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Introduction Patients 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. Objective This study aimed to assess the cost-effectiveness of pharmacist contribution in HF setting compared with usual care. Methods A 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 measures The incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2020. A series of sensitivity analysis was also performed. Results Pharmacist 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 (3,288 USD/QALYs). This ICER is considered to be cost-effective at the willingness-to-pay level of 160,000 THB/QALY (5191.87 USD). Conclusion At 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.

Background Funding is a significant barrier to employing general practice pharmacists. Objective(s) To explore the feasibility of determining the cost-benefit of pharmacists in Australian general practice. Methods Two part-time pharmacists were employed by general practices in Canberra, Australia. Diaries of the pharmacists were analysed to determine time worked and participation in income-generating activities, including Government-funded programs: Asthma Cycle of Care, Home Medicine Reviews, and Health Care Assessments. Scenarios using different practice and business models were entered into value-cost models to determine the income generated by the pharmacists relative to their salary. Results Over 19 weeks, pharmacists A and B supported 47 and 23 Asthma Cycle of Care activities, generating income to the general practice of AU$4,700 and AU$2,300, respectively. The pharmacists spent 36.4 and 24.1 hours on activities usually conducted by general practitioners (GPs), allowing additional time for GP-patient consultations. Value-cost models determined AU$0.61 - AU$1.20 income generation by pharmacists per AU$1 salary. Conclusions It was feasible to determine the value-cost ratios of employing pharmacists in general practice using these methods. Future work should focus on developing a robust business model that includes health care system savings resulting from practice pharmacist interventions, determined from randomised controlled trials.

Background: Guidelines assisted appropriate use of prophylactic antibiotics can lower the prevalence of surgical site infections (SSIs). The present study was conducted to evaluate the impact and cost-benefit value of pharmacist’s educational intervention for antibiotic use in post-surgical prophylaxis. Methods: A prospective quasi experimental study was conducted by enrolling 450 patients from tertiary care hospital of Lahore, Pakistan, 225 patients in each, control and intervention, arm using non-random convenient sampling. The study parameters included antibiotic indication, choice, dose, frequency, duration and associated costs. This study is registered with Chinese Clinical Trial Registry # ChiCTR-OON-17013246. Results and conclusion: After educational intervention, in post-intervention arm, total compliance in terms of correct antibiotic choice, dose, frequency and duration increased from 1.3% to 12.4%. The rate of inappropriate antibiotic choice did not change significantly. After intervention only metronidazole utilization decreased (16%) significantly (p = 0.011). Significant reductions were observed in mean duration of antibiotic prophylaxis (17%, p = 0.003), average number of prescribed antibiotics (9.1%, p = 0.014) and average antibiotic cost (25.7%, p = 0.03), with reduction in mean hospitalization cost (p = 0.003) and length of stay (p = 0.023). Educational intervention was significantly associated (OR; 2.4, p = 0.005) with appropriate antibiotic prophylaxis. The benefit of pharmacist intervention, mean antibiotic cost savings to mean cost of pharmacist time, was 4.8:1. Thus, the educational intervention resulted in significant reductions in the duration and average number of antibiotic use having considerable effect on therapy and hospitalization cost. Keywords: Surgery, Pharmacist interventions, Antibiotics, Rational use, Prophylaxis, Cost analysis

Background: Interventions to improve medication adherence in chronic conditions have shown limited success or sustainability. Previous data revealed that phone calls to patients regarding adherence goal awareness resulted in significant improvement in proportion of days covered (PDC). Objectives: The objective of this study was to explore specific pharmacist adherence interventions via phone in various practice settings. Methods: A prospective, randomized controlled study was conducted with patients who belonged to university-associated health care settings [ambulatory care, chain store, small health plan, and federally qualified health center (FQHC)]. At each site, patients with at least one chronic medication and a calculated PDC

Resume Objectifs Les objectifs de notre etude etaient d’analyser les prescriptions d’antibiotiques et d’evaluer la pertinence des interventions pharmaceutiques (IP) en consultations externes de pediatrie a Abidjan (Cote d’Ivoire). Methodes Nous avons mene une etude descriptive transversale de mai a decembre 2013. L’analyse des prescriptions etait documentee. L’outil de classification des IP valide par la Societe francaise de pharmacie clinique a ete utilise. La cotation des IP a ete faite par les prescripteurs. Cette cotation evoluait d’IP0 a IP3 selon que l’importance de l’impact clinique potentiel du probleme etait correlee a la gravite des consequences cliniques evitees par l’IP. La pertinence a ete evaluee par le taux d’acceptation des IP par les prescripteurs et l’evaluation de leur impact clinique. Resultats Notre etude a porte sur 150 patients d’âge moyen de 11,75 mois avec un sex-ratio (M/F) de 2. L’amoxicilline-acide clavulanique (27,2 %) et l’amoxicilline (22,3 %) ont ete les antibiotiques les plus prescrits. Soixante-trois problemes pharmacotherapeutiques (PP) ont ete detectes. Il s’agissait de plan de prise non optimal (88,9 %) et de sous-dosage (11,1 %). L’amoxicilline-acide clavulanique (61,9 %) et la josamycine (17,4 %) ont ete les antibiotiques les plus concernes par ces PP. Les IP emises etaient a type de precision des modalites d’administration (88,9 %) et d’adaptations posologiques (11,1 %). Les prescripteurs ont accepte 93,7 % des IP. Toutes les IP acceptees ont ete cotees IP1 (IP a impact clinique significatif). Conclusions Les IP effectuees sur la prescription d’antibiotiques se sont averees pertinentes avec un taux d’acceptation eleve et un impact clinique appreciable.

Background Super-utilizer patients have costly and often preventable encounters with the health care system. Our super-utilizer care coordination program consists of an interprofessional team that works to enhance care coordination, improve quality of care, develop patient autonomy, and ultimately reduce utilization and cost. Purpose To describe the processes of one super-utilizer team and detail the role and responsibilities of a pharmacist in this team. Program process Patients are considered for enrollment if they are ≥18 years of age with at least two hospital admissions in 6 months. Pharmacist procedures through the program include medication reconciliation, home visits, and transition of care services. Results Since 2012, the pharmacist has participated in the care of 21 super-utilizer patients. A total of 144 pharmacist interventions occurred, and 98 medication discrepancies were detected and addressed. Conclusion These results highlight the utility of a pharmacist in preventing and addressing medication errors for super-utilizer patients.

Summary Background Automatic stop orders (ASOs) for antimicrobials have been recommended as a component of antimicrobial stewardship programs, but may result in unintentional treatment interruption due to failure of providers to re-order an antimicrobial medication. We examined the impact of a multifaceted intervention designed to reduce the potential harms of interrupting antimicrobial treatment due to ASOs. Methods An intervention was implemented that included pharmacist review of expiring antimicrobials as well as provider education to encourage use of a long-term antimicrobial order set for commonly used prophylactic antimicrobials. Pharmacist interventions and antimicrobial re-ordering was recorded. Percent of missed doses of a commonly used prophylactic antimicrobial, single strength co-trimoxazole, was compared pre- and post-intervention using a chi-squared test. Results From November 1, 2015 to November 30, 2016, there were 401 individual pharmacist interventions for antimicrobial ASOs, resulting in 295 instances of antimicrobial re-ordering. The total percent of presumed missed single strength co-trimoxazole doses was reduced from 8.4% to 6.2% post-intervention (P Conclusions This study found that a targeted intervention was associated with a reduction in unintended antimicrobial treatment interruption related to ASOs.

The objective of this study was to describe medication adherence and medication intensification in a physician–pharmacist collaborative management (PPCM) model compared with usual care. This study was a prospective, cluster, randomized study in 32 primary care offices from 15 states. The primary outcomes were medication adherence and anti–hypertensive medication changes during the first 9 months of the intervention. The 9–month visit was completed by 539 patients, 345 of which received the intervention. There was no significant difference between intervention and usual care patients in regards to medication adherence at 9 months. Intervention patients received significantly more medication changes (4.9 vs.1.1; P = .0003) and had significantly increased use of diuretics and aldosterone antagonists when compared with usual care ( P = .01).The PPCM model increased medication intensification; however, no significant change in medication adherence was detected. PPCM models will need to develop non–adherence identification and intervention methods to further improve the potency of the care team.

Previous studies have demonstrated that computerized physician order entry (CPOE) of prescriptions reduces both turnaround time (TAT) and medication errors. However, these studies have been performed primarily in large academic centers with a relatively small number of medication orders. As such, many studies investigating the impact of CPOE on the level of pharmacist intervention have yielded conflicting results.The objective of this study was to examine the effects of CPOE on medication order TAT and the frequency of medication orders requiring pharmacist intervention in a community-based medical center.A prospective cohort study was conducted at a community-based medical center. A total of 24,767 prescriptions written for 940 patients over a six-month period were stratified into CPOE or non-CPOE (handwritten) cohorts. TAT between cohorts were tested using analysis of variance and Tukey's Honestly Significant Difference test. The number of orders requiring pharmacist intervention was compared between cohorts and tested using chi-square test or Fisher's exact test. Medication orders requiring pharmacist intervention were stratified by patient characteristics, therapeutic class, and types of medication error.Medication orders not using CPOE were approximately 8 times more likely to require pharmacist intervention (2.26% versus 0.29%; P0.001), with the majority of pharmacist interventions performed to prevent medication errors. The overall mean TAT for medication orders was significantly shorter in the CPOE group in comparison with the non-CPOE group (22.2 ± 86.5 min versus 81 ± 256.7 min; P0.001). CPOE orders nearly eliminated medication errors with wrong dosage forms and formulary issues.Medication orders entered via CPOE are associated with a significant reduction in medication TAT and less likely to require pharmacist intervention. Use of CPOE may improve quality of patient care and efficiency of health care delivery.

Background More than 3 tons of unused and expired medications are wastefully discarded every year in Taiwan, having a significant impact on environmental contamination and a financial burden on Taiwan's National Health Insurance. The aim of this study was to investigate how to instigate patient education according to their behaviors and attitudes in the hope of reducing medication waste. Methods Discarded drugs from the Drug Discarding Bin at the Shuang-Ho Hospital, a university-affiliated teaching hospital in Taiwan, were collected and analyzed. A paper-based questionnaire was utilized to study the attitudes and perspectives of the out-patients and/or patients’ family members about discarding unused medications that were prescribed and covered by the National Health Insurance policy. Results and Discussion A total of 98 kg of medications were collected during the study period of 4 weeks. Among the discarded medications, gastrointestinal drugs were at the top of the list, followed by cardiovascular drugs and anti-inflammatory drugs. Five main reasons that out-patients did not take the discarded medicines were revealed based on the results of a questionnaire: (i) I didn’t notice the expiration date or didn’t store the drugs well; (ii) I felt my disease was much better or was not improving, so I stopped taking the drugs; (iii) I was afraid of the side effects of the drugs, and refused to take them; (iv) I often forgot to take medications, thus I had many unused drugs at home; and (v) I didn’t want to take the herbal products anymore because they may have harmful ingredients, such as heavy metals. In addition, individuals with higher education would stop taking medications of their own volition, and people under 40 years old would forget to take medications more often than older people. Based on the results of the present survey, we designed an educational pharmacist intervention booklet to teach people how to use and store their medications appropriately. Hopefully, through various educational means the medication waste reduction program will gradually reduce the medication wasted by outpatients at this hospital.

Objective Poor adherence is an important challenge to healthcare professionals because it jeopardizes treatment success and increases the risk of serious complications, especially in patients with chronic diseases like diabetes. The purpose of this study was to summarize the effects of pharmacist interventions aimed at enhancing adherence to oral antidiabetic medications in patients with type 2 diabetes mellitus. Methods Five electronic databases were searched through to March 12, 2011 to identify controlled trials reporting the effects of pharmacist interventions to improve medication adherence rates in adults with type 2 diabetes. Components of the intervention were categorized as educational, behavioural, affective or provider-targeted strategies. In addition to the impact on medication adherence rates, we recorded any reported effects on health outcomes. Results Eight studies were included in this review. Education-related strategies were the most frequent (7 of 8 studies), and 6 of 8 studies used a combination of 2 or more strategies for the adherence intervention. Change in adherence rate was assessed using a variety of measurement methods, and 6 studies reported the effect of pharmacist intervention on clinical, economic or humanistic outcomes. Compared to a control group, 5 studies reported significant improvements in adherence rate with pharmacist intervention; however, glycemic control improved significantly in only 2 studies. Conclusions Pharmacist interventions to improve medication adherence in diabetes generally use an educational component combined with behavioural, affective or provider-targeted strategies. Although these interventions appear to improve adherence, the effect on health outcomes has not been established.

BackgroundPrescribing errors phenomena are very common within health care practice. These errors could result in adverse events and harm to patients. Pharmacist has an identified role in minimizing and preventing such errors.ObjectivesTo detect the incidence of prescribing errors for hospitalized patient, to evaluate the clinical impact of pharmacist intervention on the detection of these errors, and to propose a program to overcome this problem in a teaching hospital.MethodsFor one month period starting November until December 2009, the inpatient medication charts and orders were identified and rectified by ward and practicing pharmacists within inpatient pharmacy services in a teaching hospital at King Khalid University Hospital (KKUH) at King Saud University, Riyadh, Kingdom of Saudi Arabia on routine daily activities. Data were collected and evaluated. The causes of this problem were identified.ResultsApproximately 113 (7.1%) prescribing errors were detected during the study period out of 1580 medication orders. Wrong strength and wrong administration frequency of the prescribed drug were the most errors encountered in the study, which were 35%, and 23%, respectively. Other errors such as wrong patient, wrong drug, and wrong dose were also encountered. Lack of knowledge of prescribing skill was the main cause of such errors.ConclusionPrescribing errors in teaching hospital within inpatient pharmacy services were noticed. The applied method in this project might be implemented as part of pharmacy quality assurance program for ongoing detection and monitoring of such errors. Technology in prescribing process will support the practitioner to reduce the incidence of these errors. Forcing ongoing professional communication and education within the medical team about prescribing errors now appear warranted.

Objective Description and analysis of pharmaceutical interventions for patients with parenteral nutrition and an assessment of the degree of acceptance. Method Prospective six-month study. Design of a data collection sheet (with personal data, the indication for parenteral nutrition, hospital area, nutrition type, time and type of intervention, type of notification, acceptance) for recording interventions carried out based on normal activities: complete review of pharmacotherapy and clinical history. Results A total of 265 interventions were carried out during the study period (1.5 interventions/day) with a mean of 2.1 interventions/patient. The overall degree of acceptance was 83.77%; significant differences were found between type of communication for the intervention (oral and/or written) and the degree of acceptance. Conclusions Adding a pharmacist to the care team permits direct intervention in partnership with the doctor, and it is an effective method for preventing and resolving the complications, generally metabolic, that are associated with parenteral nutrition. Using this process for resolving medication-related problems in hospitalised patients, principally in surgical areas, is an addition to the pharmacist's activities in the area of nutritional support.

Several national and international studies on the care of asthma patients delivered by community pharmacists have shown that pharmacist interventions help to improve patient parameters like, for example, the patient's quality of life, self-management skills, compliance and optimization of drug therapy. These results have led to pharmacists' involvement in national asthma guidelines, e.g., in the UK and the United States. Pharmacists have now also been involved in the revised version of the German national guidelines on asthma. In this paper we will present the existing evidence in Germany on how pharmacists add value to the care of asthma patients. Furthermore, the involvement of pharmacists in the German National Disease Management Guideline for Asthma will be discussed.

Summary Objective To compare and analyze the number and types of pharmacist interventions when prescriptions were handwritten (period 1) or entered on 2 different computerized physician order entry systems (CPOE): Phedra® (period 2) and Actipidos® (period 3). Methods This study took place over 54 weeks (18 weeks for each period) in a 46-bed internal medicine department. Pharmacist interventions were categorized as either simple substitution to an available drug or “complex” interventions such as changing dosage (D), changing drug (M), stopping or substituting in cases of contraindication or overdosing (CO), new medication (N) and identifying errors due to CPOE (C). Results The study analyzed 12420 prescriptions that led to 1420 interventions. There were 720 substitutions and 98 interventions in period 1, 40 and 238 in period 2, and 97 and 227 in period 3. The percentage of interventions by types for each of the three periods, respectively were D: 52, 37 and 34%; M: 21, 22 and 35%; CO: 16, 12 and 16%; N: 11, 5 and 2%; and C: 0, 24 and 13%. The errors due to CPOE were mainly wrong dosage units and duplicate orders. Discussion Introduction of CPOE drastically reduced the number of simple substitutions and significantly increased the complex interventions. CPOE introduced new risks of serious errors. Conclusion In our study, CPOE did not prevent medication errors and led to new types of errors. The presence and intervention of clinical pharmacists remained necessary.

Objective: To assess drug treatment compliance in institutionalised elderly patients, identifying reasons for poor compliance and introducing measures to reduce its prevalence. Method: A programme was designed to improve drug treatment compliance in geriatric patients in residential homes. Drug intervention consisted of using an educational technique of a mixed nature (verbal information with written back up). A data collection sheet was designed following a review of the literature. This was carried out by means of a clinical interview and by checking for tablets which were not taken. Results: A total of 62 patients were chosen for drug management at a health and welfare centre in Alicante and 140 interventions were performed (2.8 interventions per patient). Compliance improved and there were significant differences in the variable for distrust due to lack of information (p = 0.009) and almost significant differences in the variable for better understanding of the dispensing system (p = 0.058). Duplicate treatment of the patients was eliminated in all cases after the pharmaceutical intervention. Conclusions: Our study suggests that pharmacist intervention in the drug management of geriatric patients can lead to improved treatment compliance, with the added benefits of improved knowledge of the medication and a reduction in possible drugrelated problems.

Introduction: Many studies have been published demonstrating the value of clinical pharmacists but a few involve the use of a documentation system within an electronic health record (EHR) system. C ...

From tracking medication education to determining the optimal timing of medication doses, health systems are using technology in new ways to improve patient care. These strategies and others were highlighted at the 2012 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition. With pharmacists at the center of patient care, information technology (IT) experts shared their experiences with implementing advanced programs and initiatives.