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CLINICAL PHARMACY PRACTICE IN THE PSYCHIATRIC HOSPITAL IN THE CZECH REPUBLIC: A THREE-YEAR PROSPECTIVE STUDY OF CLINICAL PHARMACEUTICAL INTERVENTION BENEFITS

Authors:

Abstract

Assesment of financial benefits of clinical pharmacist interventions in this prospective study conducted from January 1, 2016 to December 31, 2018 in the Psychiatric Hospital Bohnice in Prague.
PharmDr. Ivana Tašková
Clinical pharmacist
Psychiatric Hospital Bohnice
Prague, the Czech Republic
ivana.taskova@bohnice.cz
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Psychiatric*Hospital*Bohnice,*Prague,*the*Czech*Republic*
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Clinical pharmacy in the Czech Republic has been developing fast since 2010.
today: 40 clinical pharmacy departments (see the map bellow)
5are situated in psychiatric hospitals or clinics
General clinical pharmaceutical practice is based on:
Clinical pharmacists’ activities are covered by the health care providers.
The obligation to ensure clinical pharmaceutical services in all acute hospital units is set forth
by the Czech Republic legislation.
Some parts of clinical pharmaceutical interventions may be covered by the Health Insurance
System (since 2017). [1],[2]
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The Psychiatric Hospital Bohnice is a psychiatric facility with capacity (see photo bellow):
1,200 beds
7,400 admissions per annum
The average cost of a hospital stay is about USD 91 per day.
ADRs are associated with significant prolongation of hospital stays by 1.75 or 2.9 days, resp. [3],[4]
or
Overall preventability of ADRs was established to between 30 and 40 %. [4]
Avoidability of ADRs was assessed to be about 50 %.[5]
In order to demonstrate the benefits of clinical pharmaceutical service in the
selected psychiatric hospital:
data about all interventions made by one clinical pharmacist for the period between
2016and 2018 has been collected
total number of 2,065 interventions over the selected 3-year period has been
recorded
all the interventions with high potential to prevent ADRs had been selected,
recorded and forwarded to the treating physician
These selected intervetions were divided into several categories:
daily reviews of patients‘ medication profiles
participation in the medical rounds
ensuring rationality, safety, and efficiency of prescribed medications
applying knowledge of therapeutic use of drugs using EBM data
evaluation of potential risk of adverse drug reactions (ADRs)
Data quantifying financial benefits of the clinical pharmaceutical care in psychiatric facilities is scarce worldwide.
This unique study presents clear evidence of clinical pharmaceutical care benefits.
Total numbers of ADRs preventing interventions during the study period were:
)including only 22 % of total number of 2,065 interventions executed during the study period 2016 - 2018
The important fact to consider is the level of detail and scope of the study:
!all the costs are covered by the health care provider
!clinical pharmacist’s labour cost (FTE) amounting to USD 35,000 per annum
!health care provider is therefore investing quite significant amount of money to provide
safe, rational, and efficient pharmacotherapy
!health insurance company, or the state administration, respectively, mostly benefit from the
savings
This fact should be considered while negotiating the terms of health care performance
reimbursements, and also be reflected in the DRG system in form of future increase of
payments.
References:
[1] Gregorová, J., Rychlíčková, J. et Šaloun J., 2017. Standardization of clinical pharmacist’s activities: Methodology. Saudi
Pharmaceutical Journal 25(6), 927-933.
[2] Rychlíčková, J., Šaloun, J. et Gregorová, J., 2016. Evaluation of Clinical Pharmacists’ Interventions in the Czech Republic.
Pharmacotherapy 36(7), 766-773.
[3] Classen, D.C. et al., 1997. Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable
Mortality. JAMA 277(4), 301-306.
[4] Rottenkolber, D. et al., 2012. Cost of Adverse Drug Events in German Hospitals – A Microcosting Study. Value in Health
15(6), 868-875.
[5] Davies, C.E. et al., 2009. Adverse Drug Reactions in Hospital In-Patients: A Prospective Analysis of 3695 Patient-Episodes.
PLoS One 4(2), e4439.
Declaration of Conflicting Interests: The author declare that there is no conflict of interest.
discontinuation of the drug due to an existing ADR/high probability of ADR occurrence
discontinuation or dose reduction due to renal or hepatic impairment
discontinuation of the drug due to duplicity
discontinuation of the drug due to contraindication
dose reduction due to existing ADR/high probability of ADR occurrence
dose reduction due to drug overdose
dose reduction or discontinuation due to drug interaction
USD 20,472 saved by only one clinical pharmacist each year
)
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1 clinical pharmacist working in the equivalent of 0.8 full time equivalent (FTE)
= 462 interventions preventing ADRs
= 22 % of all interventions executed during this period
1 clinical pharmacist (FTE) is able to prevent in average 193 ADRs each year
= saving 447 extra days of hospitalization each year
= total cost of USD 40,955 per annum
If 50% ADR avoidability is taken into account, saving of USD 20,472 may be expected.
Comment: The benefit would be much greater if additional types of clinical pharmacists’ interventions were included in the
analysis (introduction of a missing drug, recommendation to execute further evaluations – e.g. laboratory assessment,
therapeutic drug monitoring etc.). No additional and indirect costs (e.g. permanent disability) were included into the
methodology of this assessment.
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P21-5>4:
2016
2017
2018
0
10
20
30
40
50
60
70
contraindication
risk of ADR occurence
existing ADR
drug interaction
duplicity
renal impairment
discontinuation of the drug
2016
2017
2018
0
5
10
15
20
25
risk of ADR occurence
existing ADR
drug interaction
renal impairment
hepatic impairment
drug overdose
change of the dose
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