The Impact of Clinical Pharmacists on Drug‐Related Problems and Clinical Outcomes

Abstract

Drug-related problems are frequent and may result in reduced quality of life, and even morbidity and mortality. Many studies have shown that clinical pharmacists can effectively identify and prevent clinically significant drug-related problems and that physicians acknowledge and act on the clinical pharmacist's suggestions for interventions to the drug-related problems. A pro-active rather than a reactive approach on the part of the pharmacists seems prudent for obtaining most benefit. This includes participation of pharmacists in the multidisciplinary team discussions -at the stage of ordering and prescribing -where all types of drug-related problems, including also potential problems, should be discussed. In addition, counselling by pharmacists about medication on discharge and follow-up after discharge resulted in better outcomes. Furthermore, clinical pharmacists can positively influence other outcomes, such as improvement of levels of markers for drug use (e.g. optimization of lipid levels, anticoagulation levels and blood pressure). Some studies have reported positive effects on hard clinical outcomes, such as reduced length of stay, fewer re-admissions and fewer disease events (e.g. heart failure events and thromboembolism). However, more studies should be undertaken with larger patient populations, including patients from multiple sites. More knowledge about patient-specific factors that predict improved care is also needed. In conclusion, there is increasing evidence that participation and interventions of clinical pharmacists in health care positively influence clinical practice.Drugs are an important input factor in the Western healthcare system. However, it has been shown that drugs may give negative health outcomes, such as increased morbidity and mortality [1][2][3] and reduced quality of life [4]. Moreover, lack of effect of the chosen drug can also be a challenge in the management of patients, and often optimal levels of blood glucose, cholesterol or blood pressure are not reached during drug treatment [5]. The reason could be the choice of drug or dosage, or patient factors such as drug-disease interactions or adherence problems.A cornerstone of clinical pharmacy is the identification, solving and prevention of drug-related problems. A drug-related problem is defined as 'an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes' [6]. Drug-related problems have been categorized by different research groups into different classification systems. In short, these problems deal with choice of drug, drug dosages, adverse drug reactions, drug interactions, lack of monitoring of drug effects/toxicity, and adherence problems. Drug-related problems include both actual and potential problems. An actual problem has resulted in clinical manifestations (e.g. a drug-related rash, an adverse drug reaction), or therapy failure due to incorrect dosage. A potential problem is not manifest, but if left unresolved, it may lead to drug-related harm ...

Assessment of Drug Related Problems in a Tertiary Care Teaching Hospital, India

“…DRPs may arise at all stages of the medication process from prescription to follow-up of treatment. Most of the problem usually occurs on administration, dispensing and during the patient's use of a medicinal product, but the lack of proper follow-up and reassessment of medical treatment by the physician is also a major problem [2]. DRPs occur more frequently in hospitalized patients where multiple changes are being made in patient's medication regimens, and lack of continuity of care may be accompanied [3].…”

Role of the Clinical Pharmacist in Detection of Drug Therapy Problems in Critically Inpatients: Experience Report

“…The emergence of a new drug therapy problem related to the use of unnecessary medication can prolong the stay of these patients in the ICU, a fact that is financially inefficient for the hospital, to the patient, the health insurance of the patient and/or the government [8]. Although no situation of category F (NCCMERP) have been identified, the presence of the pharmacist in the multidisciplinary team allows identification and interception of medication errors.…”

“…Studies show that the inclusion of the clinical pharmacist in the intensive care unit reduces mortality4 and adverse events [4][5][6][7], improves clinical outcomes4 and reduces hospital costs [6][7][8].…”

Influence of Pharmacists’ Intervention on Drug-Related Problems Related to Change in Hemoglobin Levels of Hemodialysis Patients at Adjidarmo Hospital, Lebak, Banten

“…DRPs can disturb and cause a decrease in Hb levels and increase in ureum and creatinine plasma [7]. Pharmacists play a key role in identifying and preventing DRPs by conducting interventions with the doctor, patient, and nurse based on predicted DRPs [8].…”