Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

Gallagher, James; McCarthy, Suzanne; Byrne, Stephen

doi:10.1007/s11096-014-0008-9

Cited by 94 publications

(79 citation statements)

References 46 publications

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“…However, significant methodological weaknesses were still identified. In the most recent systematic review of economic evaluations of inpatient clinical pharmacist interventions, Gallagher et al 29 found no studies from the UK. Interventions examined included antimicrobial management, medicines optimisation, specialist input into areas such as neurosurgery and intensive care and multidimensional services.…”

Section: Introductionmentioning

confidence: 99%

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

et al. 2017

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Objectives: The role of clinical pharmacists in hospitals has evolved and continues to expand.In the UK, outside a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to 1) highlight the need to identify and prioritise specific clinical pharmacy roles, responsibilities and practices that will bring the greatest benefit to patients and health-systems and 2) describe systemic weaknesses in current research methodologies for evaluating clinical pharmacy services and propose a different approach Method: Published reviews of CP services are discussed using the economic, clinical and humanistic outcomes (ECHO) framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP.Results: Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of clinical pharmacy often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding clinical pharmacy's definitive contribution to patient outcomes.Conclusion: There is a need for more research work in NHS hospitals, employing a different paradigm to address some of the weaknesses of existing research on clinical pharmacy practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital clinical pharmacy activities to patient care and the NHS. 4 Key MessagesWhat is already known on this subject• Clinical Pharmacy is a diverse, complex discipline and clinical pharmacy activities are not easily defined or described • It is important to robustly show the benefits of clinical pharmacy, in order to justify resource use and to prioritise and measure activities • Studies purporting to demonstrate the outcomes of clinical pharmacy activities are often criticized due to methodological flaws, poor intervention descriptions and weak conclusionsWhat this study adds• The current positivist mindset is weakening the case for clinical pharmacy. There is a need for a new research approach for studying and evaluating clinical pharmacy interventions • Mixed-methods studies, incorporating quantitative and qualitative methodologies are more appropriate for evaluating the outcomes of clinical pharmacy • Cost-consequence analyses are more suitable for evaluating the economic outcomes of clinical pharmacy 5

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Section: Introductionmentioning

confidence: 99%

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

et al. 2017

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“…The objective for most clinical pharmacy services is to ensure optimal and rational use of drugs for the benefit of patients and society by cooperation between pharmacist, other health professionals and the patient . At the patient level, pharmacist‐led interventions in hospitals have been summarized in recent systematic reviews and meta‐analyses investigating the effect on clinical outcome , economic outcome and patient‐reported outcome . Some of the reviews focused solely on medication reconciliation and some on medication review .…”

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confidence: 99%

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Skjøt‐Arkil

Lundby

Kjeldsen³

et al. 2018

Basic Clin Pharma Tox

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Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

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“…1 Currently, direct patient care by clinical pharmacists within multidisciplinary teams is recognized as one of the best pharmacy practice models because it minimizes risks, care costs, morbidity and mortality rates, as well as time spent in hospital; it also improves pharmacotherapy results. [2][3][4][5][6][7][8][9] Several initiatives and standards of practice for clinical pharmacy have been proposed around the world. These proposals promote the transformation of clinical pharmacy services through participation of pharmacists as providers of direct patient care, counselling, and support to medical and nursing staff in their decision-making.…”

Section: Introductionmentioning

confidence: 99%

Redesign of the Clinical Pharmacy Practice Model in a Tertiary Academic Hospital in Medellín, Colombia

Aguirre

Quintero

Vega

2017

CJHP

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Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature

Cited by 94 publications

References 46 publications

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Multifaceted Pharmacist‐led Interventions in the Hospital Setting: A Systematic Review

Redesign of the Clinical Pharmacy Practice Model in a Tertiary Academic Hospital in Medellín, Colombia

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