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Executive Summary

PHARMACISTS ON CLINICAL CARE TEAMS DECREASE DRUG COSTS, LENGTH OF STAY, a Walter Reed Army Medical Center study concludes. The year-long study, presented Dec. 7 at the American Society of Hospital Pharmacists midyear clinical meeting in Orlando, showed a decrease in average length of stay of .6 days (7.6 compared to 8.2 days) in favor of medical and surgical teams that included clinical pharmacists compared to controls. "Our study shows that pharmacists can improve patient-care outcomes and provide a significant economic benefit to the hospital...if they become integral members of the health-care team and participate in the prescriber's decision-making process," principal investigator and recently-retired Walter Reed clinical research pharmacist Darrell Bjornson, PhD, told ASHP. The association's Research and Education Foundation sponsored the study. The 3,081-patient study, conducted at Walter Reed's 861-bed center in Washington, D.C., also showed an average drug cost of $140 per patient in the clinical pharmacist groups, compared to $168 per patient in the control groups. Based on the results and a $701 per day hospital stay estimate, the investigators calculated that the clinical pharmacists saved $377 per inpatient admission, or approximately $150,000 per pharmacist per year. The pharmacist's salary was taken into account in the calculation and was costed out at 50%, or $25,000, because the pharmacists spent about 50% of their time on patient rounds. The cost/benefit ratio was, therefore, one to six. When the investigators performed a "sensitivity analysis" by manipulating variables such as salary and cost of hospital stay, the smallest cost/benefit ratio determined was one to 1.5 and the largest was one to 13. The study indicated that "a pharmacist cannot pay for him or herself based on savings in drug cost alone. It's not the drug cost that's important, it's the outcomes of appropriate drug therapy leading to shortened lengths of stay...that are important," Bjornson commented. For example, he noted that interventions by the clinical pharmacists were in many cases education efforts, or answering physicians' questions. Only about 10%-15% of the time did the pharmacist make recommendations, such as adding or deleting a drug. "We tried to select seasoned clinical pharmacists," when three pharmacists were hired for the study, Bjornson noted. All were PharmDs. A total of eight health care teams were involved in the study: three medicine control and two medicine intervention teams, and two and one control and intervention surgery teams, respectively. The medicine teams covered a total of about 110 beds and the surgery teams about 40 beds. The study looked at three outcomes: drug cost per admission; length of stay (a surrogate for morbidity); and mortality. Drug cost and length of stay showed statistically significant differences and mortality did not. However, Bjornson said there was "some hint" of a relationship between mortality and pharmacist intervention and recommended that a similar study be done in the intensive care unit of a hospital, where "there are more events, there are more deaths." In the Walter Reed study, 1.75% of the 1,201 intervention patients died, and 2.45% of the 1,880 patients in the control group died. Bjornson also suggested that studies be conducted on the impact of the clinical pharmacist in the ambulatory care setting. In addition, "studies ought to be done that target specific DRGs, if at all possible," Bjornson added. He noted that the Walter Reed study, with over 3,000 patients, had "only a handful" of DRGs with over 100 patients. Principle investigator William Hiner, former Walter Reed chief of pharmacy service and a former pharmacy consultant to the Army Surgeon General, noted that although the clinical pharmacists have not been permanently assigned to the health care teams, "I think a permanent change is pending, as these results are reported in a more formal way to the Surgeon General of the Army and the Army medical department's leadership." Walter Reed currently has clinical pharmacists on teams in the hematology/oncology area of the medical center.

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