Analysis of clinical pharmacist interventions in the neurology unit of a Brazilian tertiary teaching hospital

Abstract

It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.

Risk factors for drug-related problems in a general hospital: A large prospective cohort

“…Several strategies for detecting DRP have been used to assist in the daily monitoring of drug therapy. According to the literature, these have included medical chart review, associated or not with electronic alerting systems [17], and the integration of pharmacists into the health care teams during ward rounds [18]. In pharmacoepidemiology, medical chart review is considered the gold standard [19] for improvement of the safety of the medication process [17,[20][21][22] and, from this process, to enable the identification of clinical and demographic characteristics that may be considered predictors of increased risk developing a DRP in hospitalized patients.…”

Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

“…We carried out a cost-benefit analysis of a single arm, prospective cohort study 12 . The economic study was carried out from the hospital and PHS perspective, and composed data from patients followed-up over 36-months, from January 2013 to January 2016, without control group.…”

“…The base study for this pharmacoeconomic analysis is an open study that started in July 2012, developed at the adult ward of the Neurology Unit of the General Hospital of the Medical School of Ribeirão Preto, Universidade de São Paulo, Brazil (HCFMRP-USP). HCFMRP-USP is a tertiary hospital focused on teaching, researching, and assisting Brazilian Public Health System users 12 , 18 . The ward has 26 beds with an organizational structure that involves the following subspecialties: neuromuscular diseases, general neurology, epilepsy and movement disorders 18 .…”

Incidence, types and acceptability of pharmaceutical interventions about drug related problems in a general hospital: an open prospective cohort

“…They are considered adverse events and occur in patients at all levels of healthcare, whether home care, 2 institutional long term care, 3 community pharmacy 4 or hospital. 5 In the hospital setting, incidence rates of DRP have been reported for specific patient populations, with high incidence rates in children 6 and the elderly, 7 as well as in certain clinical specialties such as cardiology, 8 neurology 9 and surgery. 7 This high incidence of DRP negatively affects the quality of life of the patient and increases the economic and social burden of illnesses.…”