Levels of agreement among clinical pharmacists on the impact of pharmaceutical interventions in Oman: A retrospective analysis

Abstract

Objectives: Disagreement between health care providers on medication-related interventions can affect clinical outcomes. We aimed to study the outcomes and significance of clinical pharmacists' interventions and evaluate the levels of agreement between different clinical pharmacists on the impact of pharmaceutical interventions. Methodology: A retrospective study was conducted at a tertiary care hospital in Oman. The study included all documented interventions by clinical pharmacists for all categories of admitted patients that met the inclusion criteria. Results: The originator clinical pharmacists interjected to improve the efficacy of treatment in (58%, n=1740) of the interventions, followed by toxicity reduction (24%). The level of agreement in the clinical significance resulted in substantial Scotts' kappa (k) between the originator and the first reviewer, the first and second reviewers, and the second reviewer and supervisor (86%; k=0.77; P<.001), (77%; k=0.63; P<.001), (84%; k=0.77; P<.001), respectively. In terms of grading of clinical significance, the originator clinical pharmacists recorded moderate significance in 50% of the interventions, followed by major (30%), not applicable (8.4%), and minor (7.3%). The level of agreement in the clinical significance resulted in substantial Scotts' k between the originator and the first reviewer, and between the second reviewer and supervisor (82%; k=0.72; P<.001), (84%; k=0.77; P<.001), respectively. The level of agreement between the first and second reviewer was fair (55%; k=0.28; p<0.001). Conclusion: Clinical pharmacists' interventions have a crucial impact on patient safety, improving efficacy and reducing toxicities. Overall, there was a substantial agreement among clinical pharmacists on the clinical significance and grading of the interventions..

The Clinical Associations With The Differences in Rivaroxaban Dosing in Patients with Atrial Fibrillation Stratified by three Renal Function Formulae

“…They have proven a high proportion of dose changes based on gold standard guidelines with a high acceptance rate by the treating physicians. 22 was 28.2 kg/m 2 . Hypertension (n=183,82.8%) was prevalent, followed by CKD (n=116,52.5%) and DM (n=100,45.3%).…”

“…They have proven a high proportion of dose changes based on gold standard guidelines with a high acceptance rate by the treating physicians. 22 …”

Inappropriate Polypharmacy and the Need for Comprehensive Medication Management Service

“…18 Although recent studies published on clinical pharmacy services at SQUH have proven that staff shortage in this service can lead to less than optimum expectations, they have also documented a high acceptance rate among other healthcare providers about their interventions that lead to better health outcomes. [7][8][9] This might be an opportunity for SQUH to evaluate the implementation of CMM services by prioritising healthcare conditions that are likely to be associated with inappropriate polypharmacy. These could include chronic diseases such as heart failure, diabetes mellitus and hypertension.…”

“… 6 , 7 At SQUH, clinical pharmacy services have been provided to most but not all specialties since the inception of the hospital and the pharmaceutical interventions are intended to care for patients from admission until discharge. 6 – 9 The pharmaceutical interventions were able to prevent a wide range of medication errors and inappropriate polypharmacy which led to a reported annual cost avoidance of approximately US$440,000. 8 Deleting or omitting a medication from a patient list, especially if it's contributing to inappropriate polypharmacy is considered a fundamental category of pharmaceutical interventions provided by the clinical pharmacists at SQUH and its highly acknowledged by the healthcare providers.…”

“… 8 Deleting or omitting a medication from a patient list, especially if it's contributing to inappropriate polypharmacy is considered a fundamental category of pharmaceutical interventions provided by the clinical pharmacists at SQUH and its highly acknowledged by the healthcare providers. 9 Furthermore, the clinical pharmacy service provided at SQUH was further developed to an emerging concept called ‘bundle care service’ that provides a whole bundle of care to the patients on admission, which includes medication history/reconciliation on admission, pharmaceutical interventions, discharge medication review and counselling during the hospital stay or upon discharge to ensure a proper transition of care. 7 , 10 It has been reported that the full bundle of care is prioritised to patients with more than one comorbidity or to those on polypharmacy and to not all admitted patients, mainly because of the insufficient number of clinical pharmacists available at SQUH.…”