Skip to main content

Implementation of Pharmaceutical Care in Hospitals and Clinics

  • Chapter
  • First Online:
Book cover The Pharmacist Guide to Implementing Pharmaceutical Care
  • 2057 Accesses

Abstract

Although there is plenty of evidence that pharmacists performing medication reviews in a hospital setting as well as other pharmaceutical care activities is beneficial in different ways, the evidence is quite heterogeneous, and effects on primary endpoints have not yet been satisfactorily shown. There are still a number of factors that need to be determined; what methods should be used? By which profession and with which education and training? Which patients should be targeted? With an aging population, increasingly complex medication treatments, a shortage of physicians and nurses, the need for pharmaceutical care provided by clinical pharmacists in hospitals seems immense, and the question for the future will probably rather be if there are enough trained pharmacists to fill this gap. This chapter will focus on medication reviews and the opportunities and challenges for pharmacists to provide patients with pharmaceutical care in a hospital setting.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ahern F, Sahm LJ, Lynch D, McCarthy S. Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: a cross-sectional study. Emerg Med J. 2014;31(1):24–9.

    Article  Google Scholar 

  2. Gustafsson M, Sjölander M, Pfister B, Jonsson J, Schneede J, Lövheim H. Drug-related hospital admissions among old people with dementia. Eur J Clin Pharmacol. 2016;72(9):1143–53.

    Article  Google Scholar 

  3. Nivya K, Sri Sai Kiran V, Ragoo N, Jayaprakash B, Sonal Sekhar M. Systemic review on drug related hospital admissions—a pubmed based search. Saudi Pharm J. 2015;23(1):1–8.

    Article  Google Scholar 

  4. Leendertse AJ, Egberts ACG, Stoker LJ, van den Bemt PMLA, HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–96.

    Google Scholar 

  5. Scullin C, Scott MG, Hogg A, McElnay JC. An innovative approach to integrated medicines management. J Eval Clin Pract. 2007;13(5):781–8.

    Article  Google Scholar 

  6. Simpson D. What is medicines management and what is pharmaceutical care? Pharm J. 2001;266:150.

    Google Scholar 

  7. Tweedie A, Jones I. What is medicines management. Pharm J. 2001;266:248.

    Google Scholar 

  8. Hellström LM, Bondesson A, Höglund P, et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol. 2011;67(7):741–52.

    Article  Google Scholar 

  9. Bergkvist A, Midlöv P, Höglund P, Larsson L, Eriksson T. A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. LIMM-Landskrona Integrated Medicines Management. J Eval Clin Pract. 2009;15(4):660–7.

    Article  Google Scholar 

  10. Excellence L national institute for health and clinical. PSG001 technical patient safety solutions for medicines reconciliation on admission of adults to hospital: guidance [Internet]. http://guidance.nice.org.uk/PSG001/Guidance/pdf/English.

  11. Commission WDTJ. Hospital: 2012 national patient safety goals [Internet]. http://www.jointcommission.org/standards_information/npsgs.aspx. Published 2012. Accessed 4 Nov 2017.

  12. Mekonnen AB, McLachlan AJ, Brien JE. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(2):128–44.

    Article  Google Scholar 

  13. Buckley MS, Harinstein LM, Clark KB, et al. Impact of a clinical pharmacy admission medication reconciliation program on medication errors in “high-risk” patients. Ann Pharmacother. 2013;47(12):1599–610.

    Article  Google Scholar 

  14. Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices. Arch Intern Med. 2012;172(14):1057–69.

    Article  Google Scholar 

  15. Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf healthcare. 2009;18(1):32–6.

    Article  CAS  Google Scholar 

  16. Greenwald JL, Halasyamani L, Greene J, et al. Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J Hosp Med. 2010;5(8):477–85.

    Article  Google Scholar 

  17. Stuijt CCM, Vd Bemt B, Boerlage VE, Taxis K, Karapinar F. Determinants for medication reconciliation interventions on hospital admission and discharge: an observational multi-centre study. Eur J Intern Med. Sept 2017.

    Google Scholar 

  18. Karapinar-ÇArkit F, Borgsteede SD, Zoer J, Smit HJ, Egberts AC, Van Den Bemt PM. Medication safety: effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital. Ann Pharmacother. 2009;43(6):1001–10.

    Article  Google Scholar 

  19. Schnipper JL, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565–71.

    Article  Google Scholar 

  20. ASHP. Medication reconciliation handbook. Oakbrook Terrace, IL: Joint Commission Resources and the American Society of Health-System Pharmacists; 2006. ISBN: 0866889566.

    Google Scholar 

  21. Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract. 2001;21(4):104–8.

    Article  CAS  Google Scholar 

  22. European Society of Clinical Pharmacy. Providing pharmaceutical care at the hospital-primary care interface. Pharm J. 2002;268:694–6.

    Google Scholar 

  23. Lisby M, Thomsen A, Nielsen LP, et al. The effect of systematic medication review in elderly patients admitted to an acute ward of internal medicine. Basic Clin Pharmacol Toxicol. 2010;106(5):422–7.

    CAS  PubMed  Google Scholar 

  24. Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.

    Article  Google Scholar 

  25. Tan ECK, Stewart K, Elliott RA, George J. Pharmacist services provided in general practice clinics: a systematic review and meta-analysis. Res Social Adm Pharm. 2014;10(4):608–22.

    Article  Google Scholar 

  26. Viktil KK, Blix HS, Moger TA, Reikvam A. Interview of patients by pharmacists contributes significantly to the identification of drug-related problems (DRPs). Pharmacoepidemiol Drug Saf. 2006;15(9):667–74.

    Article  Google Scholar 

  27. Verdoorn S, Kwint H-F, Faber A, Gussekloo J, Bouvy ML. Majority of drug-related problems identified during medication review are not associated with STOPP/START criteria. Eur J Clin Pharmacol. 2015;71(10):1255–62.

    Article  CAS  Google Scholar 

  28. Wu JYF, Leung WYS, Chang S, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ. 2006;333(7567):522.

    Article  Google Scholar 

  29. Bergkvist A, Midlöv P, Höglund P, Larsson L, Bondesson A, Eriksson T. Improved quality in the hospital discharge summary reduces medication errors–LIMM: Landskrona integrated medicines management. Eur J Clin Pharmacol. 2009;65(10):1037–46.

    Article  Google Scholar 

  30. Murray MD, Ritchey ME, Wu J, Tu W. Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Arch Intern Med. 2009;169(8):757–63.

    Article  Google Scholar 

  31. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–64.

    Article  Google Scholar 

  32. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;282(3):267–70.

    Article  CAS  Google Scholar 

  33. Makowsky MJ, Koshman SL, Midodzi WK, Tsuyuki RT. Capturing outcomes of clinical activities performed by a rounding pharmacist practicing in a team environment. Med Care. 2009;47(6):642–50.

    Article  Google Scholar 

  34. Schumock GT, Butler MG, Meek PD, et al. Evidence of the economic benefit of clinical pharmacy services: 1996–2000. Pharmacotherapy. 2003;23(1):113-32.

    Article  Google Scholar 

  35. Ghatnekar O, Bondesson A, Persson U, Eriksson T. Health economic evaluation of the lund integrated medicines management model (LIMM) in elderly patients admitted to hospital. BMJ Open. 2013;3(1).

    Article  Google Scholar 

  36. Hellström LM, Bondesson Å, Höglund P, et al. Impact of the lund integrated medicines management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol. 2011;67(7):741–52.

    Article  Google Scholar 

  37. Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc. 2007;55(5):658–65.

    Article  Google Scholar 

  38. Schmader KE, Hanlon JT, Pieper CF, et al. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004;116(6):394–401.

    Article  Google Scholar 

  39. Gillespie U, Alassaad A, Hammarlund-Udenaes M, et al. Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs’) ability to predict hospitalization–analyses from a randomized controlled trial. PLoS One. 2013;8(5):e62401.

    Article  CAS  Google Scholar 

  40. Hepler CD. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Pharmacotherapy. 2004;24(11):1491–8.

    Article  Google Scholar 

  41. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev. 2016;2:CD008986 (Christensen M, ed).

    Google Scholar 

  42. Hohl CM, Wickham ME, Sobolev B, et al. The effect of early in-hospital medication review on health outcomes: a systematic review. Br J Clin Pharmacol. 2015;80(1):51–61.

    Article  Google Scholar 

  43. Graabaek T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol. 2013;112(6):359–73.

    Article  CAS  Google Scholar 

  44. Kempen TGH, Bertilsson M, Lindner K-J, et al. Medication reviews bridging healthcare (MedBridge): study protocol for a pragmatic cluster-randomised crossover trial. Contemp Clin Trials. 2017;61:126–32.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ulrika Gillespie .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gillespie, U. (2019). Implementation of Pharmaceutical Care in Hospitals and Clinics. In: Alves da Costa, F., van Mil, J., Alvarez-Risco, A. (eds) The Pharmacist Guide to Implementing Pharmaceutical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-92576-9_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-92576-9_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92575-2

  • Online ISBN: 978-3-319-92576-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics