Development of economic model for assessment of potential significance of pharmacist interventions

Abstract

Introduction. Pharmacists contribute to reduce the number of medication errors during medication review. Assessing the significance of pharmacist interventions (PIs) is essential to demonstrate the added value of pharmacists. Methods and tools for assessing the potential significance of PIs are diverse and their properties are questionable. Aim of the study. Assessment of significance of pharmacist intervention for health system to obtain additional resource in clinical pharmacy practice. Materials and methods. A systematic review was performed in the databases PubMed (1982 – March 2020), MEDLINE/EMBASE (2000 - March 2020), (1999 - February 2013), Cochrane library (1999-March 2020) and Scientific Electronic Library Online (SCIELO) (2001- 2019) in order to collect studies using tools for assessment of potential significance of an individual PI. Have been used two groups of keywords as the main search: drug-related problems and pharmacist interventions. Results. Adverse drug events are the major problems relating to patient safety and wellbeing. They are associated with increased rate in morbidity and mortality, extended hospitalizations, and higher costs of care. Reviewing literature have been determine that it is possible to classify the approaches of assessing the significance of an individual PI into 3 main types: approach 1 - the evaluation of actual consequences of drug related problems (e.g., actual severity of harm); approach 2 - the evaluation of actual consequences after performing a PI and following-up the patient (e.g., actual clinical outcomes); or approach 3 - the estimation of potential significance of a PI. Term “actual” is used as meaning the entity that has appeared in the patient, while the term “potential” referred to the situation in which the possibility that the entity could appear in the patient existed. The conceptual models of Donabedian suggested that the quality of healthcare interventions could be assessed through three types of indicators related to “structural features”- appropriate resources and system design; “process of care”- the method by which health care is provided; and “outcome”- the consequence of the health care provided,this model is called “structure-process-outcome”. The Kozma model, place outcomes into three categories - economic, clinical, and humanistic Outcomes (ECHO model) which characterize the value of pharmaceutical services. According to risk model, risks are analyzed by combining severity of consequences and probability in the context of existing situation, in PI are evaluated medication errors. According to the basic model of pharmacoeconomics, the value of a PI considers both inputs and outputs of a PI compared to the absence of a PI. Inputs can be thought of as resources required implementing the PI. Outputs can be thought of as consequences of a PI, in form of clinical, humanistic, or process-related consequences. The difference between the cost of the original therapy and the new therapy gives the cost savings (or the increase in the cost of therapy). Cost avoidance refers to the prevention of additional health resources which are required to treat drug adverse events if a pharmacist has not intervened such as a hospitalization or a medical visit. Cost of implementation of a PI refers to the expenses of providing the PI such as cost of pharmacist’s time, phone calls. Conclusions. Various structures and contents of tools for evaluation of impacts of PIs were highlighted. Majority of tools focused primarily on assessing clinical aspect and failed to detect other impacts.