Impact Of Clinical Pharmacy Services Research Articles

Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes.

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.

The Impact of Clinical Pharmacy Services on Direct Oral Anticoagulant Medication Selection and Dosing in the Ambulatory Care Setting

Background: Off-label dosing of direct oral anticoagulants (DOACs) is both common and associated with adverse patient outcomes. Evidence describing best practices to support optimal direct oral anticoagulant (DOAC) dosing is limited. Objective: To describe the impact of clinical pharmacist intervention on DOAC prescribing. Methods: This retrospective study was a descriptive analysis conducted within an integrated healthcare system with a centralized, pharmacist-led Anticoagulation Management Service (AMS). Patients prescribed a DOAC between January 1, 2020 and December 31, 2020 were included. Pharmacy dispensing reports were generated for pharmacist review and anticoagulant drug therapy changes were recommended to physicians where appropriate. The primary objective was to describe the number and type of recommendations made. Secondary objectives were to determine the provider acceptance rate based on the intervention type and on clinical vs formulary recommendations. Results: Clinical pharmacists made 147 recommendations for 2331 unique patients included in the analysis. Twenty-three recommendations (16%) were to decrease the dose, 46 (31%) were to increase the dose, 14 (10%) were to change the medication due to clinical scenario, 62 (42%) were to change the medication due to cost, and 2 (1%) were another issue. One hundred twenty-three (84%) recommendations were accepted. The provider acceptance rate was similar for clinical and formulary recommendations (85% and 82% respectively). Conclusion: Implementation of report-driven clinical pharmacist intervention led to an improvement in appropriate DOAC medication selection and dosing.

The Impact of Clinical Pharmacy Services in a Tertiary Care Center Specialized in Pediatric Hemato-Oncology.

Clinical pharmacy services (CPS) have shown beneficial effects on several outcome measures in hospital patients, including the reduction of drug-related problems (DRP) and of therapy costs. Less is known about the impact of CPS in pediatric haemato-oncology, even though this patient population is highly susceptible to DRP. CPS were implemented in a tertiary care children’s hospital specialized in hemato-oncology and hematopoietic stem cell transplantation. The main outcome measures were type and number of DRP, type and number of pharmaceutical interventions (PI), their acceptance rate, and their clinical significance and economic benefit. During 6 months and 32 ward rounds, 275 DRP were identified and addressed by PI. The acceptance of PI was high (73.4%), and up to 80% of PI were rated as very significant or significant by independent external raters. The estimated therapy cost reductions were substantial, approaching at least EUR 54,600 for avoided follow-up costs. Conclusion: CPS improve medication safety in pediatric hemato-oncology and may reduce therapy costs.

Implementation of a strategy for identification and monitoring of clinical outcome measures in a department of pharmacy

Abstract Purpose To describe a department of pharmacy strategy to identify and monitor outcome measures that represent the impact of clinical pharmacy services on patient outcomes. Summary Our department established the Clinical Impact Committee, with the goal of developing and maintaining an approach to demonstrate the impact of clinical pharmacists on patient care outcomes. We describe the committee’s structure, aims, and key stakeholders, inclusive of both departmental leadership and clinical pharmacist representatives across service lines. We also describe the systematic process used by the committee for identifying clinical outcome measures that are both aligned with organizational priorities and representative of pharmacists’ impact. This involved assembly of a crosswalk of clinical outcome measures that are prioritized by the organization and attributable to the work of clinical pharmacists. We found it imperative to connect pharmacists’ efforts to the priorities of the organization to demonstrate value and continue to justify pharmacy resources. Once the crosswalk of clinical outcome measures was assembled, the Clinical Impact Committee leveraged modified Delphi methodology to build consensus on the measures to prioritize. Once determined, the final outcome measures were developed into outcomes dashboards, to be monitored by the committee and leveraged by frontline pharmacists. Conclusion Our organization was successful in developing a structure, the Clinical Impact Committee, to identify, prioritize, and monitor measures that demonstrate pharmacist contributions to patient care outcomes. Further, our approach includes an intentional alignment with organizational priorities, allowing us to understand and communicate the contributions of our teams to meeting-defined organizational quality priorities.

A Study and Report on Impact of Clinical Pharmacy Services Over Indian Health Care System in the Management of Chronic Disorders/Diseases in Hospital

The study aims to ensure safe, effective, economic, and patient friendly with the knowledge inputs of each professional practice. With the primary and secondary objectives being: to study the role of the clinical pharmacist/doctor of pharmacy professional in the management of chronic diseases/illness, minimise medication/prescription errors, minimise/prevent adverse drug reactions, all types of drug interactions, and unnecessary healthcare costs, reducing drug-related problems and to monitor drug therapy efficiently, attain desired pharmacological effect of the drug, improve quality of life of the patients suffering from chronic conditions, provide patient counselling in a way that it helps to provide effective drug treatment in thereby improving the patient's condition, improve medication adherence, patient compliance and patient safety and therefore to provide drug or poison information services as needed. In India, chronic diseases such as cardiovascular diseases, diabetes, cancer, HIV and mental health disorders and injuries are the leading causes of death and disability. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health care systems are essential for the implementation of cost-effective interventions. This study enrolled 200 patients totally, out of which, 120 (sample size) patients’ prescriptions were analysed for potential drug interactions and were also selected for comparison of results of other related clinical pharmacy services. The majority of the population being males (65) and the rest being females (55) and among the study population, around 60 (132.5%) patients were geriatric, about 17 (38%) were renal impairment patients and about 13 (29.5%) were hepatic impaired patients. Out of the 45 interventions proposed, the most frequent suggestion was on substitution for 26.67% of the population and monitoring 26.67%. Out of this, 20.69% of the interventions/suggestions made were accepted and therapy was changed. Hence the prospective study was performed based on other categories which are discussed further using various software and spreadsheets to calculate the desired results and hence with the overall objective being to improve and make better the patients’ health and quality of life.

Assessing the impact of clinical pharmacy services on the healthcare outcomes of patients attending an outpatient haemodialysis unit in a rural hospital in Egypt: a quasi-experimental study

Abstract Objectives This study aimed to investigate the impact of newly introduced clinical pharmacy services on the health care of chronic haemodialysis patients attending an outpatient haemodialysis unit in a rural hospital with limited resources in Alexandria, Egypt. Methods A quasi-experimental pre-/post-test study was conducted from November 2016 till June 2018. Clinical pharmacists collected relevant information using a pre-specified form. Patients’ data were reviewed for drug-related problems (DRPs), which were documented using the Pharmaceutical Care Network Europe (PCNE) classification system, version 8.02 and resolved by the clinical pharmacists. Measured values of calcium, phosphorus and haemoglobin were compared with target levels set by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Proportions of patients achieving therapeutic values of each parameter were compared before and after implementing the program using the McNemar test. We also reported the analysis of DRPs identified and addressed by the clinical pharmacy team. Key findings A total of 685 DRPs were identified during the follow-up period. Improper dose and inappropriate drug selection were the most common DRPs (45.8% and 18.9%, respectively). There was a statistically significant increase in the proportion of patients achieving target corrected calcium levels (30% pre-intervention versus 69.6% post-intervention, P = 0.001) and haemoglobin levels (9.1% pre-intervention versus 31.9% post-intervention, P = 0.003), but not in phosphorus levels (18.6% pre-intervention versus 22% post-intervention, P = 0.7). Conclusions Clinical pharmacists were able to resolve frequent DRPs and improve some markers of health care in haemodialysis patients.

The impact of clinical pharmacy services on patients with hypertension.

Globally, hypertension is a major concern in all health care systems. The role of clinical pharmacists in managing hypertension is essential not only in dispensing drugs but also in actively participating in managing treatment regimens. The goal of this study was to support the role of clinical pharmacists in managing patient hypertension therapy. This study was designed as a pragmatic, prospective, quasi-experimental study. In this study, 160 patients were enrolled, but seven patients withdrew from the study. The effects of the intervention were studied on the remaining 153 participants. Blood pressure, MINICHAL score, and DAI-10 score were measured at the beginning and at the end of the study. The patients received different medication counselling sessions that included medication education. The counselling sessions were conducted three times, with each session 4months apart from the previous session. The first session was conducted at the beginning of the study following the enrolment of the patients. Only the first session was carried out in person for all the participants, while the other two sessions were conducted either in person or via a phone call. Ninety-three male participants (60.8%) and 60 female participants were included (39.2%), and the mean age was 44.18 (±8.385). Most patients enrolled in the study were diagnosed with hypertension within the previous 12 months from the beginning of the study. The mean changes in SBP and DBP between the baseline and final readings were 13.1 and 5.4 mmHg, respectively P < .001). In addition, the DAI-10 positive score improved from 33.3% of the study population at the beginning of the study to 86.3% of the population at the end of the study. The interventions of clinical pharmacists were found to be significantly important in improving the outcomes of hypertensive patients. Therefore, legislation making clinical pharmacy services compulsory in Middle Eastern health care systems, and particularly the UAE, is needed to expand the roles of pharmacists within the health care system.

Proposed guidance on cost-avoidance studies in pharmacy practice.

Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists' action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.

Impact of Clinical Pharmacy Services on Patient Management in the Chemotherapy Infusion Clinics: A 5-Year Study at a Comprehensive Cancer Center

Background: Chemotherapy requires careful dosing and monitoring and is associated with numerous adverse events. There is limited data describing the impact of clinical pharmacists in the chemotherapy ambulatory setting. Objective: This study aimed to evaluate the impact of clinical pharmacy services on patient management in the adult chemotherapy infusion clinics. Methods: This was a 5-year retrospective study that utilized the pharmacy electronic documentation system to determine the type of interventions and adverse drug events (ADEs) reported by the clinical pharmacists in the chemotherapy infusion clinics. Interventions were described based on the type of intervention and medication involved. ADEs were evaluated based on the type of ADE, the suspected medication, and the required management. Results: During the study period, 3,279 interventions and 1,445 ADEs were reported. The most common interventions involved dose adjustments (51%), followed by addition (23%) or discontinuation (21%) of prescribed medications. Carboplatin (20%) and zoledronic acid (14%) were the most common medications that required pharmacist interventions. The most common types of ADEs were hematologic (22%) and infusion-related reactions (20%). Docetaxel was the most common medication associated with ADEs (20%). Among the reported ADEs, most required adding supportive care (44%), followed by adjusting chemotherapy doses (22%). Conclusion: Clinical pharmacy services at the chemotherapy infusion clinics play an important role in optimizing the chemotherapy regimens as well as identifying and managing ADEs. Future studies should be directed to measure the impact of these services on patient outcomes as well as, physicians and pharmacy operational workload and cost savings.

Impact of Clinical Pharmacy Services on Health-Related Quality of Life in Rheumatoid Arthritis Patients

Impact of Clinical Pharmacy Services on Health-Related Quality of Life in Rheumatoid Arthritis Patients

Economic impact of clinical pharmaceutical activities in hospital wards: A systematic review.

The positive impact of clinical pharmacy services (CPS) in improving clinical outcomes such as reduction of drug related problems is well demonstrated. Despite these results, the deployment of these activities is not systematically observed in the hospital setting. This systematic review first aimed to describe existing evidence regarding economic evaluation of ward-based CPS focusing on the entire treatment of a patient in a hospital setting. Secondly, the quality of economic evaluations of existing evidence was assessed. A comprehensive literature search was performed in PubMed/Medline, Science Direct and the NHS Economic Evaluation databases from January 2000 to March 2019. English or French language articles describing an economic evaluation of ward-based CPS on inpatients in hospital settings were included. Articles not describing a single study, dealing with a CPS not considering the entire medication regimen of the patient or presenting both inpatient and outpatient CPS were excluded. Selected articles were analyzed according to Drummond's check-list for assessing economic evaluations. Forty-one studies were included. About one third were American publications. CPS implemented in ICU represented about half of the selected articles. Pharmacist-to-bed ratios varied according to countries and care unit type with the most favorable ratios in ICU and in American studies. Cost-avoidance was mostly used to express economic impact and ranged from €1579 to €3,089328. Studies yielding the greater economic impact were conducted in the USA with implementation of full-time equivalents pharmacists or establishing of collaborative practice agreements. Only 6 articles dealt correctly with at least 7 of the 10 Drummond's checklist assessment criteria. This review suggests that the existing evidence is not sufficient to conclude to a positive economic impact of CPS conducted according to clinical pharmacy guidelines. Funding resources, remuneration of clinical pharmacy activities and provision of standardized national clinical and economic databases appear to be essential evolutions to improve CPS development.

The Role of Clinical Pharmacy in Preventing Prescribing Errors in the Emergency Department of a Governmental Hospital in Jordan: A Pre-Post Study.

Background: Clinical pharmacists have a vital role in intercepting prescribing errors (PEs) but their impact within a Jordanian hospital emergency department (ED) has never been studied. Objective: To evaluate the impact of clinical pharmacy services on PEs and assess predictors of physicians' acceptance of clinical pharmacists' interventions. Setting: This study was conducted in the ED of the largest governmental hospital in Jordan. Method: This was a pre-post study conducted in October and November 2019 using a disguised observational method. There were 2 phases: control phase (P0) with no clinical interventions, and active phase (P1) where clinical pharmacists prospectively intervened upon errors. The clinical significance of errors was determined by a multidisciplinary committee. The SPSS software version 24 was used for data analysis. Main Outcome Measure: PEs incidence, type, severity, and predictors for physicians' acceptance. Results: Of 18003 patients, 8732 were included in P0 and 9271 in P1. PEs incidence decreased from 24.6% to 5.4%. Contraindication, drug selection, and dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0) to 12.6%, 0.0%, and 0.0% (P1), respectively. Albeit not statistically significant, drug-drug interaction, drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively. Significant and serious errors were significantly reduced from 68.7% and 3.0% (P0) to 8.9% and 1.8% (P1), respectively. During P1, most errors were minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians' acceptance were: significant errors (OR 3.1; 95% CI 2.6-4.3; P = 0.03) and non-busy physicians (OR 2.1; 95% CI 1.6-2.7; P = 0.04). Conclusion: Clinical pharmacists significantly reduced PEs in the ED by 76%; most of interventions were significant. Policymakers are advised to implement active clinical pharmacy in the ED.

Impact of clinical pharmacy services in a hematology/oncology ward in Morocco.

Clinical pharmacists are contributing to safe medication use by providing comprehensive management to patients and medical staff. The aim of this study is to document and evaluate the role of clinical pharmacy services in oncology department. A prospective, descriptive, observational study was carried out from July 2018 through June 2019 at the Department of Medical Oncology at the National Institute of Oncology, Morocco. Medication reviews concerning hospitalized adult cancer patients were performed every day by the clinical pharmacist assigned to the department. A total of 3542 prescriptions of 526 adult cancer patients were analyzed. The pharmacist identified 450 drug-related problems (12.7% of the prescriptions) primarily related to the analgesics (31.5%). Medication problems included mostly untreated indications (31.3%), overdosing (17.1%), drug-drug interactions (12.4%), underdosing (11.1%), administration omissions (6.7%), drug not indicated (6.0%), and contraindication (5.3%). Interventions (n = 450) led to drug additions (30.7%), drug dosing adjustments (27.1%), treatment discontinuations (20.0%), recall of the treatment (6.2%), replacement of a drug with another one (5.1%), administration optimization (4.0%), therapeutic drug monitoring (3.1%), alternate routes of administration (2.5%), and extension of treatment duration (1.3%). Most (98%) of the interventions were accepted and implemented by the medical staff-172 (38.2%) having a significant clinical impact on the patient, 88 (19.6%) as having a very significant clinical impact, and 71(15.8%) as having a potential vital impact. This work highlights the positive clinical relevance of pharmacists' interventions in oncology and the importance of medicopharmaceutical collaboration to prevent medication error.

Clinical pharmacy services in Brazil, particularly cardiometabolic diseases: a systematic scoping review and meta-analyses.

Objective:To map the clinical pharmacy services conducted in Brazil, their characteristics, outcomes, and process measures in general population, as well as the assessment of the clinical impact on people with cardiometabolic diseases (cardiovascular diseases and metabolic diseases).Methods:A systematic scoping review and meta-analysis were conducted. The electronic searches were re-run in March 2020. To the clinical impact assessment, meta-analyses of cardiometabolic outcomes (i.e., change of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total cholesterol, glycated hemoglobin (HbA1c), fasting glycemia, LDL-, and HDL-cholesterol) were led. The risk of bias was assessed with the Cochrane Collaboration tools.Results:71 studies were identified (7,402 patients), being the majority quasi-experimental studies (n=41) and published by research groups of Southeast Brazil (n=33). Medication therapy management (n=62) was the most frequent clinical pharmacy service, performed on outpatient setting (n=45), with adults or elderly people (n=58) with hypertension (n=18) or diabetes (n=10). Process measures (n=58) (e.g. resolution of drug related-problem) were widely used as indicator, followed by clinical (n=44) (e.g. change in SBP), humanistic (n=12) (e.g. change in quality-of-life score assessed by Short-Form 36 Health Survey Questionnaire), and economic outcomes (n=3) (incremental cost-effectiveness ratio for reduction in HbA1c). Regarding the assessment of clinical impact of the services, 20 studies were included in meta-analyses, showing improvement in most cardiometabolic outcomes when considered individual studies. However, the evidence presents high risk of bias, high heterogeneity (median 67-90%) and imprecision, contributing to wide prediction intervals and low reliability.Conclusions:A predominance of studies on cardiometabolic diseases, process measures, and clinical outcomes were identified. Considering the assessment of the clinical impact of clinical pharmacy services in cardiometabolic diseases, an improvement in most cardiometabolic outcomes was showed, however, with low confidence and wide prediction interval. Therefore, development of larger studies with low risk of bias and major homogeneity is necessary for a better comprehension of clinical pharmacy service characteristics, benefits, and the population groups most benefited.

The impact of clinical pharmacy services on pneumococcal vaccine frequency and appropriateness in a family medicine clinic

ObjectiveTo evaluate the impact of an ambulatory clinical pharmacy service (inclusive of immunization needs assessments) on the frequency and appropriateness of pneumococcal vaccine administration in a family medicine clinic. MethodsThis cohort study had an observational and retrospective design and included patients who received pneumococcal vaccines at a family medicine clinic in a medically underserved area in Southwestern Pennsylvania across a 42-month period from January 1, 2015, to June 30, 2018. The outcome measures included the administration and appropriateness of pneumococcal 13-valent conjugate (PCV13) and pneumococcal 23-valent polysaccharide (PPSV23) vaccines across 3 time cohorts including before, during, and after the establishment of a clinical pharmacy service. ResultsA total of 457 pneumococcal vaccines were administered, including 198 (43.3%) PCV13 and 259 (56.7%) PPSV23, across all time cohorts. Overall vaccine administration per month increased by 143% with the introduction of a dedicated clinical pharmacy service, including a 270% increase for PCV13 and an 87% increase for PPSV23. A strong correlation was found between recommendations made and doses administered for both pneumococcal vaccines (r = 0.89; P < 0.003). Across the entire time frame, PPSV23 administrations were appropriate in more than 96% of instances, whereas the appropriateness of PCV13 administrations were statistically significantly improved after the introduction of a fully dedicated clinical pharmacy service (58.5% vs. 90.8%; P < 0.05). The appropriateness of vaccine administration remained high even after the reduction of clinical pharmacy services. ConclusionClinical pharmacy service implementation in a family medicine clinic was associated with increased pneumococcal vaccine administration and increased appropriateness of PCV13 administrations.

The impact of a pharmacist-driven, collaborative practice on diabetes management in an Urban underserved population: a mixed method assessment

ABSTRACTThe objective of this manuscript is to describe the results of a pharmacist-driven, Type 2 diabetes targeted, collaborative practice within an urban, underserved federally qualified health center. Pharmacists within a primary care team managed patients with chronic illnesses utilizing a collaborative practice agreement. Pharmacists, pharmacy residents, and supervised students provided care for patients with Type 2 diabetes. The first visit incorporated past medical history, medication reconciliation, determination of adherence and patient knowledge of diabetes pathophysiology, care plan, including diet and exercise, medications, and possible complications. Pharmacists had the authority to optimize medications and order laboratory tests and referrals. Diabetes, hypertension, and medication use outcomes data were collected and analyzed to assess the impact of clinical pharmacy services. Patient and provider satisfaction were assessed via surveys and focus group interviews. Ninety-nine patients were included in the evaluation. The mean A1c level was 9.8% at baseline and 8.4% at follow-up (p< .05). There were significant improvements in patient attainment of A1c <9%, ACE Inhibitor/angiotensin receptor blocker and statin use, and tobacco cessation at follow-up (p< .05). Eleven providers who responded to the satisfaction survey answered 73% of the questions with strongly agree. The seven patients who participated in the satisfaction survey, and focus group were satisfied with the care they received from the pharmacists. The focus group highlighted similar personal goals, barriers, and interests in nutrition education. Working as part of a collaborative care team, pharmacists were able to have a significant impact on improving the health outcomes of patients with Type 2 diabetes and patient and provider perceptions of the vital role of pharmacists.

Correction to: The impact of clinical pharmacy services in Nepal in the context of current health policy: a systematic review

The Fig. 1 was incompletely filled. The correction and corresponding data are shown below. Addition to Fig. 1 “Records identified through database searching”: Cochrane library (n = 6). The original article has been corrected.

Impact of Clinical Pharmacy Services in Care of Patients with Cardiovascular Diseases: [A Prospective Study

scholarly articles on cardiology Journal of Cardiology & Cardiovascular Therapy is an Open Access, international peer reviewed journal launched from Juniper Publishers. Cardiology is a branch of medicine deals with the disorders of heart that keeps cardiologists up to date with advances in the diagnosis and treatment of cardiovascular diseases.

The impact of clinical pharmacy services in Nepal in the context of current health policy: a systematic review

The necessity of clinical pharmacy services is increasing globally, and their provision is the upcoming direction of hospital pharmacists. The aim of this review was focused on the impact of clinical pharmacy services in the Nepalese healthcare setup. The English-language databases of Web of Science, PubMed, ScienceDirect, and Cochrane Library were searched using the following keywords: ‘pharmacy’, ‘clinical pharmacy’, pharmaceutical services’, ‘pharmacists’, pharmaceutical care’, ‘pharmacy practice’, ‘hospital pharmacy’, ‘pharmaceutical interventions’, and ‘Nepal’. Eligibility for inclusion, risk of bias assessment, and data extraction from the included studies were determined by two authors, and a narrative synthesis was conducted. This review contained a total of 14 published articles. The included studies involved the counseling and educating of patients, working as a member of the healthcare team, detecting prescribing errors, suggesting clinicians or nurses, reviewing prescriptions on the ward, giving training and monitoring of the implementation of policies, etc. The outcome of these interventions showed a reduction in the direct healthcare cost, excessive use of medicines, and prescription errors, as well as improvement in the drug utilization pattern, knowledge, as well as satisfaction of patients. In order to implement and enhance clinical pharmacy services, governmental, educational, and administrative support may be needed.

A Pilot Project for Clinical Pharmacy Services in a Clinic for Children With Medical Complexity.

The primary objective of the project was to assess the impact of clinical pharmacy services in a clinic for children with medical complexity. Secondary objectives were to identify and characterize the drug-related needs of these patients and to describe and develop the role of a pharmacist in the clinic. This was a prospective descriptive study in which a clinical pharmacist staffed the clinic for children with medical complexity for 11 weeks, from January to March 2011. This allowed for the collection of baseline data, such as patient characteristics and measurements of pharmacist workload and assessment (eg, types of drug therapy problems, medication reconciliation, medication teaching). A pharmacist participated in 46 clinic visits with 43 patients, identifying a total of 42 drug therapy problems. Of the 42 problems, 35 actual and 7 potential drug problems were identified, resulting in approximately 1 problem per patient. The most common actual problems included "dose too small" (37.1%) and "patient requires a medication for untreated condition" (20%). Common potential problems included "drug interactions" (43%) and "adverse effects" (57%). The pilot study demonstrates that children with medical complexity are at high risk for drug therapy problems and the presence of a clinic pharmacist is beneficial in the identification, prevention, and resolution of drug therapy problems, while helping ensure continuity of care in this population.