Clinical pharmacy service evaluation

Pharmacoeconomic data can be a powerful tool to support various clinical decisions, ranging from the level of the patient to the level of an entire health care system. Figure 1-2 shows various decisions that may be supported using pharmacoeconomics, including effective formulary management, individual patient treatment, medication policy, and resource aUocation. For discussion purposes, the application of pharmacoeconomics to decision making is divided into two basic areas drug therapy evaluation and clinical pharmacy service evaluation. 

Pillai A, Thomas SS, Garg M (2004) The electronic immediate discharge document experience from the South West of Scotland. Inform Prim Care 12 67-73 Schumock GT, Meek PD, Ploetz PA, Vermeulen LC (1996) Economic evaluation of Clinical Pharmacy service - 1988-1995. Pharmacotherapy 16 1188-1208 Schumock GT, Butler MG, Meek PD, Ploetz PA, Vermeulen LC, Arondekar BW et al. (2003) Evidence of the economic benefit of clinical pharmacy service 1996-2000. Pharmacotherapy 23 113-132... 

After his first year at the hospital, Ted has formulated several ideas for new clinical pharmacy services that the department could offer that might generate revenue. During his annual performance evaluation, he discusses these ideas with his boss, the director of pharmacy (DOP). The DOP is happy that Ted has come forward with his ideas and encourages him to investigate these options further. One idea that is of particular interest is to develop a service or business to provide consultant pharmacy services to area nursing homes. 

American College of Clinical Pharmacy. 1994. Establishing and evaluating clinical pharmacy services in primary care. Pharmacotherapy 14 743-58. 

Schumock G, BuderM. 2003. Evaluating and justifying clinical pharmacy services. In Grauer D, Lee J, Odom T, et al. (eds), Pharmacoeconomics and Outcomes Applications for Patient Care, 2ded. Kansas City, MO American College of Clinical Pharmacy. 

Schumock G, Meek P, Ploetz P, Vermeulen LC. 1996. Economic evaluations of clinical pharmacy services 1998— 1995. Pharmacotherapy 16 1188. 

Soraya Dhillon is a Foundation Professor and Head of The School of Pharmacy at the University of Hertfordshire. Professor Dhillon has extensive experience in Clinical Pharmacy and Clinical Pharmacokinetics and has held positions in Community and Hospital Pharmacy. She has published widely in the evaluation of clinical pharmacy services and education. She currently holds a nonexecutive role as Chairman of Luton Dunstable Foundation Trust and has a particular interest in driving forward patient safety initiatives. 

Improving pharmacy services Decentralized pharmacy services Patient education programs Cost-justifying clinical pharmacy services Missing dose evaluation... 

Economic evidence supporting the practice of pharmaceutical care is sub-stantial. An evaluation of care delivered by pharmacists in a variety of health care settings reported an average benefit of 16.70 of value to the health care system realized for each 1 invested in clinical pharmacy services. In the Minnesota Pharmaceutical Care Project, there was a bene-fit-to-cost estimate of 11 for every 1 invested. ... 

Schumock GT, Meek PD, Ploetz, PA et al. Economic evaluation of clinical pharmacy service — 1988-1995. Pharmacotherapy 1996 16 1188-1208. 

The template for the evaluation of a clinical pharmacist was designed to be flexible and adaptable to a particular institution, clinical pharmacy service, and clinical pharmacist. The administrator (evaluator) and clinical pharmacist for whom it will be used should work together to modify and individualize the tool as necessary. Such communication is vital to its effective use. The pharmacist being evaluated must be an active participant in the process. 

Schumock, G.T. Meek, P.D. Ploetz, P.A. Vermeulen, 49. L.C. Publications Committee of the American College of Clinical Pharmacy Economic evaluations of clinical pharmacy services—1988-1995. Pharmacotherapy 1996,... 

Economic Evaluations of Clinical Pharmacy Services (ACCP)... 

In the time that has passed since the original ACCP prospectus, the literature has continued to grow in both depth and breadth of evidence supportive of the financial justification of clinical pharmacy services. New service models and philosophies of practice have developed in the past 6 years, the most notable being that of pharmaceutical care. " In addition, our ability to evaluate scientifically and measure the impact of clinical services on costs and outcomes has matured with the increased understanding and use of analytical techniques in health economics and pharmacoeconomics. " The effect of these advances on the quality and quantity of literature is unknown. The ACCP Board of Regents thus asked the ACCP Publications Committee to update this prospectus. 

Commonly these articles expressed net savings on an annual basis or for the time period of the study. For example, a study in 1992 described annual net cost savings of 221,056 for clinical pharmacy services provided in an ambulatory care clinic. It did not, however, include a control group. In other cases, savings were expressed per patient admission or per patient-day. In 1993, a well-conducted and controlled evaluation described an average net savings of 377 per patient admission as a result of clinical pharmacists assigned to selected inpatient medical services. 

University hospital Pharmacotherapeutic monitoring To evaluate impact of clinical pharmacy service on hospital costs using cost-benefit analysis 1.08 1 and 1.59 1... 

The conclusions drawn from our review and evaluation of literature assessing the economic value of clinical pharmacy services published from 1988-1995 are multifocal. The total number of articles published on this topic has grown, as demonstrated by the number in this review (104, average 13/yr) versus the original prospectus (58, average 4/yr), which included articles published from 1974-1987. Although the number of published articles on this topic appears sufficient, an opportunity does exist for improvement in the quality of study design. 

Despite the limitations of many of the articles as true economic evaluations, this literature contains a wealth of information pertinent to the clinical practice of pharmacy that serves to document innovative and successful experiences and programs. Of importance, we did find that when studies were well conducted (considered true economic evaluations), the results were likely to be favorable that is, the studies were able to demonstrate net savings or positive benefit cost ratios. Because of lack of standardization in reporting of results and variability in study design, it is difficult to make a general statement as to the degree of benefit derived from clinical pharmacy services. However, we were able to abstract calculated benefit cost ratios from the seven applicable studies and describe a range of value from 1.08 1 to 75.84 1 (mean 16.70 1). In other words, for every... 

We undertook this review and evaluation with the intent of providing the reader a resource to access original literature published assessing the economic value of clinical pharmacy services, and to evaluate the quality of that literature. The articles included in this review represent only those published in standard literature. We did not consider unpublished studies and therefore our results may be subject to inherent publication bias (so-called file drawer effect). We included only articles that contained some consideration of the financial impact of clinical pharmacy services. Certainly, many useful articles describe and evaluate clinical pharmacy services, but focus on nonfinancial outcomes and impact, and are worthy of review. Finally, our review of the literature, although intended to be systematic and thorough, may not have captured all the published literature on this topic. 

Having reviewed and evaluated the published literature on the economic value of clinical pharmacy services, we make the following recommendations to clinicians, investigators, authors, reviewers, and journal editors ... 

Clinical pharmacy services provided in settings outside the traditional hospital should be included in future economic evaluations. 

It is hoped that the data summarized in this article will assist individual pharmacists, departmental managers, and health system administrators to document and recognize the cost effectiveness of pharmacists clinical services. Pharmacy practitioners should take pride in both the quantity and strength of this literature, and feel empowered to use it to justify further expansion or refinement of their caregiving responsibilities. Attention to our recommendations regarding the design and performance of future economic evaluations of clinical pharmacy services will further add to the strength of this literature and the conclusions that may be drawn from it. 

Appendix 1 Evaluations of economic value of clinical pharmacy services—1988-1995 Objective... 

ChI 81 To evaluate clinical pharmacy services and determine cost savings and justification for additional pharmacy staff COD None Personnel costs DCA Annual net savings 25,862 ... 

---