Pharmacist Interventions In Patients Research Articles

Telephone versus In-Person Pharmacist-Led Medication Reviews in Home Dialysis Patients: Evaluating Quality of Care and Patient Satisfaction

The COVID-19 pandemic required pharmacists in a provincial Home Dialysis Clinic to adapt from in-person to telephone-based medication reviews. Studies have shown that in-person pharmacist interventions in patients with chronic kidney disease (CKD) lead to a reduction of drug therapy problems (DTPs), however, it's unknown if telephone interventions provide similar outcomes. The purpose of this study was to evaluate whether differences in quality of care exist between in-person vs. telephone medication reviews in home dialysis patients and to evaluate patient satisfaction with telephone medication reviews. Data from the two most recent in-person medication reviews was compared with the two most recent telephone medication reviews for each patient (n = 46). There were no statistically significant differences in DTPs identified between in-person and telephone medication reviews (p = 0.431). Physician acceptance of pharmacist recommendations was higher for in-person medication reviews (p = 0.009). Patients were satisfied with the care they received with pharmacist-led telephone medication reviews, however, 29% (n = 7) would prefer an in-person medication review once per year with telephone medication reviews the rest of the time. Overall, patients were satisfied with the care they received from telephone medication reviews.

Improving medication adherence in patients with hypertension through pharmacist-led telehealth services

Background Pharmacist-led telehealth services have resulted in improvements in several disease states, including diabetes and conditions requiring anticoagulation. Pharmacists who used telehealth methods to follow up with their patient have noticed an increase in medication adherence. Methods Using PubMed and EBSCO secondary databases, inclusion criteria were any peer-reviewed study design such as randomized controlled trials, literature reviews, systematic reviews, and cohort studies published within the last 10 years. Search terms included pharmacist, telemedicine, telehealth, cardiovascular disease, and medication adherence. Results Seventeen articles were reviewed. Most pharmacist interventions for patients with hypertension involving telemedicine, E-Health, or remote monitoring were performed in the outpatient setting. The primary target of most studies consisted of improving medication adherence. Conclusion Pharmacist services play an integral role in maintaining medication adherence among the hypertensive population. Telehealth is an effective method of communication with patients to ensure their health is maintained, minimizing barriers of access to care.

Impact of pharmacist intervention in patients with Alzheimer's disease

To assess the therapy relative to indication, effectiveness, safety and adherence in patients with Alzheimer’s disease (AD). An interventional, prospective, non-randomized study was conducted in a single secondary care center in Brazil. The pharmacist-led medication therapy management (MTM) was conducted to detect drug-related problems (DRPs) at baseline and after six months of intervention. The health status outcomes (i.e. cognitive screening tests; levels of glucose; total cholesterol; triglycerides; thyroid stimulating hormone; serum free thyroxine and blood pressure) were measured. 66 patients with AD were included, of whom 55 patients completed the follow-up of six months. 36 patients (36/55) were non-adherent to AD drug therapy. Out of detected 166 DRPs, 116 were solved. Four patients were withdrawn from the AD protocol due to resolution of prodromal symptoms. On the conclusion of the study, the MTM improved and controlled blood pressure, glucose, total cholesterol, triglycerides levels (p<0.05). The pharmacist-led MTM was effective in solving 69.8% of DRPs, improving and controlling the clinical parameters evaluated.

Evaluation and clinical impact of a pharmacist-led, interdisciplinary service focusing on education, monitoring and toxicity management of immune checkpoint inhibitors.

Immune-related adverse events are complications of immune checkpoint inhibitors which require robust patient education and proactive follow-up to ensure timely identification and management. Oncology pharmacist practice models with other anticancer modalities have been well documented, but there is limited evidence assessing the spectrum of pharmacist interventions in patients receiving immune checkpoint inhibitor(s) and the impact of these interventions on patient outcomes. Patients initiated on immune checkpoint inhibitor(s) from 1 January 2016 to 31 August 2019 were included for data collection and analysis. Part 1 featured an intensive pharmacist follow-up cohort (study cohort) and summarized pharmacist interventions. Part 2 compared patient outcomes between the study cohort and a standard of care cohort (control cohort) from a different oncology centre. Patient outcomes included emergency department visits not resulting in admission, hospitalizations due to immune-related adverse event(s), immune checkpoint inhibitor cycles received, treatment discontinuation due to immune-related adverse event(s), completion of finite programmed death-1/death-1 ligand treatment course and completion of ipilimumab. Clinical outcomes were compared using a retrospective, matched cohort design based on age, cancer diagnosis and immune checkpoint inhibitor(s). A total of 143 patients were included in Part 1 encompassing 1664 pharmacist recommendations across 11 categories. The matched cohort yielded 92 matches (n = 184) with a higher odds of immune checkpoint inhibitor discontinuation due to immune-related adverse event(s) in the control cohort (odds ratio (OR) (95% confidence interval (CI)) = 5.5 (1.2-24.8); p = 0.022). Intensive immune-related adverse event education, proactive follow-up and immune-related adverse event management by pharmacists result in clinically meaningful interventions which correlate to improved patient outcomes, namely lower odds of treatment discontinuation due to immune-related adverse event(s).

Cost-effectiveness analysis of pharmacist interventions in patients with heart failure in Thailand

IntroductionPatients with heart failure (HF) are likely to have multiple diseases with complex therapy regimens. Pharmacist intervention in HF treatment can reduce all-cause mortality and hospitalization, but the economic outcome is not known. ObjectiveThis study aimed to assess the cost-effectiveness of pharmacist contribution in HF setting compared with usual care. MethodsA decision analytical model was developed to estimate the cost and outcome from a health care system perspective in Thailand. Clinical inputs were obtained from literature review. Pharmacist costs, hospitalization cost for HF, risk of hospitalization death, risk of nonhospitalization death, and readmission rate were based on data from Thailand. The cost and outcome were discounted at 3% annually. Outcome measuresThe incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2020. A series of sensitivity analysis was also performed. ResultsPharmacist intervention incurred higher total costs than usual care, because total cost of pharmacists was 186,040 THB (5936 USD) whereas usual care cost was 151,654 THB (4839 USD). It also provided more quality-adjusted life years (QALYs) than usual care, from 2.4 to 2.8. In addition, patient life years (LY) were increasing from 3.3-3.8. This yielded an ICER of 77,398 THB/LY (2467 USD/LY) or 103,037 THB/QALYs (3288 USD/QALYs). This ICER is considered to be cost-effective at the willingness-to-pay level of 160,000 THB/QALY (5191.87 USD). ConclusionAt this current situation in Thailand, pharmacists may represent good value for the nation’s limited health care resources. The information should be used in national policies to plan for pharmacist work force implementation and production line in the near future.

PMH50 IMPACT of Clinical Pharmacist Intervention in Patients with Bipolar Affective Disorder in South India

PMH50 IMPACT of Clinical Pharmacist Intervention in Patients with Bipolar Affective Disorder in South India

Effects of pharmacist interventions on heart failure outcomes: A systematic review and meta‐analysis

AbstractHeart failure (HF) patients tend to have multiple comorbidities resulting in complex therapy regimens and medication adherence issues. Nevertheless, the evidence of pharmacists' contributions to improving clinical outcomes in HF is limited. To assess the impact of pharmacist intervention on all‐cause hospitalization, mortality, and quality of life (QoL) in HF) patients. A systematic search of PubMed, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and CINAHL was performed up to April 30, 2020. Randomized controlled trials (RCTs) evaluating pharmacist interventions compared with usual care in adult HF patients were selected. Data were extracted independently by two authors. Random effects meta‐analysis models were used to pool treatment effects and confidence intervals (CIs). Twenty‐nine trials identified 6965 predominantly HF with reduced ejection fraction (HFrEF) patients. The average age was 72.0 years (interquartile range [IQR] 66.0‐76.0) and 48% were men (IQR 40.0%‐68.0%). The majority were New York Heart Association (NYHA) Functional class (FC) II‐III with median left ventricular ejection fraction (LVEF) of 38.5% (IQR 34.5%‐49.5%). Pharmacist interventions were associated with a significant reduction of all‐cause mortality (risk ratio [RR] 0.72; 95% CI 0.58‐0.89; P = 0.003) and all‐cause hospitalizations (RR 0.87; 95% CI 0.77‐0.99; P = 0.041). A significant increase in the 36‐item Short form Health survey (SF‐36) on role physical (Mean deviation [MD], 8.5; 95% CI, 1.00 to 16.01, P = 0.026) and mental health (MD, 7.49; 95% CI, 3.88 to 11.10, P &lt; 0.001) were observed. In addition, a significant improvement in Minnesota Living with Heart Failure Questionnaire score was observed (MD ‐3.55; 95% CI ‐6.28 to −0.82; P = 0.01). Pharmacist interventions in patients with HF significantly reduced all‐cause mortality and hospitalizations and improved QoL. Integration of a pharmacist into a HF care team or care pathway should be strongly considered as an important element of a multidisciplinary team.

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

AbstractAimThe role of clinical pharmacists in the care of hospitalised general medicine patients is evolving from a reactive model of care to a model with an emphasis on interdisciplinary care and more advanced models of care. The purpose of this review was to evaluate the published literature on the effects of roles of clinical pharmacists that extend beyond those activities considered to be standard clinical practice in Australia, on clinical outcomes in hospitalised general medicine patients.Data sourcesA search of English‐language publications in six databases was conducted.Study selectionPeer‐reviewed, English‐language articles were identified across the date range January 2000 to June 2020. Studies were included if they evaluated an inpatient pharmacy service in a general medicine population and the article included a study design with a clear comparator and outcomes such as medication errors or medication appropriateness. Studies evaluating pharmacists’ activities that are considered standard clinical practice for pharmacists in Australia, such as participation on ward rounds, medication reconciliation and patient education were excluded.ResultsTwelve studies met the inclusion criteria: four evaluating pharmacist‐led anticoagulation or thromboprophylaxis management, one evaluating pharmacist‐led vaccination, three evaluating a pharmacist charting model, two evaluating pharmacist‐led de‐escalation of therapy, one evaluating a pharmacist intervention in patients with chronic kidney disease and one evaluating pharmacist‐led glycaemic control.ConclusionsThe addition of advanced clinical pharmacist services in the care of general medicine inpatients generally resulted in improved care, with no evidence of harm. Future studies should include multiple sites, larger sample sizes, reproducible interventions and identification of patient‐specific factors that lead to improved outcomes.

Role of Pharmacist Intervention in the Management of Anemia Associated with Chronic Kidney Diseases at the Hemodialysis Setting

<!DOCTYPE html> <html> <head> </head> <body> <p style="text-align: justify;"><strong>Background:</strong> The potential impact of pharmacist interventions could improve health outcomes of patients with anemia. However, this attempt has not been documented yet in the developing countries. Aim of the study is to investigate the effect of pharmacist interventions in optimizing management of anemia associated with chronic kidney disease. <strong>Methods: </strong>An interventional randomized control trial was carried out on 120 anemic patients on hemodialysis for eight months. The impact of the pharmacist&rsquo;s interventions in optimizing anemia management to reach hemoglobin target were investigated. Data were analyzed by GraphPad Prism version 8.2.1. <strong>Results:</strong> During 16-week period, 1646 interventions and recommendations were performed. The interventions were at the physician, patients, drugs, hospital and administrative level. At the physician level a total of 180 (10.9%) recommendations were proposed, at the drug level, the pharmacist provided 595 (36.1%) interventions which were mainly related to erythropoietin and iron dose adjustment. At the patient and the hospital level 734 (44.6%) and 137 (8.3%) interventions have been made respectively. Hemoglobin level increased significantly to (11.25 &plusmn; 2.29) after 16-weeks in interventional group (<em>p</em>-value &lt;0.5), while in non-interventional group it was increased to (9.99 &plusmn; 2.54) at 16th week although the change was significant compare to the baseline level but it has not reached the target hemoglobin level. In the interventional group 39 (65%) patients reached the target hemoglobin while it was 25 (41.6%) in non-interventional group with a significant difference between both groups (<em>p</em>-value =0.017). <strong>Conclusion:</strong> In conclusion the implementation of pharmacist intervention in patients with chronic kidney disease-associated anemia improved hemoglobin level and healthcare outcomes. <p style="text-align: justify;"><strong>Key words: </strong>Anemia, Chronic kidney disease, Hemodialysis, Hemoglobin, Pharmacist intervention. </body> </html>

Long-term impact of pharmacist intervention in patients with bipolar disorder: extended follow-up to the EMDADER-TAB study

BackgroundPharmaceutical care (PC) through the Dader method (DMet) vs. the usual care process (UCP) significantly reduced psychiatric hospitalizations and emergency service consultations during one year of follow-up of outpatients with bipolar I disorder (BD-I). To date, the effect of long-term PC on the use of health services by BD-I patients once pharmacist intervention has ended is unknown. ObjectiveTo determine whether the effect of PC measured by the decrease in psychiatric hospitalizations and emergency service consultations is maintained one year after pharmacist intervention ceases. MethodsThis was a retrospective analysis of patients who had previously participated in a randomized, controlled, prospective, single-center clinical trial to compare PC (intervention group) vs. UCP (control group) in BD-I patients. Data were collected from November 2012 to March 2014. The primary outcome was the use of health services measured by the number of psychiatric hospitalizations and emergency service consultations. Descriptive statistics, Student's t-test, Kaplan–Meier function, and Log-Rank test were used. ResultsThe study included 92 patients: 43 in the intervention group and 49 in the control group. Eleven psychiatric hospitalizations occurred for the intervention group and 19 for the control group. One year after pharmacist intervention ceased, there were no significant differences between the groups in psychiatric hospitalizations (p = 0.261). There were 14 emergency service consultations for the intervention group, and 24 for the control group without significant differences (p = 0.212). ConclusionsPC through the DMet has no long-term effects on psychiatric hospitalizations and emergency department consultations in patients with BD-I following discontinuation of pharmacist intervention; the effect dissipates when the intervention ceases. Future studies should focus efforts on identifying factors associated with PC that explain why the outcomes derived from this intervention are not maintained in the long term.

A review of health‐related outcomes from community pharmacist interventions in patients with chronic obstructive pulmonary disease

AbstractCurrently, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world and is predicted to be the third leading cause by the year 2020. The purpose of this manuscript is to review the expanding role of community pharmacists in the detection and management of patients with COPD. Pharmacists in the community setting can improve outcomes in patients with COPD by minimizing risk factors through smoking cessation interventions, prevention of disease by evaluating immunization history and early detection by providing spirometry. In addition, these pharmacists are well‐positioned for initiating medication therapy management (MTM) services, reducing noncompliance by counseling on proper medication use to ensure adherence and correct inhalation technique, as well as participating in transition of care. There is evidence that pharmacists can support other health care professionals with appropriate treatment recommendations, reducing overall direct and indirect health care costs. In summary, medications are an important tool in managing COPD, with adherence being critically important for these patients, and community pharmacists are an accessible health care professional able to perform needed medication and wellness related interventions that can improve patient outcomes.

Impact of Pharmacist Interventions on the Long-Term Clinical Outcomes in Patients with Myocardial Infarction.

Controlling modifiable risk factors (MRFs) in patients with cardiovascular diseases has been shown to be effective in reducing re-hospitalization rates. The aim of this study was to investigate the rates of controlled MRFs and clinical outcomes after pharmacist interventions in patients with myocardial infarction (MI) after hospital discharge. This prospective randomized clinical study was conducted at one medical center in Taiwan, and enrolled patients with MI from January 1, 2012 to December 31, 2014. Patients received medication reconciliation and education from a pharmacist before hospital discharge. The intervention group (IG) received continuous consultations from the pharmacist after discharge, whereas the control group (CG) did not. Primary outcomes included achieving blood pressure < 140/70 mmHg, low-density lipoprotein-cholesterol (LDL-C) < 70 mg/dL, and hemoglobin A1c (HbA1c) < 7% targets. The secondary outcome was major adverse cardiac events (MACEs), defined as re-hospitalization due to MI, unstable angina and stroke. Two hundred and eight patients completed the study protocol (106 in the IG and 102 in the CG). The rate of achieving blood pressure goal was similar between the two groups. More patients in the IG achieved LDL-C and HbA1c goals than those in the CG at 1 year and 2 years post discharge. However, there was no significant difference in the cumulative incidence of MACEs between the two groups (5.7% vs. 9.8%) (p = 0.262). Diabetes was the only independent predictor of re-hospitalization due to a MACE. Pharmacist interventions led to a higher rate of optimal controlled MRFs but did not significantly reduce the MACE rate in the patients with MI.

Pharmacist intervention in patients receiving treatment for Chagas disease: An emerging challenge for non-endemic countries

Abstract Background Spain has the second highest number of Chagas disease-infected patients among non-endemic countries. However, there is limited knowledge about pharmacist involvement in managing patients with Chagas disease. Method A retrospective observational study was performed in two periods (before and after intervention) to describe the characteristics of patients with Chagas disease. Pharmacist intervention, based on two pharmacist-visit programs and development of information for patients, was applied to patients under pharmacological treatment in a non-endemic country. Depending on the initial results in 2010–2011, specific pharmacist attention program for patients with Chagas disease was implemented in 2012. The results of 2010–2011 (before intervention) and 2013 (after intervention) were compared. Results A high number of adverse drug reactions were reported in both periods, 50.0% (2010–2011) vs. 90.9% (2013). With regard to treatment completion, in 2010–2011, 60% achieved the treatment completion criteria (>95% days of treatment) vs. 68.2% in 2013 (p = 0.580). There was, however, a significant increase in the detection of ADRs in the second period (50.0% vs. 90.9%; p = 0.003) and an increase in the severity (75% [6/8] of uncompleted treatments were due to ADRs vs. 100% [7/7] in the first and second period, respectively). Conclusions This study was useful to provide more information about patients with Chagas disease, provide pharmacist intervention/information material to patients, and detect a point of improvement in hospital follow-up care. Although it was not possible to demonstrate it with a statistically significant result, we believe that pharmacist intervention that includes in-depth patient information about possible ADRs and their management could increase adherence and treatment completion rates. In addition, pharmacist intervention helped to better detect and control ADRs that could lead to generating better health outcomes in Chagas disease. Although our patients' health literacy was not evaluated, it would be a potential avenue for future research.

Clinical Evaluation of Pharmacist Interventions in Patients Treated with Anti-methicillin-Resistant Staphylococcus aureus Agents in a Hematological Ward.

The therapeutic effects of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents, vancomycin (VCM), teicoplanin (TEIC), and arbekacin (ABK), depend on their concentrations in blood. Therefore, therapeutic drug monitoring (TDM) is important when these antibiotics are used. In the hematological ward at Tokushima University Hospital, pharmacists have ordered the measurement of blood VCM, TEIC, and ABK concentrations to promote the use of TDM in accordance with an agreed protocol since 2013. Moreover, the infection control team includes several medical disciplines and has advised on the optimal treatment using VCM, TEIC, and ABK since 2013. This study aimed to investigate the clinical effectiveness of these pharmacist interventions. We retrospectively studied 145 cases in which patients were treated with VCM, TEIC, or ABK between January 2012 and December 2013 in the hematological ward at Tokushima University Hospital. The patients were divided into a control group (71 cases) and an intervention group (74 cases), and their clinical outcomes were compared. The rate of achievement of effective drug concentrations significantly increased in the intervention group (74%), compared to the rate in the control group (55%). Moreover, univariate and multivariate Cox proportional hazard regression revealed that pharmacist intervention and appropriate concentrations of anti-MRSA agents were independent factors associated with reduced hospitalization periods in patients with lymphoma. Our study revealed that proactive pharmacist intervention may improve the therapeutic effect of anti-MRSA agents in hematology ward patients.

Community pharmacist intervention in patients with renal impairment.

In France, community pharmacists do not have free access to patients' lab results, and it is therefore impossible for them to identify patients with renal impairment. (1) to evaluate the ability of community pharmacists (CPs) to identify drug related problems (DRP) in patients at risk for or suffering from renal impairment; (2) to evaluate the proportions of recommendations by CPs that lead to a modification by GP. A prospective and observational study involving 24 community pharmacists in France. Following special training, community pharmacists were asked to select 52 patients with the following characteristics: ≥65 years of age; prescribed at least two diabetic and/or antihypertensive drugs. Serum creatinine value was obtained for each patient and glomerular filtration rate estimated (eGFR) with the aMDRD formula. Those with a eGFR 60 ml/min/1.73 m² were considered having chronic kidney disease (CKD). Data was collected concerning whether the community pharmacists identified drug related problems and tried to inform the GP who prescribed the medications. Identified DRP were reviewed by a team of nephrologists and hospital clinical pharmacists. The proportion of CKD patients and those without serum creatinine monitoring, the number of drug related problems identified by community pharmacists, and the proportion of drug related problems resolved by the community pharmacists intervention to the GP. Of the total 791 patients identified, 180 (22.8 %) exhibited CKD, and 57 (7.2 %) had not undergone serum creatinine monitoring. Among the 1297 drugs prescribed, 260 had to be adapted to eGFR. The proportion of DRP was 21.5 % (56/260), of which 40 % (20) were identified by community pharmacists. Once the GP was informed, 33.3 % (6/18) of DRP were resolved. Community pharmacists identified 40 % of DRP related to CKD prescriptions, leading to prescription modification by GPs in a third of the cases. These interventions are likely to decrease drug-related morbidity and mortality.

Cost-effectiveness and cost-utility of a community pharmacist intervention in patients with depression (PRODEFAR study)

Introduction: Non-adherence to antidepressants is common and limits the effectiveness of antidepressants. Pharmacists are in an ideal position to help patients cope with antidepressant treatment and, as experts in pharmacotherapy, can provide complementary skills to other health professionals. Pharmacists' interventions are effective in the improvement of adherence to antidepressants. However, little is known about the efficiency of such interventions. The study aimed to evaluate the cost-effectiveness and cost-utility of a community pharmacist intervention (CPI) in comparison with usual care (UC) in depressed patients initiating treatment with antidepressants in primary care. Methods: The economic evaluation was conducted alongside a randomized controlled trial with 6 months follow-up. Patients were recruited by general practitioners and randomized to CPI and UC. The intervention consisted of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116658– http://www.ijic.org/ patients about side-effects and stressing the importance of carrying out general practitioners' advice. Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months. Results: A total of 179 patients were randomized to UC (92) and CPI (87). Although overall costs were higher in the CPI group than in UC patients, there were no significant differences between groups at baseline. From a societal perspective, the incremental cost-effectiveness ratio (ICER) was for the CPI compared with UC was €9,872 per extra QALY and €1,866 for extra adherent patient. In terms of remission of depressive symptoms, the UC dominated the CPI. If willingness to pay (WTP) is €30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the CPI being cost-effective was 0.71, 0.46 and 0.75, respectively from the societal perspective. From a healthcare perspective, the probability of the CPI being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is €30,000. Discussion and conclusions: A low intensity CPI addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to IC. Regular implementation of the CPI is not recommended. Sample size calculation was based on the effectiveness analysis and the study could have been underpowered to detect differences. Only 74% of the patients in the CPI group received at least one intervention in the pharmacy and this may have limited its impact. A 6-month follow-up is a short period to evaluate long term costs and effects of the intervention. Future research needs to evaluate more complex and intensive pharmacist interventions in community pharmacy. It will be necessary to improve the collaborative relationship between the pharmacist and the practitioner, and the integration of the pharmacist into the primary care team. Also needed will be development of strategies that facilitate the attachment of the patient to the pharmacy and the establishment of a relationship between the pharmacist and the patient.

The effects of pharmacist intervention on emergency department visits in patients 80 years and older: subgroup analyses by number of prescribed drugs and appropriate prescribing.

BackgroundClinical pharmacist interventions have been shown to have positive effect on occurrence of drug-related issues as well as on clinical outcomes. However, evidence about which patients benefiting most from the interventions is limited. We aimed to explore whether pharmacist intervention is equally effective in preventing emergency department (ED) visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing.MethodsPatient and outcome data from a randomized controlled trial exploring the clinical effects of a ward-based pharmacist intervention in patients, 80 years and older, were used. The patients were divided into subgroups according to the number of prescribed drugs (<5 or ≥5 drugs) and the level of inappropriate prescribing [using the Screening Tool Of Older People's potentially inappropriate Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) with a score of ≥2 (STOPP) and ≥1 (START) as cutoff points]. The effect of the intervention on the number of times the different subgroups visited the ED was analyzed.ResultsThe pharmacist intervention was more effective with respect to the number of subsequent ED visits in patients taking <5 drugs on admission than in those taking ≥5 drugs. The rate ratio (RR) for a subsequent ED visit was 0.22 [95% confidence interval (CI) 0.09–0.52] for <5 drugs and 0.70 (95% CI 0.47–1.04) for ≥5 drugs (p = 0.02 for the interaction). The effect of intervention did not differ between patients with high or low STOPP or START scores.ConclusionIn this exploratory study, the pharmacist intervention appeared to be more effective in preventing visits to the ED for patients who were taking fewer drugs before the intervention. Our analysis of STOPP and START scores indicated that the level of inappropriate prescribing on admission had no effect on the outcomes of intervention with respect to ED visits.

Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection.

BackgroundSubstantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection.MethodsIn this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia–University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load.ResultsAfter pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1–6.2) to 4.2 (95% CI =3.3–5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm3 [95% CI =175.8–345.6] to 312.0 cells/mm3 [95% CI =23.5–40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load.ConclusionThis study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

Effectiveness of the Dader Method for pharmaceutical care in patients with bipolar I disorder: EMDADER-TAB: study protocol for a randomized controlled trial.

BackgroundBipolar I disorder (BD-I) is a chronic mental illness characterized by the presence of one or more manic episodes, or both depressive and manic episodes, usually separated by asymptomatic intervals. Pharmacists can contribute to the management of BD-I, mainly with the use of effective and safe drugs, and improve the patient’s life quality through pharmaceutical care. Some studies have shown the effect of pharmaceutical care in the achievement of therapeutic goals in different illnesses; however, to our knowledge, there is a lack of randomized controlled trials designed to assess the effect of pharmacist intervention in patients with BD. The aim of this study is to assess the effectiveness of the Dader Method for pharmaceutical care in patients with BD-I.Methods/designRandomized, controlled, prospective, single-center clinical trial with duration of 12 months will be performed to compare the effect of Dader Method of pharmaceutical care with the usual care process of patients in a psychiatric clinic. Patients diagnosed with BD-I aged between 18 and 65 years who have been discharged or referred from outpatients service of the San Juan de Dios Clinic (Antioquia, Colombia) will be included. Patients will be randomized into the intervention group who will receive pharmaceutical care provided by pharmacists working in collaboration with psychiatrists, or into the control group who will receive usual care and verbal-written counseling regarding BD. Study outcomes will be assessed at baseline and at 3, 6, 9, and 12 months after randomization. The primary outcome will be to measure the number of hospitalizations, emergency service consultations, and unscheduled outpatient visits. Effectiveness, safety, adherence, and quality of life will be assessed as secondary outcomes. Statistical analyses will be performed using two-tailed McNemar tests, Pearson chi-square tests, and Student’s t-tests; a P value <0.05 will be considered as statistically significant.DiscussionAs far as we know, this is the first randomized controlled trial to assess the effect of the Dader Method for pharmaceutical care in patients with BD-I and it could generate valuable information and recommendations about the role of pharmacists in the improvement of therapeutic goals, solution of drug-related problems, and adherence.Trial registrationRegistration number NCT01750255 on August 6, 2012. First patient randomized on 24 November 2011.

Exploring the Quality of Systematic Reviews on Pharmacist Interventions in Patients With Diabetes

To assess the reporting and methodological quality of systematic reviews and meta-analysis studies on pharmacist interventions in patients with diabetes. A comprehensive literature search was performed in MEDLINE, Scopus, and LILACS databases for systematic reviews and meta-analysis studies published from January 1990 to June 2013. The standardized search strategy included the use of MeSH terms or text words related to pharmacist interventions, diabetes, and systematic reviews. The overview included systematic reviews and meta-analysis studies published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on outcomes for diabetic patients. Two independent authors performed study selection, data extraction, and quality assessment with a consensus process to address disagreements. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) checklists were used to assess reporting characteristics and methodological quality, respectively. The literature search yielded 101 records of potential interest, of which 7 satisfied the inclusion criteria. The total average (SD) for PRISMA and AMSTAR scores were 17.4 (5.6) out of 27 and 6.9 (2.0) out of 11, respectively. The most frequent problems included nonregistration of study protocol, absence of a list of excluded studies, and unclear acknowledgment of conflicts of interests. The reporting and methodological quality of systematic reviews and meta-analysis studies were suboptimal, with some areas needing further improvement. It is necessary to ensure better transparency and reproducibility in the literature of clinical pharmacy services for diabetic patients.