| Summary: | 碩士 === 臺北醫學大學 === 藥學系 === 91 === The purpose of this study was to determine the effect of interventions by a clinical pharmacist on the cost of drug therapy and possible health cost avoidance in a 13-bed surgical intensive care unit (SICU) in a private medical center.
All patients admitted to the SICU from October 2001, to May 2002 were consecutive random to receive either pharmacist’s pharmaceutical care (care group) or not (control group). Costs that were avoided or added as a result of pharmacist’s interventions were calculated according to the drug price determined by the Bureau of National Health Insurance and the drug acquisition costs of the hospital. All pharmacist’s interventions were subjected to physicians’ reviews and to cost avoidance evaluation.
There were 169 patients in control group and 185 patients in care group. The average time spent was 3.15 hours per day. A total of 106 interventions and 86 drug information services were documented during the study period.
The majority of pharmacist’s interventions involved “drug therapy omission (16.0%),” “pharmacokinetic consult (13.2%),” “abnormal laboratory test result (12.3%);” pharmacist’s recommendations included “discontinue drug (23.6%),” “change drug (22.6%)” and “initiate drug order (17.9%);” as far as physicians’ order changed based upon pharmacist’s recommendations were “drug discontinuation (21.7%),” “drug changed (16.0%).”
Except for the 15.1% of recommendations were not accepted by physicians, there were 84.9% recommendations resulted in order changed. The major classes of drug involved were anti-infective agents (35.6%), cardiovascular drugs (18.3%) and gastrointestinal drugs (12.5%).
These interventions during the study period accounted for NT$375,333 and NT$258,135 in cost saving（based on reimbursed price from health insurance and drug acquisition costs, respectively）. Since the annual salary of the pharmacist was about NT$750,000 (NT$260.42 per hour), the benefit-to-cost ratio was 2.20（calculated by drug acquisition costs）.
As far as evaluators’ responses to the question, “Could this event have resulted in adverse health consequences to the patient if no pharmacist’s intervention?” the responded “yes” that patients could be harmed were 69 (65.1%) and 55 (51.9%) interventions by two evaluators, respectively. The most responded health adverse consequences were that “the risk of adverse effects would be increased” in both evaluators, the frequency were 49.3% and 56.6%, respectively. The majority of interventions were given a rank of “very significant” (41.5%) and “significant” (34.9%) by two evaluators, respectively.
The average of potential cost avoidance totaled NT$1,074,288 (from NT$708,712 to NT$1,462,008) for the eight-month period. The mean cost avoidance per month was NT$134,286 (from NT$88,589 to NT$182,751).
There was no statistical difference between the care group and the control group in 3 indicators of the patients’ outcome: transferred to ordinary ward, transferred to other intensive care unit, and death or AAD (Against Advice Discharge). There was no statistical difference in length of stay (LOS) between these two groups (the care group was 7.43 ± 0.92 days (mean ± SEM) and the control group was 7.60 ± 1.05 days (mean ± SEM), respectively).
Based on the results of this study, the clinical pharmacist providing pharmaceutical care in SICU had a positive impact on the cost saving of drug therapy and cost avoidance of health care cost.
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