Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review
- 396 Downloads
Aim of the review
To identify and review the clinical and economic impact of pharmacists’ interventions on antibiotic use.
A literature search was conducted on Medline (1966–2003) to identify original articles measuring the impact of pharmacists’ interventions on antimicrobial therapy at patient’s or prescriber’s level.
Forty-three articles were included: 20 uncontrolled before-after studies, four controlled before-after studies, five controlled trials, 12 randomized controlled trials and two interrupted time series (ITS). The described interventions were grouped into four categories: patient-specific recommendations (pharmacists’ interventions concerning patient-specific drug therapy), implementation of policies, education, and therapeutic drug monitoring. These interventions were often combined to provide a multifaceted intervention, making it difficult to isolate the impact of one specific intervention. Measured outcomes were: appropriateness of prescribing (evaluated in 17 studies, 16 showing significant improvement), costs (analysed in 22 studies, nine showing a statistically significant reduction in costs after or with the intervention), and length of hospital stay (mixed results). Other measured outcomes were: drug use, prescriptions, length of treatment, dose intervals, switch to oral route, mortality rate, and treatment failure.
Over the years, the number of studies and quality of methodology has increased. The most frequently observed outcomes with a positive impact were appropriateness of prescribing and cost savings. The vast majority of studies used multiple interventions, in conjunction with pharmacists’ recommendations to physicians. Coupled with the use of practice guidelines or educational strategies, these interventions demonstrated a positive impact on economic or clinical outcomes. However, the data are still sparse and sometimes contradictory; therefore, further studies with randomized controlled designs are needed.
KeywordsAntibacterial agents Economics Literature Review Outcome assessment (health care) Pharmacists Pharmaceutical Pharmaceutical services
Unable to display preview. Download preview PDF.
Sharon Ho, Gloria Tsang, and Lydie Cubaynes for their contribution in editing the paper.
- 1.Levy SB. The Antibiotic Paradox. How the misuse of antibiotics destroys their curative powers, 2nd edn. Cambridge: Perseus Publishing; 2002.Google Scholar
- 6.Schentag JJ, Ballow CH, Fritz AL, Paladino JA, Williams JD, Cumbo TJ et al. Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease division, and the microbiology laboratory. Diagn Microbiol Infect Dis 1993;16(3):255–64.PubMedCrossRefGoogle Scholar
- 11.Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ 1998;317(7156):465–8.PubMedGoogle Scholar
- 15.Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev 2000;3:CD000336.Google Scholar
- 16.Ahern JW. Effectiveness of a criteria-based educational program for appropriate use of antibiotics. Infect Med 2002;19:364–374.Google Scholar
- 19.Presentation of data from randomised controlled trials (RCTs) and controlled before and after studies (CBAs): the Cochrane collaboration. Effective practice and organisation of care (EPOC) group. http://www.epoc.uottawa.ca/methods.htm, accessed Feb. 21, 2004.Google Scholar
- 39.Fraser GL, Stogsdill P, Dickens JD, Jr., Wennberg DE, Smith RP, Jr., Prato BS. Antibiotic optimization. An evaluation of patient safety and economic outcomes. Arch Intern Med 1997;157(15):1689–94.Google Scholar
- 45.Pastel DA, Chang S, Nessim S, Shane R, Morgan MA. Department of pharmacy-initiated program for streamlining empirical antibiotic therapy. Hosp Pharm 1992;27(7):596–603, 614.Google Scholar
- 52.Smith M, Murphy JE, Job ML, Ward ES. Aminoglycoside monitoring: use of a pharmacokinetic service versus physician recommendations. Hosp Formul 1987;22(1):92–9, 102.Google Scholar
- 54.Khanderia U. The cost-effectiveness of clinical pharmacist intervention on tobramycin prescribing. Hosp Formul 1986;21(10):1049–50, 1055–6.Google Scholar
- 60.Lawlor MC, Lucarotti RL. Clinical pharmacist impact on parenteral cephalosporin prescribing. Hosp Formul 1983;18(4):402–4, 407–8.Google Scholar