Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis |
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| Affiliation: | 1. School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom;2. Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt;3. National Guideline Centre, Royal College of Physicians, London, United Kingdom;4. National Institute for Health and Care Excellence, London, United Kingdom;5. NHS East and North Hertfordshire Clinical Commissioning Group, Hertfordshire, United Kingdom;6. Endocrinology and Acute Internal Medicine, Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom;7. Intensive Care Medicine, University of Birmingham; Honorary Consultant in Intensive Care Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom;1. Pharmacy Department, Kaiser Permanente Colorado, Lafayette, CO;2. Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO;3. Quality Department, Kaiser Permanente Colorado, Aurora, CO;4. Pharmacy Department, Lutheran Medical Center, Wheat Ridge, CO;5. Pharmacy Department, Kaiser Permanente Colorado, Denver, CO;6. Pharmacy Department, Kaiser Permanente Colorado, Englewood, CO;1. Department of Health Sciences, ARRC Building, University of York, Heslington, York, YO10 5DD, UK;2. School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK;3. School of Pharmacy, University of Reading, Harry Nursten Building, PO Box 226, Whiteknights, Reading, Berkshire, RG6 6AP, UK;1. Emergency Department, Princess Alexandra Hospital, Brisbane, Australia;2. Cardiology/Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia;3. School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia;4. Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia;1. School of Pharmacy, Department of Biopharmaceutics and Clinical Pharmacy, University of Jordan, Amman 11942, Jordan;2. Pharmacy Department, Cambridge University Hospitals, Cambridge, UK;3. School of Pharmacy, University of East Anglia, UK |
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| Abstract: | ![]()
BackgroundPharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined.ObjectiveTo systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness.MethodsThe protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched.Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate.ResultsEighteen RCTs and 7 economic studies were included. The RCTs were from USA (n = 3), Sweden (n = 2), Belgium (n = 2), China (n = 2), Australia (n = 2), Denmark (n = 2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n = 2), Sweden (n = 2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean = −1.74 days [95% CI: 2.76, −0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) = 1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) = £632/QALY-gained). No evidence was found for 7-day pharmacist presence.ConclusionsPharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective. |
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| Keywords: | Clinical pharmacy Systematic review Meta-analysis Cost effectiveness Acute medicine |
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