Collaborative clinical pharmacokinetic services

Rr, Maddox; Tw, Vanderveen; Em, Jones; Hl, Trammel; Jf, Cormier; Ej, Jessup; Crass, RE; Nj, Robertson; Al, Paysinger

doi:10.1093/ajhp/38.4.524

Cited by 4 publications

(4 citation statements)

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“…All seizure activity 254 4 Other studies have shown that clinical pharmacists can help to optimize serum concentration monitoring. [5][6][7] Our study showed a cost savings of more than $28,000 when a pharmacist was involved in patient care. In a previous study, we demonstrated an annual savings of approximately $60,000 when a clinical pharmacist was involved in phenytoin-level monitoring of all patients receiving phenytoin in a neurosurgical intensive care unit.…”

Section: Discussionmentioning

confidence: 74%

Pharmacist Impact on Posttraumatic Seizure Prophylaxis in Patients with Head Injury

et al. 2002

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Phenytoin is the most commonly administered antiepileptic agent for the prevention of early (< or = 7 days) posttraumatic seizures. Use of the agent, however, requires strict monitoring due to its narrow target range and nonlinear pharmacokinetics. The impact of a clinical pharmacist participating in the care of patients with head injury on posttraumatic seizure prophylaxis with regard to phenytoin dosing and monitoring, cost avoidance, and patient outcome, was measured retrospectively. Parameters from time periods before (BP) and after (AP) a clinical pharmacist participated in patient care were compared. The average number of days that phenytoin was given was 13.4 (BP) and 7.6 (AP), and the duration of phenytoin prophylaxis was 7 days or less in 35% and 65% of patients, respectively. The average number of phenytoin levels drawn from each patient was 10.3 (BP) and 3.4 (AP). Seizures occurred in 4.7% (BP) and 1.5% (AP) of patients. A cost savings of approximately $28,000 was observed for the AP group. A clinical pharmacist reduced the use of posttraumatic seizure prophylaxis and associated costs without jeopardizing patient outcomes.

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Section: Discussionmentioning

confidence: 74%

Pharmacist Impact on Posttraumatic Seizure Prophylaxis in Patients with Head Injury

et al. 2002

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“…[5][6][7][8][9] All hospital-based systems for the remuneration of clinical care services were initiated in the early 1980s and have been discontinued, with the exception of those in Japan. [10][11][12][13][14][15] However, the current status of remuneration for these services in Japan has changed from the model described in the papers retrieved for this review, [16][17][18] and further information could not be obtained (personal communication, E. Akaho, 25 July 2006).…”

Section: Payersmentioning

confidence: 99%

A systematic review of remuneration systems for clinical pharmacy care services

Chan¹,

Grindrod²,

Bougher³

et al. 2008

Canadian Pharmacists Journal

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Objective: To provide descriptions of existing remuneration models for pharmacist clinical care services and to summarize the existing evaluations of economic, clinical, and humanistic outcome studies of the remuneration models. Methods: We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, EconLit, Scopus, Web of Science, Google Scholar, and PubMed from date of inception to June 2006. We also searched the World Wide Web, hand-searched pertinent journals and reference lists, and contacted experts in pharmacy practice research. One reviewer assessed titles and, with a second independent reviewer, assessed abstracts and full-text articles for inclusion and abstracted data. Disagreements were resolved by discussion or by a third independent reviewer. We included English language articles that described or evaluated current remuneration systems for pharmacist clinical care services and that involved a substantial number of pharmacists and that were paid by a third party other than the patient. Due to heterogeneity between systems, data were compiled qualitatively. Then, based on these results, an expert panel developed recommendations for implementing a remuneration model into current pharmacy practice in Alberta. Results: We identified 28 remuneration systems. Most commonly, payers were government agencies, and services were directed at the management of chronic diseases or complex medication regimens. While capitation models were evident, most systems provided payment according to each intervention carried out. Program evaluations were available from 14 models, and in many systems, initial uptake by pharmacists was high, but participation dropped after initial enrolment. Conclusion: To ensure that the provision of clinical care services will provide a sustainable avenue of income for pharmacists and costeffective quality care for patients, a viable business model with additional training and support for pharmacists and ongoing program evaluation is needed.

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“…This is consistent with previous studies involving pharmacist involvement in the care of patients with epilepsy. [26][27][28][29][30][31][32][33] The increased costs in hospitals without pharmacist-managed antiepileptic drug therapy are substantial, particularly considering, as mentioned above, the implications of the potential savings to the Medicare system and the whole heath care system. Most likely, far more seizure blood levels were obtained in patients who did versus did not receive pharmacistmanaged antiepileptic drug therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Similarly, several studies have documented the benefits of pharmacistprovided services and pharmacist involvement in the care of patients receiving antiepileptic drugs. [26][27][28][29][30][31][32][33] Most of these studies are from older clinical pharmacy literature; thus, they focused on achieving therapeutic blood levels and the frequency of blood level assays. As such, they are not directly comparable with collaborative drug therapy studies.…”

mentioning

confidence: 99%

Clinical and Economic Outcomes of Pharmacist-Managed Antiepileptic Drug Therapy

Bond

Raehl

2006

Pharmacotherapy

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This study explores the associations between pharmacist-managed antiepileptic drug therapy in hospitalized Medicare patients and diagnoses indicating the need for these drugs. It also explores the following major heath care outcomes: death rate, hospital length of stay (LOS), Medicare charges, drug charges, laboratory charges, complications, and adverse drug reactions. Data were drawn from the 1998 MedPAR and 1998 National Clinical Pharmacy Services databases. Pharmacist-managed antiepileptic drug therapy was evaluated in a study population of 9380 Medicare patients with diagnosed epilepsy or seizure disorders treated in 794 United States hospitals. This population was derived from the 38,311 hospitalized Medicare patients with epilepsy or seizure disorders (MedPAR). In hospitals without pharmacist-managed antiepileptic drug therapy, death rates were 120.61% higher, with 374 excess deaths (chi(2)=5.983, df=1, p=0.014, odds ratio [OR]=1.553, 95% confidence interval [CI] 1.102-2.189). Hospital LOS was 14.68% higher, with 8069 patient-days (Mann-Whitney U test [U]=3833132, p=0.0009); total Medicare charges were 11.19% higher, with 14,372,550 dollars in excess total charges (U=3644199, p=0.0003); per-patient drug charges were $115 +/- $92 higher (p=NS); laboratory charges were 32.24% higher, with 5,664,970 dollars in excess charges; and aspiration pneumonia rate was 54.61% higher (chi(2)=5.848, df=1, p=0.015, OR=1.233, 95% CI 1.081-1.901). Although the frequencies of other complications and adverse effects were higher, these differences were not statistically significant compared with hospitals with pharmacist-managed antiepileptic drug therapy. Clinical and economic outcomes were improved among hospitalized Medicare patients whose antiepileptic drug therapy was managed by pharmacists.

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Collaborative clinical pharmacokinetic services

Cited by 4 publications

References 0 publications

Pharmacist Impact on Posttraumatic Seizure Prophylaxis in Patients with Head Injury

Pharmacist Impact on Posttraumatic Seizure Prophylaxis in Patients with Head Injury

A systematic review of remuneration systems for clinical pharmacy care services

Clinical and Economic Outcomes of Pharmacist-Managed Antiepileptic Drug Therapy

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