Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial

Bladh, Lina; Ottosson, Ellinor; Karlsson, John; Klintberg, Lars; Wallerstedt, Sven

doi:10.1136/bmjqs.2009.039693

Cited by 68 publications

(132 citation statements)

References 30 publications

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“…6 Recently randomised controlled studies showed reductions in drug-related inpatient and outpatient readmissions, reduced hospital stay and improved health-related quality of life. [7][8][9] The economic effects of these outcomes have been studied, and in two review studies, it was concluded that clinical pharmacist interventions are associated with cost savings, although the mixed methodological quality limited the overall conclusions. 10 11 However, the cost for pharmacy services for avoiding one death in hospitals was calculated at $320 and each dollar spent on clinical pharmacy services gave $4.8 in return.…”

Section: Key Messagesmentioning

confidence: 99%

Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

et al. 2013

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ObjectiveTo evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits.MethodPublished data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature.ResultsThe total cost for the LIMM model was €290 compared to €630 for standard care, in spite of a €39 intervention cost. The main cost offset arose from avoided drug-related readmissions in the Admission part (€262) whereas only €66 was offset in the Discharge part as a result of fewer outpatient visits and correction time. The reduced disutility was estimated to 0.005 quality-adjusted life-years (QALY), indicating that LIMM was a dominant alternative. The probability that the intervention would be cost-effective at a zero willingness to pay for a gained QALY compared to standard care was estimated to 98%.ConclusionsThe LIMM medication reconciliation (at admission and discharge) and medication review was both cost-saving and generated greater utility compared to standard care, foremost owing to avoided drug-related hospital readmissions. When implementing such a review process with a multidisciplinary team, it may be important to consider a learning curve in order to capture the full advantage.

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Section: Key Messagesmentioning

confidence: 99%

Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

et al. 2013

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“…In a randomised controlled study performed by our research group (http://clinicaltrials.gov identifier: NCT01016301),13 we have reported positive effects of a composite in-hospital clinical pharmacist service (medication reviews, drug treatment discussion with the patient at discharge and a medication report) on self-rated health status as measured by the simple question ‘In your opinion, how is your state of health? Is it very good, rather good, neither good nor bad, rather poor or very poor?’ Health status was thus registered as an integer from 1 (very poor) to 5 (very good), and at 6-month follow-up, intervention patients had better self-reported health than control patients as measured by this question (mean±SD: 3.14±0.87 vs 2.77±0.94, p=0.020) 13.…”

Section: Introductionmentioning

confidence: 99%

A cost-effectiveness analysis of an in-hospital clinical pharmacist service

Wallerstedt

Bladh

Ramsberg³

2012

BMJ Open

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Setting: Two internal medicine wards at Sahlgrenska University Hospital, Göteborg, Sweden.Participants: Of 345 patients (61% women; median age: 82 years; 181 control and 164 intervention patients), 240 patients (62% women, 82 years; 124 control and 116 intervention patients) had EuroQol-5 dimensions (EQ-5D) utility scores at baseline and at 6-month follow-up.Outcome measures: Costs during a 6-month follow-up period in all patients and incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) in patients with EQ-5D utility scores. Inpatient and outpatient care was extracted from the VEGA database. Drug costs were extracted from the Swedish Prescribed Drug Register. A probabilistic analysis was performed to characterise uncertainty in the costeffectiveness model. Results:No significant difference in costs between the randomisation groups was found; the mean total costs per individual6SD, intervention costs included, were V10 748613 799 (intervention patients) and V10 344614 728 (control patients) (p¼0.79). For patients in the cost-effectiveness analysis, the corresponding costs were V10 912613 999 and V9290612 885. Intervention patients gained an additional 0.0051 QALYs (unadjusted) and 0.0035 QALYs (adjusted for baseline EQ-5D utility score). These figures result in an incremental costeffectiveness ratio of V316 243 per unadjusted QALY and V463 371 per adjusted QALY. The probabilistic uncertainty analysis revealed that, at a willingness-to-pay of V50 000/QALY, the probability that the intervention was cost-effective was approximately 0.2.Conclusions: The present study reveals that an intervention designed like this one is probably not cost-effective. The study thus illustrates that the complexity of healthcare requires thorough health economics evaluations rather than simplistic interpretation of data.

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“…Drug-related problems found, % (95 % CI) 31 (29)(30)(31)(32)(33) Interventions, n (%) 537 (31) Acceptance rate for Interventions…”

Section: Timingmentioning

confidence: 99%

Clinical pharmacist service in the acute ward

Nielsen

Andersen

Rasmussen³

et al. 2013

Int J Clin Pharm

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Background The majority of hospitalised patients have drug-related problems. Clinical pharmacist services including medication history, medication reconciliation and medication review may reduce the number of drug-related problems. Acute and emergency hospital services have changed considerably during the past decade in Denmark, and the new fast-paced workflows pose new challenges for the provision of clinical pharmacist service. Objective To describe and evaluate a method for a clinical pharmacist service that is relevant and fit the workflow of the medical care in the acute ward. Setting Acute wards at three Danish hospitals. Methods The clinical pharmacist intervention comprised medication history, medication reconciliation, medication review, medical record entries and entry of prescription templates into the electronic medication module. Drug-related problems were categorised using The PCNE Classification V6.2. Inter-rater agreement analysis was used to validate the tool. Acceptance rates were measured as the physicians' approval of prescription templates and according to outcome in the PCNE classification. Main outcome measure Acceptance rate of the clinical pharmacists' interventions through the described method and inter-rater agreement using the PCNE classification for drug-related problems. Results During 17 months, 188 patients were included in this study (average age 72 years and 55 % women). The clinical pharmacists found drug-related problems in 85 % of the patients. In the 1,724 prescriptions, 538 drug-related problems were identified. The overall acceptance rate by the physicians for the proposed interventions was 76 % (95 % CI 74-78 %). There was a substantial inter-rater agreement when using the PCNE classification system. Conclusion The methods for a clinical pharmacist service in the acute ward in this study have been demonstrated to be relevant and timely. The method received a high acceptance rate, regardless of no need for oral communication, and a substantial inter-rater agreement when classifying the drug-related problems.

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Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial

Cited by 68 publications

References 30 publications

Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

Health economic evaluation of the Lund Integrated Medicines Management Model (LIMM) in elderly patients admitted to hospital

A cost-effectiveness analysis of an in-hospital clinical pharmacist service

Clinical pharmacist service in the acute ward

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