article reviewed research conducted on economic evaluations of clinical pharmacy services (CPS) in China. We aimed to identify the types of CPS and the possible economic effects of these...

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

AbstractStudies evaluating the cost‐effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient‐level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies were included. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non‐randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59‐95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost‐effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence.

Evaluation of drug-related problems and subsequent clinical pharmacists' interventions at a Swiss university hospital.

The evaluation of clinical pharmacy services is essential for their further development and establishment. We analysed drug-related problems (DRPs) and subsequent clinical pharmacists' interventions (PIs) at a Swiss university hospital. We conducted a retrospective analysis of DRPs and subsequent PIs that were identified and implemented during interdisciplinary ward rounds in internal medicine at the University Hospital Basel, Switzerland, between 2015 and 2017. We estimated the potential clinical and economic impact of PIs using a validated evaluation tool (CLEOde ). Based on medication reviews of 5441 patients, clinical pharmacists identified 5024 DRPs, of which 2892 DRPs (57.6%) were followed by a PI that was directly accepted and implemented by the physician in charge and included in the present analysis. The leading cause and type of PIs were inappropriate dose and dose adjustment, respectively. Overall, 97.8% of DRPs were followed by PIs with an expected clinical benefit for the patients (major: 11.1%; moderate: 27.6%; minor: 59.1%). The drugs most often involved in PIs of major clinical impact were antithrombotics, acid blockers and cardiovascular drugs. With regard to the economic impact, 40.7% of DRPs implied PIs resulting in an increase of immediate therapy costs, whereas 39.3% implied PIs resulting in a decrease of immediate therapy costs. The remaining PIs were cost-neutral. This study emphasizes that clinical pharmacists may help improve the effectiveness and safety of pharmacotherapy on acute care medical wards.

Evaluation of Clinical Pharmacy Services in the Intensive Care Unit of a Tertiary University Hospital in the Northwest of Iran.

Objective:Current literature indicates that the presence of clinical pharmacists in hospitals results in improved patient care, rational drug therapy, and treatment costs. This study assessed the clinical pharmacy services in the intensive care unit (ICU) of a tertiary hospital at Tabriz University of Medical Sciences, Iran.Methods:During a 9-month cross-sectional study (2014–2015), the clinical pharmacy interventions in 27 sessions and educational activities for patients and health-care professionals were randomly assessed based on the Australian guideline and standard of practice for clinical pharmacy. The interventions of clinical pharmacist were evaluated in terms of their clinical importance.Findings:In this study, a total of 832 interventions on 242 patients were performed by the clinical pharmacist, and approximately 93.6% of the interventions were approved by the attending physician. Most interventions concerned adding a new medication to a drug regimen or switching to a needed new medication. Each patient received an average of three interventions. The clinical pharmacist provided drug information to employees and medical staff in 108 of the total 832 interventions (13%). Medical residents who were surveyed indicated that the quality of education, research, and patient care was improved by the attendance of a clinical pharmacist.Conclusion:The results of this study show that the collaboration of a clinical pharmacist with the medical staff of an ICU can improve pharmacotherapy approach and increase the quality of education.

The Evaluation of Clinical Pharmacy Services in an Educational Hospital

The Evaluation of Clinical Pharmacy Services in an Educational Hospital

Evaluation of clinical pharmacy services within the primary care-mental health integration model at the Tuscaloosa Veterans Affairs Medical Center.

Introduction:The purpose of this review is to evaluate the direct delivery of health care to veterans before and after incorporating clinical pharmacy services within primary care mental health integration (PCMHI) at the Tuscaloosa Veterans Affairs Medical Center. Prior to establishing the role of the clinical pharmacy specialist (CPS) within PCMHI, the primary care providers deferred all mental health assessments to specialty mental health. As the demands of the service grew exponentially, assistance from clinical pharmacy was critical.Methods:A randomized, computer-generated list of 114 patients selected for the retrospective chart review was used to evaluate clinical outcomes in patients enrolled in the PCMHI clinic 1 year preincorporation and postincorporation of CPS. Outcome measures included the number of patients discharged from the PCMHI clinic upon achieving therapeutic goals or discharged to specialty mental health due to therapeutic failure or adverse drug events with first- and second-line psychotropic agents.Results:When contrasting the end points, there was a 60% increase in the number of patients who achieved therapeutic goal and a 32% decrease in the number of patients discharged to specialty mental health clinic postincorporation of CPS into PCMHI as compared to preincorporation of CPS (P = .024).Discussion:The results support the significance of CPS in the PCMHI in providing pharmacotherapy, patient education, and medication monitoring for managing psychiatric conditions, such as depression, anxiety, and insomnia. In addition, patients had greater accessibility to medication and frequent monitoring and follow-up, ultimately improving patient outcomes.

PHS173 - Initiation and evaluation of Clinical Pharmacy Services to Surgical Ward in a South Indian tertiary care Teaching Hospital

PHS173 - Initiation and evaluation of Clinical Pharmacy Services to Surgical Ward in a South Indian tertiary care Teaching Hospital

Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature.

Clinical and cost-effectiveness evidence are needed to justify the existence or extension of routine clinical pharmacy services in hospital settings. Previous reviews have indicated that clinical pharmacist interventions are likely to have a positive economic impact on hospital budgets but highlighted issues relating to the quality of studies. The primary aim of this review was to feature economic evaluations of clinical pharmacy services which targeted hospital inpatients. The review focused on the current cost-effectiveness status of different services, in addition to evaluating the quality of individual studies. Results of this systematic review were compared with cost-effectiveness and quality related findings of reviews which considered earlier time frames and alternative settings. A systematic review of the literature included a review of the following databases: Academic Search Complete, Cochrane Library, EconLit, Embase Elsevier, NHS Economic Evaluation Database and PubMed. Only studies with an economic assessment of a clinical pharmacy service provided in a hospital setting were included. Data relating to the cost-effectiveness was extracted from eligible studies. Methodologies employed and overall quality of the studies was also reviewed. A grading system was applied to determine the quality of studies. Consolidated Health Economic Evaluation Reporting Standards statement was employed to determine which aspects of a high quality health economic study were employed. Twenty studies were deemed eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15 %) were deemed to be "good-quality" studies. No 'novel'clinical pharmacist intervention was identified during the course of this review. Clinical pharmacy interventions continue to provide cost savings. However, the standard of studies published has stagnated or even deteriorated in comparison with those included in previous reviews. Utilisation of published guidelines at initial stages of future studies may help improve the overall quality of studies.

Evaluation of Clinical Pharmacy Services Offered for Palliative Care Patients in Qatar

ABSTRACTPalliative care is an emerging concept in the countries of the Gulf Cooperation Council, a political and economic union of Arab states bordering the Persian Gulf, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Clinical pharmacy services have not yet been evaluated in this region. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from September 30 to December 1, 2013. They were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient were calculated. Classification categories were sent to 10 practicing pharmacists in each of Qatar and Canada, who ranked the categories on the basis of perceived importance. A total of 96 interventions were documented, giving 3 interventions per patient and an acceptance rate of 81%. Discontinuing therapy (29%), initiating therapy (25%), and provision of education/counseling (13.5%) were most common. No differences were found between rankings from pharmacists in Qatar or Canada. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. Interventions align with the perceived importance from pharmacists in both Qatar and Canada.

Transparent and reproducible reports of economic evaluations of clinical pharmacy services: A goal for the future?

The recent AJHP article by De Rijdt et al.[1][1] on the economic effects of clinical pharmacy interventions was of particular interest to us.[1][1] Knowing “what works” and what is most effective in health care is crucial for deciding which interventions are the most rational and efficient,[2][2

Transparent and reproducible reports of economic evaluations of clinical pharmacy services: A goal for the future?

Transparent and reproducible reports of economic evaluations of clinical pharmacy services: A goal for the future?

Where Does High‐Quality Research in Economic Evaluation Come From?

Pharmacotherapy: The Journal of Human Pharmacology and Drug TherapyVolume 29, Issue 1 p. 1-2 Free Access Where Does High-Quality Research in Economic Evaluation Come From? James X. Zhang Ph.D., M.S., Corresponding Author James X. Zhang Ph.D., M.S. Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia. Department of Pharmacy, School of Pharmacy, Medical College of Virginia Campus, Virginia Commonwealth University, 209E McGuire Hall, P.O. Box 980533, Richmond, VA 23298; e-mail: [email protected].Search for more papers by this author James X. Zhang Ph.D., M.S., Corresponding Author James X. Zhang Ph.D., M.S. Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia. Department of Pharmacy, School of Pharmacy, Medical College of Virginia Campus, Virginia Commonwealth University, 209E McGuire Hall, P.O. Box 980533, Richmond, VA 23298; e-mail: [email protected].Search for more papers by this author First published: 06 January 2012 https://doi.org/10.1592/phco.29.1.1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Newhouse, J.P.. An iconoclastic view of health cost containment. Health Aff 1993; 12(suppl 1): 152– 71. 2 World Health Organization. The world health report 2000: health systems—improving performance. Geneva: World Health Organization, 2000. 3 Perez, A., Doloresco, F., Hoffman, J.M.et al. Economic evaluations of clinical pharmacy services: 2001–2005. Pharmacotherapy 2009; 29(1): 129. 4 Gold, M.R., Siegel, J.E., Russell, L.B.et al. Cost-effectiveness in health and medicine New York: Oxford University Press, 1996. 5 Drummond, M.F., O'Brien, B., Stoddart, G.L., Torrance, G.W.. Methods for the economic evaluation of health care programmes, 2nd ed. Oxford: Oxford University Press, 1997. Volume29, Issue1January 2009Pages 1-2 ReferencesRelatedInformation