[Evaluation of the impact of a clinical pharmacist on the quality and cost of pharmacotherapy in a general surgical department, the Hillel-Yaffe Medical Center].
BACKGROUND: Clinical pharmacy could be defined as an umbrella of services aimed at maximizing the pharmacotherapeutic effect, minimizing the risk for developing adverse drug effects and reducing drug expenditures for the health care system. Clinical pharmacists, in Israel and abroad, have been practicing in different health care settings aiming to implement the principles mentioned above. Most of the articles previously published reviewed the role of the clinical pharmacist in internal medicine wards or in intensive care units. This article focuses on the role of the clinical pharmacist in a general surgery department and the influence of this service on the quality and cost of pharmacotherapy and on intravenous antibiotic therapy in particular. AIMS: Improving the quality of pharmacotherapy while optimally using economic resources in a general surgery ward. METHODS: During September 1999 to August 2000, the clinical pharmacist joined physician rounds in the surgical ward. During the rounds he advised physicians about clinical and economical aspects of drug treatment, and collected data on his activity on a specific designated form. The data was processed on a central computerized database, and analyzed to determine the influence of the clinical pharmacist on clinical and economical outcomes. RESULTS: At the end of the study period the following were found: The pharmacist made 219 interventions. These included adverse drug effects, which were identified and/or prevented. When considering the economic data, a substantial reduction of 56% in intravenous antibiotic therapy was noted (direct saving of about 140,000 NIS). Such savings were accompanied by changes in the prescribing patterns in the department, which were translated into increased rate of oral antibiotic prescribing and reduction in the use of certain i.v. antibiotics while undamaging the quality of the pharmacotherapeutic effect. CONCLUSION: The results of this study indicate that participation of a clinical pharmacist during physicians rounds improved the quality of the pharmacotherapy, assisted in changing clinicians prescribing habits, and at the same time significantly reduced the direct expenditures on medications in general and of intravenous antibiotic therapy in particular.