Evidence demonstrating the pharmacist's direct impact on clinical outcomes in pediatric patients: An opinion of the pediatrics practice and research network of the American College of Clinical Pharmacy

LaRochelle, Joseph M.; Smith, Katherine; Benavides, Sandra; Bobo, Kelly; Chung, Allison M.; Farrington, Elizabeth; Kennedy, Audrey; Knoppert, David; Lee, Bernard T.; Manasco, Kalen B.; Pettit, Rebecca S.; Phan, Hanna; Potts, Amy; Sandritter, Tracy; Hagemann, Tracy M.

doi:10.1002/jac5.1217

Cited by 5 publications

(8 citation statements)

References 36 publications

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“…However, few hydroxyurea adherence interventions have addressed systematic hydroxyurea adherence barriers, such as those that prevent patients from filling their hydroxyurea (e.g., limited access to pharmacies, challenges with prior authorizations, difficulty identifying pharmacies with the ability to dispense the liquid hydroxyurea formulation, and pharmacies that provide automatic refills). One strategy that may hold significant promise, as demonstrated in other chronic diseases such as cystic fibrosis, for increasing medication adherence is the involvement of clinical pharmacists as an integral part of the care team for children with SCA 40–47 . The impact of clinical pharmacists has been described, with outcomes including improved hydroxyurea dose escalation rate, immunization completion rates, and screening for complications such as microalbuminuria and sickle cell retinopathy 48 .…”

Section: Discussionmentioning

confidence: 99%

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia

Reeves

Dombkowski

Peng

et al. 2023

Pediatric Blood & Cancer

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Objective Hydroxyurea lowers the incidence of vaso‐occlusive pain crises (VOC) and acute chest syndrome (ACS) among children with sickle cell anemia (SCA). Our objective was to assess the relationship between levels of adherence to hydroxyurea and clinical outcomes among children and adolescents with SCA. Methods This retrospective cohort study included Medicaid data (2005–2012) from Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. The study population consisted of children 1–17 years old with SCA enrolled in Medicaid for 3 years. Among children that initiated hydroxyurea, the medication possession ratio (MPR) was calculated as the proportion of days covered by hydroxyurea. Six months after initiation of hydroxyurea, clinical outcomes were assessed through the end of the study period: numbers of VOC‐related inpatient admissions and emergency department visits, and encounters for ACS. Multivariable Poisson models were used to predict outcomes by MPR quartile adjusting for previous healthcare utilization, state, and age. Results Hydroxyurea was initiated by 515 children. The median MPR was 0.53 (interquartile range = 0.3–0.8). The annual median number of visits was 0.0 for ACS, 1.3 for VOC‐related emergency department, and 1.4 for VOC‐related inpatient admissions. For each outcome, the highest quartile of MPR had the lowest predicted count; this difference was significant for ACS visits when compared with the lowest quartile of MPR. Conclusion This study demonstrated a high level of adherence (>75%) was essential to achieve a lower incidence of common negative clinical outcomes. Further, moderate and severe hydroxyurea nonadherence may be more common than previously appreciated among children, emphasizing the importance of developing and testing innovative strategies to increase adherence.

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Section: Discussionmentioning

confidence: 99%

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia

Reeves

Dombkowski

Peng

et al. 2023

Pediatric Blood & Cancer

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“…Few studies evaluating pediatric pharmacist interventions report financial implications (8–13, 19, 20). Recent studies evaluating adult ICU and ED pharmacist impact found monetary benefit-to-cost ratios of 9.62:1 and 10.63:1, respectively (14–17).…”

Section: Discussionmentioning

confidence: 99%

“…With regard to administrative and supportive tasks, pediatric pharmacists were most involved with drug information consultation and patient own medication evaluation. These interventions highlight the reliable and invaluable uses of a pharmacist's specialty knowledge and minimize concerns related to nuanced aspects of patient care plans (6)(7)(8)(9)(10)(11)(12)(13). Pharmacists are a vital contribution to a safety culture, and although these interventions are valued by hospital and regulatory bodies, it remains difficult to quantify these types of services provided by pharmacists from a potential CA perspective.…”

Section: What This Study Meansmentioning

confidence: 99%

“…ED and ICUs that once consisted of physicians and nurses have evolved to include pediatric trained pharmacists, who apply physiologic and pharmacology knowledge to patient care (6,7). The shift from a distribution role to participation in direct patient care activities as members of the multidisciplinary team has improved outcomes and decreased hospital costs (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Professional healthcare organizations, such as the American Academy of Pediatrics, have also endorsed pharmacists as members of the medical team (20).…”

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confidence: 99%

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Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Kiskaddon,

Smith,

Gilliland

et al. 2023

Critical Care Explorations

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OBJECTIVES: To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions. DESIGN: A multicenter, prospective, observational study performed between August 2018 and January 2019. SETTING: Academic and community hospitals in the United States with pediatric critical care units. SUBJECTS: Pediatric clinical pharmacists. INTERVENTIONS: Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA. MEASUREMENTS AND MAIN RESULTS: Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1. CONCLUSIONS: There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.

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“…17 Many studies have supported that clinical pharmacists have demonstrated improvement in the care of pediatric patient. 18…”

Section: Pulmonologymentioning

confidence: 99%

Clinical pharmacists’ role in paediatric patients’ medical care

Balakrishnan

Ravichandran

Dillibatcha

et al. 2020

Int J Contemp Pediatr

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Clinical pharmacists give valuable administrations to adult patients, however, their advantages for pediatric and neonatal patients are less characterized. Many studies state that medication errors in children are more common than in adults with a greater risk of death.Clinical Pharmacists are accepted as the primary source for providing evidence-based information and advice, to ensure the delivery of correct, safest, and most effective medication to patients. This paper presents a review of the role of clinical pharmacists in the pediatric unit and emphasis the importance of clinical pharmacists for all patients, especially in the pediatric age group.

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Evidence demonstrating the pharmacist's direct impact on clinical outcomes in pediatric patients: An opinion of the pediatrics practice and research network of the American College of Clinical Pharmacy

Cited by 5 publications

References 36 publications

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia

Adherence to hydroxyurea and clinical outcomes among children with sickle cell anemia

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study

Clinical pharmacists’ role in paediatric patients’ medical care

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