 |
|
Clinical Pharmacists and Inpatient Medical Care
A Systematic Review
Peter J. Kaboli, MD, MS;
Angela B. Hoth, PharmD;
Brad J. McClimon, MD, PharmD;
Jeffrey L. Schnipper, MD, MPH
Arch Intern Med. 2006;166:955-964.
Background The role of clinical pharmacists in the care of hospitalized patients has evolved over time, with increased emphasis on collaborative care and patient interaction. The purpose of this review was to evaluate the published literature on the effects of interventions by clinical pharmacists on processes and outcomes of care in hospitalized adults.
Methods Peer-reviewed, English-language articles were identified from January 1, 1985, through April 30, 2005. Three independent assessors evaluated 343 citations. Inpatient pharmacist interventions were selected if they included a control group and objective patient-specific health outcomes; type of intervention, study design, and outcomes such as adverse drug events, medication appropriateness, and resource use were abstracted.
Results Thirty-six studies met inclusion criteria, including 10 evaluating pharmacists' participation on rounds, 11 medication reconciliation studies, and 15 on drug-specific pharmacist services. Adverse drug events, adverse drug reactions, or medication errors were reduced in 7 of 12 trials that included these outcomes. Medication adherence, knowledge, and appropriateness improved in 7 of 11 studies, while there was shortened hospital length of stay in 9 of 17 trials. No intervention led to worse clinical outcomes and only 1 reported higher health care use. Improvements in both inpatient and outpatient outcome measurements were observed.
Conclusions The addition of clinical pharmacist services in the care of inpatients generally resulted in improved care, with no evidence of harm. Interacting with the health care team on patient rounds, interviewing patients, reconciling medications, and providing patient discharge counseling and follow-up all resulted in improved outcomes. Future studies should include multiple sites, larger sample sizes, reproducible interventions, and identification of patient-specific factors that lead to improved outcomes.
Author Affiliations: Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center (Drs Kaboli and Hoth); and Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics (Drs Kaboli and McClimon), Iowa City; and Division of General Internal Medicine, Brigham and Women’s/Faulkner Hospitalist Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Dr Schnipper).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Realizing the pharmacoeconomic benefit of clinical pharmacy
Kaboli
Am J Health Syst Pharm 2008;65:1123-1123.
FULL TEXT
Economic effects of clinical pharmacy interventions: A literature review
De Rijdt et al.
Am J Health Syst Pharm 2008;65:1161-1172.
ABSTRACT
| FULL TEXT
Pharmacist Monitoring of QTc Interval-Prolonging Medications in Critically Ill Medical Patients: A Pilot Study
Ng et al.
The Annals of Pharmacotherapy 2008;42:475-482.
ABSTRACT
| FULL TEXT
ASHP-SHM Joint Statement on Hospitalist-Pharmacist Collaboration
Cobaugh et al.
Am J Health Syst Pharm 2008;65:260-263.
FULL TEXT
Pharmacist privileging in a health system: Report of the Qualified Provider Model Ad Hoc Committee
Blair et al.
Am J Health Syst Pharm 2007;64:2373-2381.
ABSTRACT
| FULL TEXT
Survey of pharmacist-managed inpatient anticoagulation services
Phillips and Wittkowsky
Am J Health Syst Pharm 2007;64:2275-2278.
ABSTRACT
| FULL TEXT
Effect of a clinical pharmacist's interventions on duration of antiretroviral-related errors in hospitalized patients
Heelon et al.
Am J Health Syst Pharm 2007;64:2064-2068.
ABSTRACT
| FULL TEXT
Medical and nursing staff highly value clinical pharmacists in the emergency department
Fairbanks et al.
Emerg. Med. J. 2007;24:716-718.
ABSTRACT
| FULL TEXT
An essential ingredient
Woods
Am J Health Syst Pharm 2007;64:1911-1911.
FULL TEXT
Effects of an integrated clinical information system on medication safety in a multi-hospital setting
Mahoney et al.
Am J Health Syst Pharm 2007;64:1969-1977.
ABSTRACT
| FULL TEXT
Patient care interventions by pharmacy students in the intensive care unit
Thompson et al.
Am J Health Syst Pharm 2007;64:1788-1789.
FULL TEXT
Strategic approach for improving the medication-use process in health systems: The high-performance pharmacy practice framework
Vermeulen et al.
Am J Health Syst Pharm 2007;64:1699-1710.
ABSTRACT
| FULL TEXT
ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and Health Systems: Ensuring the Best Use of Medicines in Hospitals and Health Systems
Am J Health Syst Pharm 2007;64:1320-1330.
FULL TEXT
Impact of a Pharmacy Resident on Hospital Length of Stay and Drug-Related Costs
Terceros et al.
The Annals of Pharmacotherapy 2007;41:742-748.
ABSTRACT
| FULL TEXT
Pharmacists versus nonpharmacists in adverse drug event detection: A meta-analysis and systematic review
Phansalkar et al.
Am J Health Syst Pharm 2007;64:842-849.
ABSTRACT
| FULL TEXT
Improving adherence in patients with alcohol dependence: A new role for pharmacists
Peterson
Am J Health Syst Pharm 2007;64:S23-S29.
ABSTRACT
| FULL TEXT
The State of US Emergency Care: A Call to Action for Hospital Pharmacists
Idrees and Clements
The Annals of Pharmacotherapy 2006;40:2251-2253.
ABSTRACT
| FULL TEXT
Pharmacist Critique Was Ill-Informed
Karpa
The Annals of Pharmacotherapy 2006;40:1441-1444.
ABSTRACT
| FULL TEXT
|
