Top

BMC Health Services Research

Published in:

Open Access 01-12-2018 | Research article

Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital

Authors: Zhiwei Bao, Chunmei Ji, Jing Hu, Can Luo, Wentong Fang

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

Limited studies have evaluated the effectiveness of pharmacist interventions on outpatient prescription. The goal of this study was to evaluate the clinical and economic impacts of pharmacist interventions on randomly sampled outpatient prescriptions.

Method

Outpatient prescriptions of our hospital were sampled automatically and reviewed by pharmacists since 2011. Pharmacists intervened in inappropriate prescriptions (IPs) real-timely, and summarized and analyzed the information monthly. Cost-benefit analysis was performed to estimate the economic benefit of the pharmacist intervention.

Results

From 2011 to 2016, pharmacists reviewed 101,271 prescriptions and intervened in 5155 prescriptions. With the interventions of pharmacists, the number of IPs decreased from 1845 to 238, while the inappropriate percentage decreased from 12.60 to 1.22%. The inappropriate rates of different departments and the types decreased annually. IPs were mainly from the Department of Medicine and Department of Surgery and category 1 (Non-indicated medications) in all years. The benefit-to-cost ratios of pharmacist interventions were always more than 1. In the same years, the benefit-to-cost ratios in public payments were higher than those with insurance and self-payment.

Conclusion

This form of pharmacist intervention constitutes a method that showed positive clinical and economic benefits and is worth expanding in large hospitals. Pharmacists should pay more attention on prescriptions in department of surgery or prescriptions with public payments.

Viswanathan M, Kahwati LC, Golin CE, Blalock S, Coker-Schwimmer E, Posey R, Lohr KN. Medication Therapy Management Interventions in Outpatient Settings [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014. Report No.: 14(15)-EHC037-EF

Joint Commission International. Joint commission international accreditation standards for hospitals. 5th ed; 2014.

Rotta I, Salgado TM, Silva ML, Correr CJ, Fernandez-Llimos F. Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000-2010). Int J Clin Pharm. 2015;37(5):687–97. https://doi.org/10.1007/s11096-015-0137-9. 26001356 CrossRefPubMed

Hepler CD. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Pharmacotherapy. 2004;24(11):1491–8. https://doi.org/10.1592/phco.24.16.1491.50950. 15537552 CrossRefPubMed

Suggett E, Marriott J. Risk factors associated with the requirement for pharmaceutical intervention in the hospital setting: a systematic review of the literature. Drugs Real World Outcomes. 2016;3(3):241–63. https://doi.org/10.1007/s40801-016-0083-4. 27747829 CrossRefPubMedPubMedCentral

Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med. 2009;169(19):1748–55. https://doi.org/10.1001/archinternmed.2009.316.%20PMID:%2019858431.CrossRefPubMedPubMedCentral

Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–64. https://doi.org/10.1001/archinte.166.9.955. 16682568 CrossRefPubMed

Grant JJ, Adams MB, Decker K, McFarland S, Lee CK. Evaluating the impact of a pediatric weight-based dosing procedure in outpatient pharmacy. J Am Pharm Assoc. 2016;56(1):54–7. https://doi.org/10.1016/j.japh.2015.11.004. 26802921 CrossRef

Ma JD, Tran V, Chan C, Mitchell WM, Atayee RS. Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice. J Oncol Pharm Pract. 2016;22(6):113–23. https://doi.org/10.1177/1078155215607089.%20PMID:%2026428283.CrossRef

10.

Chen M, Zhou Q. Pharmaceutical interventions by collaboration between staff pharmacists and clinical pharmacists and implementation of joint commission international accreditation standards on medication use may optimize pharmacotherapy in geriatric patients. Clin Interv Aging. 2016;11(11):1575–7. https://doi.org/10.2147/CIA.S123900. 27877026 CrossRefPubMedPubMedCentral

11.

Battis B, Clifford L, Huq M, Pejoro E, Mambourg S. The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy. J Oncol Pharm Pract. 2016; Epub 2016 Oct 12; https://doi.org/10.1177/1078155216672314.%20PMID:%2027733666.

12.

Lam MS, Cheung N. Impact of oncology pharmacist-managed oral anticancer therapy in patients with chronic myelogenous leukemia. J Oncol Pharm Pract. 2016;22(6):741–8. https://doi.org/10.1177/1078155215608523. 26419691 CrossRefPubMed

13.

Dempsey JT, Matta LS, Carter DM, Stevens CA, Stevenson LW, Desai AS, et al. Assessment of drug therapy-related issues in an outpatient heart failure population and the potential impact of pharmacist-driven intervention. J Pharm Pract. 2017;30(3):318–23. https://doi.org/10.1177/0897190016641491. 27080398 CrossRefPubMed

14.

Lucca JM, Ramesh M, Narahari GM, Minaz N. Impact of clinical pharmacist interventions on the cost of drug therapy in intensive care units of a tertiary care teaching hospital. J Pharmacol Pharmacother. 2012;3(3):242–7. https://doi.org/10.4103/0976-500x.99422. 23129959 CrossRefPubMedPubMedCentral

15.

Zhang HX, Li X, Huo HQ, Liang P, Zhang JP, Ge WH. Pharmacist interventions for prophylactic antibiotic use in urological inpatients undergoing clean or clean-contaminated operations in a Chinese hospital. PLoS One. 2014;9(2):e88971. https://doi.org/10.1371/journal.pone.0088971. 24586465 CrossRefPubMedPubMedCentral

16.

Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, et al. Clinical and economic impact of pharmacists' intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm. 2016;38(5):1124–32. https://doi.org/10.1007/s11096-016-0339-9. 27365091 CrossRefPubMed

17.

National Health and Family Planning Commission of the People’s Republic of China. Hospital prescription review management specification [in Chinese], 2010. Available from http://www.nhfpc.gov.cn/yzygj/s3590/201003/ac4d04a85da5478793761224abc10fd3.shtml.

18.

National Health and Family Planning Commission of the People’s Republic of China. Prescription Administrative Policy [in Chinese], 2010. Available from http://www.gov.cn/flfg/2007-03/13/content_549406.htm.

19.

National Health and Family Planning Commission of the People’s Republic of China. National Special Measure Scheme on Clinical Use of Antibiotics [in Chinese], 2013. Available from http://www.gov.cn/flfg/2012-05/08/content_2132174.htm.

20.

ASHP guidelines on a standardized method for pharmaceutical care. In: Deffenbaugh J, ed. Best practices for health-system pharmacy. Bethesda, MD: American Society of Health-System Pharmacists, 1996:109–11.

21.

The peoples bank of china RMB exchange rate [in Chinese], 2016. Available from http://www.pbc.gov.cn/rmyh/108976/index.html.

22.

Riordan DO, Walsh KA, Galvin R, Sinnott C, Kearney PM, Byrne S. The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: a systematic review. SAGE Open Med. 2016;4:1–18. https://doi.org/10.1177/2050312116652568. 27354917 CrossRef

23.

Kajizono M, Aoyagi M, Kitamura Y, Sendo T. Effectiveness of medical supportive team for outpatients treated with sorafenib: a retrospective study. J Pharm Health Care Sci. 2015;1(1):1–6. https://doi.org/10.1186/s40780-014-0005-0.%20PMID:%2026819717. CrossRef

24.

Bedouch P, Tessier A, Baudrant M, Labarere J, Foroni L, Calop J, et al. Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists' interventions. J Eval Clin Pract. 2012;18(4):911–8. https://doi.org/10.1111/j.1365-2753.2011.01704.x. 21689216 CrossRefPubMed

25.

Fernandez-Llamazares CM, Calleja-Hernandez MA, Manrique-Rodriguez S, Perez-Sanz C, Duran-Garcia E, Sanjurjo-Saez M. Impact of clinical pharmacist interventions in reducing paediatric prescribing errors. Arch Dis Child. 2012;97(6):564–8. https://doi.org/10.1136/archdischild-2011-301239. 22362718 CrossRefPubMed

26.

Vantard N, Ranchon F, Schwiertz V, Gourc C, Gauthier N, Guedat MG, et al. EPICC study: evaluation of pharmaceutical intervention in cancer care. J Clin Pharm Ther. 2015;40(2):196–203. https://doi.org/10.1111/jcpt.12242. 25594148 CrossRefPubMed

27.

Delpeuch A, Leveque D, Gourieux B, Herbrecht R. Impact of clinical pharmacy services in a hematology/oncology inpatient setting. Anticancer Res. 2015;35(1):457–60. 25550587PubMed

28.

Le Guen R, Madelaine I, Tournamille JF, Bellanger A, Astier A, Braguer D, et al. Study impacto: descriptive analyzis of pharmacist's clinical practice in onco-hematology. Ann Pharm Fr. 2015;73(3):223–8. https://doi.org/10.1016/j.pharma.2014.10.002.%20PMID:%2025934530. CrossRefPubMed

29.

Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005;9(5):R516–21. https://doi.org/10.1186/cc3793.%20PMID:%2016277713. CrossRefPubMedPubMedCentral

30.

Nerich V, Limat S, Demarchi M, Borg C, Rohrlich PS, Deconinck E, et al. Computerized physician order entry of injectable antineoplastic drugs: an epidemiologic study of prescribing medication errors. Int J Med Inform. 2010;79(10):699–706. https://doi.org/10.1016/j.ijmedinf.2010.07.003. 20829102 CrossRefPubMed

31.

Suzuki S, Chan A, Nomura H, Johnson PE, Endo K, Saito S. Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy. J Oncol Pharm Pract. 2015;23(1):18–25. https://doi.org/10.1177/1078155215614998.%20PMID:%2026561587. CrossRef

32.

Chappuy M, Garcia S, Uhres AC, Janoly-Dumenil A, Dessault J, Chamouard V, et al. Pharmacist's interventions on outpatient prescriptions in a university hospital drugs sales service. Ann Pharm Fr. 2015;73(4):297–306. https://doi.org/10.1016/j.pharma.2014.11.001.%20PMID:%2025558801. CrossRefPubMed

33.

Ah YM, Lee JY, Moon MR, Cho YS, Kim HS, Yi NJ, et al. Clinical and economic evaluation of pharmacists' contribution to patient care on a multi-disciplinary liver transplant team. Int J Clin Pharmacol Ther. 2016;54(2):102–9. https://doi.org/10.5414/cp202501. 26709599 CrossRefPubMed

34.

Rychlickova J, Saloun J, Gregorova J. Evaluation of clinical Pharmacists' interventions in the Czech Republic. Pharmacotherapy. 2016;36(7):766–73. https://doi.org/10.1002/phar.1777. 27270831 CrossRefPubMed

Title: Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital
Authors: Zhiwei Bao
Chunmei Ji
Jing Hu
Can Luo
Wentong Fang
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3306-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital

Abstract

Background

Method

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Healthcare workers’ perspectives and practices regarding the disclosure of HIV status to children in Malawi: a cross-sectional study

Studying the impact of a medication use evaluation for polymedicated older patients by the community pharmacist (SIMENON): study protocol

Comparing the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016

Exploring implementation of an electronic referral management system and enhanced primary care service for oral surgery: perspectives of patients, providers and practitioners

‘Physical activity, that’s a tricky subject.’ Experiences of health care professionals with physical activity in type 2 diabetes care

Factors related to and economic implications of inhospital death in German lung cancer patients - results of a Nationwide health insurance claims data based study