Impact of a Ward-based clinical pharmacist on the Quality use of medicines in a Sri Lankan teaching hospial

Abstract

OBJECTIVES: To investigate the impact of ward-based clinical pharmacy service (CPS) on appropriateness of discharge medications, resolution of drug-related problems (DRPs), reduction of drug-related hospital re-admissions, prevention of adverse drug reactions (ADRs), improvement of patients’ knowledge and adherence and to determine the level of acceptance of doctors and nurses towards ward-based CPS. METHODOLOGY: This was a controlled trial conducted in a tertiary care hospital in Sri Lanka. Control group (CG) received usual care. Intervention group (IG) received CPS in addition to the usual care. Appropriateness of prescribing was assessed at discharge with Medication Appropriateness Index (MAI). Pharmacist performed a prospective medication review in IG, identified DRPs were discussed with healthcare team and patients. At discharge pharmacist counseled patients in IG regarding prescriptions. Medication knowledge and adherence were assessed on sixth day post-discharge. Re-admission and post-discharge ADRs were identified during six months follow-up period. A staff survey was performed to assess the perspectives of healthcare team. RESULTS: Proportion of patients with appropriate medications at discharge was significantly higher in IG compared to CG; 56.0% (202/361) and 29.7% (105/354), respectively (P < 0.001). Mean MAI score per patient was significantly lower (i.e. more appropriate) in IG compared to CG (1.25 vs. 4.3; P < 0.001). A significantly higher proportion of DRPs in IG were resolved compared to CG (57.6% vs. 13.2%; P < 0.05). IG had a significantly higher medication knowledge score and adherence score. (Knowledge: IG - 75.81±19.14 vs. CG - 40.84±19.20; P < 0.001; Adherence: IG - 92.97±15.04 vs. CG - 80.42±28.29; P < 0.001). Drug-related hospital re¬admissions were significantly lower in IG (IG: 11.6%, CG: 24.6%; P < 0.001). There was no significant difference in number of ADRs/patient (CG: 20.0%, IG: 23.0%; P = 0.320). The percentage of cessation of offending drugs was significantly higher in IG (IG: 81.3%, CG: 35.3%; P = 0.013). The majority of doctors were happy to work with CPs. Nurses were resistant to this collaboration. CONCLUSIONS: Ward-based CPS improved the quality use of medicines in patients in the study setting. Doctors had positive attitudes towards inclusion of a ward-based CPs. There is a need to improve liaison between CPs and nursing staff.