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      The Effectiveness of Clinical Pharmacist-Led Consultation in the Treatment of Infectious Diseases: A Prospective, Multicenter, Cohort Study

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          Abstract

          Background

          Antimicrobial resistance (AMR) is a serious global health threat and leads to a huge challenge to infectious diseases (ID) treatment. To tackle AMR, regional ‘Antimicrobial Stewardship Programs’ (ASP) have been implemented in many countries. Due to insufficient clinical pharmacy resources, a major intervention mode of ASP in China is through clinical pharmacist-led consultation (CPC). The current study aims to prospectively evaluate this intervention and compare the effectiveness of CPC served by ID and non-ID clinical pharmacists.

          Methods

          We conducted a prospective and multicenter cohort study based on a regional registry database in 17 hospitals in Western China, including consecutive patients with ID between April 2017 and December 2019. Baseline characteristics including sex, age, liver and kidney function, comorbidity, infection severity were prospectively collected and recorded. The main exposure of interest was whether the attending physician adopted recommendations of the clinical pharmacist in the therapeutic scheme. The outcome was the infection effective response, assessed during day 3–7 after completing CPC. Multivariate analyses were performed by generalized linear mixed models.

          Results

          A total of 2,663 ID patients were included in the final analysis according to the predesigned inclusion and exclusion criteria. The number of patients whose treatment followed and did not follow the pharmacists’ suggestion was 2,529 and 134, respectively. CPC intervention could improve the ID patient prognosis in the context of other confounders controlled ( Adjusted Odds ratio( AOR)=1.838, 95% Confidence Interval( CI)=[1.212, 2.786]), and the effectiveness of CPC served by ID and non-ID clinical pharmacists might be equivalent ( AOR=0.958, 95% CI[0.740, 1.240]). Special consultation ( AOR=1.832, 95% CI[1.106, 3.035]) and surgical treatment of infectious sites ( AOR=1.380, 95% CI[1.039, 1.834]) had positive influences on the patient prognosis, while hypoalbuminemia ( AOR=0.694, 95% CI[0.523, 0.921]), liver dysfunction ( AOR=0.705, 95% CI[0.559, 0.889]), presence of high-risk factors ( AOR=0.775, 95% CI[0.613, 0.980]), and increased infection severity ( AOR=0.631, 95% CI[0.529, 0.753])were associated with a decrease in effective response rate, independently.

          Conclusion

          This study suggests that CPC is a promising pharmacist-led intervention to improve ID treatment, and it can achieve standardization among clinical pharmacists with different backgrounds by some measures. Policy/decision-makers should promote this intervention mode in developing countries or regions where there is an insufficient number of clinical pharmacists.

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          Most cited references29

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          Antimicrobial Resistance.

          The development of antibiotics is considered among the most important advances of modern science. Antibiotics have saved millions of lives. However, antimicrobial resistance (AMR) threatens this progress and presents significant risks to human health.
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            Antimicrobial stewardship across 47 South African hospitals: an implementation study.

            The available data on antimicrobial stewardship programmes in Africa are scarce. The aims of this study were to assess the implementation of an antimicrobial stewardship programme in a setting with limited infectious disease resources.
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              Qatar pharmacists’ understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care

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                Author and article information

                Contributors
                Journal
                Front Pharmacol
                Front Pharmacol
                Front. Pharmacol.
                Frontiers in Pharmacology
                Frontiers Media S.A.
                1663-9812
                08 September 2020
                2020
                : 11
                : 575022
                Affiliations
                [1] 1 Department of Pharmacy, Guizhou Provincial People’s Hospital , Guiyang, China
                [2] 2 Department of Pharmacy, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region , Chengdu, China
                [3] 3 Experimental Cancer Medicine, Department of Laboratory Medicine, Karolinska Institute , Stockholm, Sweden
                [4] 4 Clinical Research Center and Center of Allogeneic Stem Cell Transplantation(CAST), Karolinska University Hospital Huddinge , Stockholm, Sweden
                [5] 5 Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University , Tokyo, Japan
                [6] 6 Department of Pharmacy, The Second People’s Hospital of Guiyang , Guiyang, China
                [7] 7 Department of Pharmacy, Xingyi People’s Hospital , Xingyi, China
                [8] 8 Department of Pharmacy, Qian Xi Nan People’s Hospital , Xingyi, China
                [9] 9 Department of Pharmacy, The First People’s Hospital of Bijie City , Bijie, China
                [10] 10 Department of Pharmacy, Tongren Municipal People’s Hospital , Tongren, China
                [11] 11 Department of Pharmacy, The People’s Hospital of Qiannan , Duyun, China
                [12] 12 Department of Pharmacy, The Affiliated Hospital of Guizhou Medical University , Guiyang, China
                [13] 13 Department of Pharmacy, Guizhou Cancer Hospital , Guiyang, China
                [14] 14 Department of Pharmacy, The Second Affiliated Hospital of GuiZhou Medical University , Kaili, China
                [15] 15 Department of Pharmacy, The First People’s Hospital of Guiyang , Guiyang, China
                [16] 16 Department of Pharmacy, Affiliated Wudang Hospital of Guizhou Medical University , Guiyang, China
                Author notes

                Edited by: Iris Hoxha, University of Medicine, Tirana, Albania

                Reviewed by: Khezar Hayat, University of Veterinary and Animal Sciences, Pakistan; Yaser Mohammed Al-Worafi, Ajman University of Science and Technology, United Arab Emirates

                *Correspondence: Juan Xie, 12237786@ 123456qq.com

                †These authors have contributed equally to the work and share first authorship

                This article was submitted to Pharmaceutical Medicine and Outcomes Research, a section of the journal Frontiers in Pharmacology

                Article
                10.3389/fphar.2020.575022
                7506045
                33013418
                668a7c52-cc76-4fc8-a1b3-8e841fea348f
                Copyright © 2020 Zhang, Li, He, Zheng, Kwong, Lu, Lv, Huang, He, Li, Wang, Fang, Wei, Liu, Chen, Qin and Xie

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 June 2020
                : 24 August 2020
                Page count
                Figures: 4, Tables: 1, Equations: 1, References: 36, Pages: 11, Words: 5416
                Categories
                Pharmacology
                Original Research

                Pharmacology & Pharmaceutical medicine
                antimicrobial stewardship program,clinical pharmacist-led consultation,infectious diseases,pharmaceutical service,cohort study

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