Evaluation of Pharmaceutical Care Services and Their Impact on Medication Safety in Hospitalized Patients

Abstract

The changes in documented drug-related problems following pharmacist-led pharmaceutical-care intervention among hospitalized patients and to describe the pharmacist interventions used to address identified medication related problems. Drug-related problems can compromise the safety and appropriateness of pharmacotherapy in hospitalized patients. Pharmacist-led pharmaceutical care provides a structured approach to medication review, identification of medication-related problems, and communication of therapeutic recommendations. A data analysis was conducted using previously generated aggregate data from a pharmacist-led intervention study. Documented drug-related problems were examined at baseline and endpoint across the reported medication related categories. Absolute changes and percentage reductions were calculated from the available baseline and endpoint counts. Documented pharmacist intervention categories were also reviewed. The overall number of documented drug-related problems decreased from 230 at baseline to 123 at endpoint, corresponding to a 46.52% reduction. Reductions were observed across most categories, including inappropriate drug selection according to guidelines or formulary recommendations, inappropriate drug combinations, excessive medication use, and dose related problems. Smaller reductions were observed for inappropriate duplication and medication use without an indication. The findings demonstrate variation in the magnitude of change between individual drug-related problem categories. The findings indicate that pharmacist-led pharmaceutical care was accompanied by a reduction in documented drug-related problems among hospitalized patients. Structured medication review and pharmacist intervention may support safer and more appropriate medication use. Further prospective studies using patient-level data are warranted to evaluate clinical outcomes and establish the longer-term contribution of pharmacist-led pharmaceutical care.