Effect of a Pharmacist on Adverse Drug Events and Medication Errors in Outpatients With Cardiovascular Disease

Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB 7360, Kerr Hall, Room 2212, Chapel Hill, NC 27599-7360, USA.
Archives of internal medicine (Impact Factor: 17.33). 05/2009; 169(8):757-63. DOI: 10.1001/archinternmed.2009.59
Source: PubMed

ABSTRACT Adverse drug events and medication errors are threats to quality care. Inpatient studies suggest that a pharmacist may reduce these events, but outpatient studies have not been forthcoming.
We conducted a pooled analysis of 2 randomized controlled trials to determine the effect of pharmacist intervention on adverse drug events and medication errors. We studied 800 outpatient cases of hypertension stratified into complicated (n = 535) and uncomplicated (n = 265). Patients in the complicated stratum had heart failure or other cardiovascular complication. Computer programs examined 1-year electronic record data to identify events classified as adverse drug events and preventable or potential adverse drug events. Medication errors included preventable and potential adverse drug events.
Of the 800 participants (mean [SD] age, 59 [10] years), 484 (90.5%) and 258 (97.4%) participants remained in the complicated and uncomplicated strata, respectively, at 12 months. Compared with the control group, the risk of any event was 34% lower in the intervention group (risk ratio, 0.66; 95% confidence interval [CI], 0.50-0.88), including a lower risk of adverse drug events (risk ratio, 0.65; 95% CI, 0.47-0.90), preventable adverse drug events (risk ratio, 0.52; 95% CI, 0.25-1.09), potential adverse drug events (risk ratio, 0.70; 95% CI, 0.40-1.22), and medication errors (risk ratio, 0.63; 95% CI, 0.40-0.98).
This post hoc analysis suggests that pharmacist intervention to improve medication use in outpatients with cardiovascular disease decreases the risk of adverse drug events and medication errors. Further studies are needed to confirm this finding.

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    • "Interacting with the health care team in patient rounds, interviewing patients and conducting medication histories; providing recommendations on drug selection and follow-up all resulted in improved outcomes 2 3 Murray et al . 4 reported the effect of pharmacist interventions in outpatients with cardiovascular disease reduced the risk of adverse drug events by 34% compared with the control group. . The positive impact of CPS (or pharmaceutical care services) on clinical, economic and humanistic outcomes has been demonstrated in numerous studies in the North America and United Kingdom (UK). "
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    ABSTRACT: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however. To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital. The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs). A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively. Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes.
    03/2013; 11(1):51-7. DOI:10.4321/S1886-36552013000100009
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    • "Utilizing a multidisciplinary approach to manage patients with CVD is endorsed by the American Heart Association3 and may be one mechanism to improve treatment outcomes. Several studies have shown that pharmacists can reduce clinical events4,5,6,7 and adverse drug reactions8, improve medication adherence9, and lessen health care costs5,6,7 in patients with CVD. However, these benefits were achieved with interventions that focused on a specific issue within CVD (e.g., medication adherence, prevention of adverse events) or on one discrete cardiovascular diagnosis (e.g., heart failure, anticoagulation). "
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    ABSTRACT: Utilizing a multidisciplinary approach to management of patients with certain chronic cardiovascular diseases (CVD) has been shown to improve treatment outcomes. The role of clinical pharmacists in comprehensive outpatient CVD management has not been evaluated. The objective of this pilot study was to evaluate the impact of a clinical pharmacist added to cardiologist care on blood pressure (BP), a key surrogate marker of CVD, in outpatients with CVD compared to cardiologist care alone. A retrospective, matched-control study was conducted in patients established in a cardiovascular clinic. The intervention was referral to a pharmacist clinic; control was usual care from the cardiologist. The surrogate marker evaluated was the change in BP. Patients in the pharmacist-intervention (n=57) experienced significant reductions in diastolic BP (-2.6 mmHg, p=0.05) and non-significant reductions in systolic BP (-4.3 mmHg, p=0.16) compared to baseline, whereas patients in the control group experienced non-significant increases in both systolic and diastolic BP (+1.6/+0.7 mmHg, p=NS). Similarly, there were significant reductions in diastolic BP and non-significant reductions in systolic BP for the intervention group when compared to controls (difference 3.3 mmHg, p=0.04 and 5.9 mmHg, p=0.1, respectively). Lastly, the proportion of patients categorized as having Stage 2 BP was significantly reduced in the intervention group (p=0.02), but not in the controls (p=0.5). The multidisciplinary model of care that included a clinical pharmacist reduced BP more than usual care by a cardiologist alone. This benefit was demonstrated in complex patients with CVD who were already receiving specialized care. The impact of this model on clinical outcomes requires further evaluation and should be a high priority given the burden of CVD in the population.
    07/2012; 10(3):173-9. DOI:10.4321/S1886-36552012000300008
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    ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.
    Hospital pharmacy 12/1122; 41(7). DOI:10.1310/hpj4311-937
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