Maximizing acceptance of clinical pharmacy recommendations to reduce length of hospital stay in a private hospital from Amman, Jordan

Background Clinical pharmacy interventions (CPI) usually require prior medical authorization. Physicians approve 80% of CPI and reject 20%. If pharmacists show that physicians should authorize all 100% CPI, the profession will step closer to a fully independent prescriber status. This study used an artificial neural network (ANN) model to determine whether clinical pharmacy (CP) may improve outcomes associated with rejected CPI. Method This is a non-interventional, retrospective analysis of documented CPI in a 100-bed, acute-care private hospital in Amman, Jordan. Study consisted of 542 patients, 574 admissions, and 1694 CPI. Team collected demographic and clinical data using a standardized tool. Input consisted of 54 variables with some taking merely repetitive values for each CPI in each patient whereas others varying with every CPI. Therefore, CPI was consolidated to one rejected and/or one accepted per patient per admission. Groups of accepted and rejected CPI were compared in terms of matched and unmatched variables. ANN were, subsequently, trained and internally as well as cross validated for outcomes of interest. Outcomes were length of hospital and intensive care stay after the index CPI (LOSTA & LOSICUA, respectively), readmissions, mortality, and cost of hospitalization. Best models were finally used to compare the two scenarios of approving 80% versus 100% of CPI. Variable impacts (VI) automatically generated by the ANN were compared to evaluate the effect of rejecting CPI. Main outcome measure was Lengths of hospital stay after the index CPI (LOSTA). Results ANN configurations converged within 18 s and 300 trials. All models showed a significant reduction in LOSTA with 100% versus 80% accepted CPI of about 0.4 days (2.6 ± 3.4, median (range) of 2 (0–28) versus 3.0 ± 3.8, 2 (0–30), P-value = 0.022). Average savings with acceptance of those rejected CPI was 55 JD (~ 78 US dollars) and could help hire about 1.3 extra clinical pharmacist full-time equivalents. Conclusions Maximizing acceptance of CPI reduced the length of hospital stay in this model. Practicing Clinical Pharmacists may qualify for further privileges including promotion to a fully independent prescriber status.

Evaluation of Clinical Pharmacy Services Offered for Palliative Care Patients in Chennai

Palliative care is an emerging concept in developing countries like India. North region is having more illiterate people comparing to southern part of India and shows poor palliative care services offered in those regions. Clinical pharmacy services are in developing stages in those regions. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from a period of three months (September to November, 2020) and were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient was calculated. A total of 98 interventions were documented, giving 2 interventions per patient and an acceptance rate of 62%. Discontinuing therapy (35%), initiating therapy (22%), and provision of education/counseling (8%) were most common Interventions. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. The major conclusions from this study are that clinical pharmacy services are being offered for palliative care patients in chennai, with an emphasis on initiating and discontinuing through clinical pharmacist is effective. Keywords: Clinical pharmacy; hospice; palliative care; pharmacy; pharmacy education

Improvement of Statin Utilization in Veterans With Diabetes Through Pharmacy Interventions

This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of <em>Clinical Diabetes</em>. The following article describes an effort aimed at increasing the use of statins among veterans with diabetes at a Veterans Affairs medical center in New Mexico.

Improvement of Statin Utilization in Veterans With Diabetes Through Pharmacy Interventions

This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of <em>Clinical Diabetes</em>. The following article describes an effort aimed at increasing the use of statins among veterans with diabetes at a Veterans Affairs medical center in New Mexico.