PHARMACEUTICAL CARE IN MEDICAL PROGRESSIVE CARE PATIENTS

OBJECTIVE: To develop, implement, and assess the outcomes of a system for providing pharmaceutical care to medical progressive care patients . METHODS: A system for providing pharmaceutical care was developed an d implemented for an 8-week period beginning in June 1995. Both patien t care outcomes and drug therapy cost change from the intervention per iod were compared with those of an 8-week baseline period, Variables c ompared included unit length of stay, hospital length of stay, transfe rs to the intensive care unit, readmissions, and adverse drug reaction s requiring treatment. Differences between periods for these variables were assessed by using chi(2) tests and t-tests with alpha set at p l ess than 0.05. The clinical significance of the interventions were ass essed independently by four physicians: two intensivists and two inter nists. The total drug therapy cost change from the intervention period was calculated as follows: total cost avoidance from individual recom mendations subtracted from the total cost incurred from individual rec ommendations. RESULTS: The pharmacist evaluated 152 patients during th e intervention period. A total of 235 pharmacotherapy recommendations were made on 103 patients, of whom 86.4% were accepted. Significantly fewer adverse drug reactions (ADRs) received treatment during the inte rvention period (p = 0.027). The mean unit length of stay was lower du ring the intervention period (4.8 +/- 3.7 d) than during the baseline period (6.0 +/- 5.6 d); however, this difference was not significant ( p = 0.053), individual physician assessment of the pharmacists' recomm endations revealed that 75.8% were considered somewhat significant, si gnificant, or very significant. The total drug therapy cost change fro m the intervention period was -$6534.53. The projected annual drug the rapy cost reduction fi om this study is $42474.45. CONCLUSIONS: The pr ovision of pharmaceutical care to medical progressive care patients wa s associated with a substantial decrease in drug therapy cost and a de crease in the number of ADRs that required treatment.