Clinical pharmacy services, pharmacy staffing, and the total cost of care in United States hospitals

This study evaluated direct relationships and associations among clinical p harmacy services, pharmacist staffing, and total cost of care in United Sta tes hospitals. A database was constructed from the 1992 American Hospital A ssociation's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services Database. A multiple regression analysis, contro lling for severity of illness, was employed to determine the relationships and associations. The study population consisted of 1016 hospitals. Six cli nical pharmacy services were associated with lower total cost of care: drug use evaluation (p=0.001), drug information (p=0.003), adverse drug reactio n monitoring (p=0.008), drug protocol management (p=0.001), medical rounds participation (p=0.0001), and admission drug histories (p=0.017). Two servi ces were associated with higher total cost of care: total parenteral nutrit ion (TPN) team participation (p=0.001) and clinical research (p=0.0001). To tal costs of care/hospital/year were lower when any of six clinical pharmac y services were present: drug use evaluation $1,119,810.18 (total $1,005,58 9,541.64 for the 898 hospitals offering the service), drug information $5,2 26,128.22 (total $1,212,461,747.04 for the 232 hospitals offering the servi ce), adverse drug reporting monitoring $1,610,841.02 (total $1,101,815, 257 .68 for the 684 hospitals offering the service), drug protocol management $ 1,729,608. (total $614,010,985.55 for the 355 hospitals offering the servic e), medical rounds participation $7,979,720.45 (total $1,212,917,508.41 for the 152 hospitals offering the service), and admission drug histories $6,9 64,145.17 (total $208,924,355.10 for the 30 hospitals offering the service) . Clinical research $9,558,788.01 (total $1,013,231,529.06 for the 106 hosp itals offering the service) and TPN team participation $3,211,355.12 (total $1,027,633,638.43 for the 320 hospitals offering the service) were associa ted with higher total costs of care. As staffing increased for hospital pha rmacy administrators (p=0.0001) and clinical pharmacists (p=0.007), total c ost of care decreased. As staffing increased for dispensing pharmacists, to tal cost of care increased (p=0.006). Based on this total cost of care mode l, optimal hospital pharmacy administrator staffing was 2.01/100 occupied b eds. Staffing for dispensing pharmacists should be as low as possible, and definitely fewer than 5.11/100 occupied beds. Staffing for clinical pharmac ists should be as high as possible, but definitely more than 1.11/100 occup ied beds. The results of this study suggest that increased staffing levels of clinical pharmacists and pharmacy administrators, as well as some clinic al pharmacy services, were associated with reduced total cost of care in Un ited States hospitals.