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      Evaluación clínica y económica de las intervenciones farmacéuticas en un hospital de comunidad Translated title: Clinical and economic evaluation of pharmaceutical interventions in a community hospital

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          Abstract

          Resumen Objetivo: Cuantificar, evaluar e interpretar las intervenciones farmacéuticas realizadas por el equipo de farmacia clínica, desde un punto de vista clínico y económico, en las áreas de internación clínico-quirúrgica y crítica de adultos y en el área pediátrica de un hospital de comunidad. Método: Estudio retrospectivo, observacional y transversal de 6 meses de duración. Se clasificaron las intervenciones farmacéuticas según su problema relacionado con medicamentos y su relevancia clínica como potencialmente letal, seria, significativa y no significativa. También, se determinó el exceso de estancia potencialmente prevenido por la intervención. Considerando toda esta arista clínica, se estimó el costo unificado potencialmente evitado, en el período de estudio, para determinar el impacto económico. Se realizó un análisis de subgrupos para poder comparar el impacto clínico y económico correspondiente a cada sector del hospital. Resultados: Se analizaron 2.442 intervenciones farmacéuticas que corresponden a un total de 1.156 pacientes. Las intervenciones más frecuentes fueron las relacionadas con las dosis indicadas. Según severidad, la mayoría de las intervenciones se clasificaron como significativas, habiendo evitado, en promedio, 2,67 días de exceso de estancia. La aceptación fue del 95%. Se calculó un costo unificado potencialmente evitado superior a los 13 millones de pesos argentinos durante el período de estudio. Conclusiones: Se observó un impacto clínico y económico favorable de las intervenciones, tanto a nivel global como en las subpoblaciones de pacientes de cada sector considerado.

          Translated abstract

          Summary Objective: To quantify, evaluate and interpret the pharmaceutical interventions carried out by the clinical pharmacy team from a clinical and economic perspective in areas of clinical-segurical and critical care for adults and in the pediatric area of a community hospital. Methods: Retrospective, observational and cross-sectional study lasting 6 months. Pharmaceutical interventions were classified according to their problems related to drugs and their clinical relevance as potentially lethal, serious, significant and non-significant. The excess in stay potentially prevented by the intervention was also determined. Considering all this clinical edge, we estimated the unified cost potentially avoided, in the study period, to determine the economic impact. A subgroup analysis was performed to compare the clinical and economic impact corresponding to each section considered. Results: 2,442 pharmaceutical interventions were analyzed corresponding to a total of 1,156 patients. The most frequent interventions were those related to the indicated doses. According to severity, most of interventions were classified as significant, having avoided, on average, 2.67% of excess in stay. Acceptance was 95%. An unified potentially avoided cost of over 13 million Argentine pesos was calculated during the study period. Conclusions: A favorable clinical and economic impact related to the interventions was observed, both globally and in the subpopulations of patients in each section.

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          Most cited references23

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          The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II.

          In a sample of 30,195 randomly selected hospital records, we identified 1133 patients (3.7 percent) with disabling injuries caused by medical treatment. We report here an analysis of these adverse events and their relation to error, negligence, and disability. Two physician-reviewers independently identified the adverse events and evaluated them with respect to negligence, errors in management, and extent of disability. One of the authors classified each event according to type of injury. We tested the significance of differences in rates of negligence and disability among categories with at least 30 adverse events. Drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent). Nearly half the adverse events (48 percent) were associated with an operation. Adverse events during surgery were less likely to be caused by negligence (17 percent) than nonsurgical ones (37 percent). The proportion of adverse events due to negligence was highest for diagnostic mishaps (75 percent), noninvasive therapeutic mishaps ("errors of omission") (77 percent), and events occurring in the emergency room (70 percent). Errors in management were identified for 58 percent of the adverse events, among which nearly half were attributed to negligence. Although the prevention of many adverse events must await improvements in medical knowledge, the high proportion that are due to management errors suggests that many others are potentially preventable now. Reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.
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            Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality.

            To determine the excess length of stay, extra costs, and mortality attributable to adverse drug events (ADEs) in hospitalized patients. Matched case-control study. The LDS Hospital, a tertiary care health care institution. All patients admitted to LDS Hospital from January 1, 1990, to December 31, 1993, were eligible. Cases were defined as patients with ADEs that occurred during hospitalization; controls were selected according to matching variables in a stepwise fashion. Controls were matched to cases on primary discharge diagnosis related group (DRG), age, sex, acuity, and year of admission; varying numbers of controls were matched to each case. Matching was successful for 71% of the cases, leading to 1580 cases and 20,197 controls. Crude and attributable mortality, crude and attributable length of stay, and cost of hospitalization. ADEs complicated 2.43 per 100 admissions to the LDS Hospital during the study period. The crude mortality rates for the cases and matched controls were 3.5% and 1.05%, respectively (P<.001). The mean length of hospital stay significantly differed between the cases and matched controls (7.69 vs 4.46 days; P<.001) as did the mean cost of hospitalization ($10,010 vs $5355; P<.001). The extra length of hospital stay attributable to an ADE was 1.74 days (P<.001). The excess cost of hospitalization attributable to an ADE was $2013 (P<.001). A linear regression analysis for length of stay and cost controlling for all matching variables revealed that the occurrence of an ADE was associated with increased length of stay of 1.91 days and an increased cost of $2262 (P<.001). In a similar logistic regression analysis for mortality, the increased risk of death among patients experiencing an ADE was 1.88 (95% confidence interval, 1.54-2.22; P<.001). The attributable lengths of stay and costs of hospitalization for ADEs are substantial. An ADE is associated with a significantly prolonged length of stay, increased economic burden, and an almost 2-fold increased risk of death.
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              The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.

              To assess the additional resource utilization associated with an adverse drug event (ADE). Nested case-control study within a prospective cohort study. The cohort included 4108 admissions to a stratified random sample of 11 medical and surgical units in 2 tertiary-care hospitals over a 6-month period. Cases were patients with an ADE, and the control for each case was the patient on the same unit as the case with the most similar pre-event length of stay. Postevent length of stay and total costs. Incidents were detected by self-report stimulated by nurses and pharmacists and by daily chart review, and were classified as to whether they represented ADEs. Information on length of stay and charges was obtained from billing data, and costs were estimated by multiplying components of charges times hospital-specific ratios of costs to charges. During the study period, there were 247 ADEs among 207 admissions. After outliers and multiple episodes were excluded, there were 190 ADEs, of which 60 were preventable. In paired regression analyses adjusting for multiple factors, including severity, comorbidity, and case mix, the additional length of stay associated with an ADE was 2.2 days (P=.04), and the increase in cost associated with an ADE was $3244 (P=.04). For preventable ADEs, the increases were 4.6 days in length of stay (P=.03) and $5857 in total cost (P=.07). After adjusting for our sampling strategy, the estimated postevent costs attributable to an ADE were $2595 for all ADEs and $4685 for preventable ADEs. Based on these costs and data about the incidence of ADEs, we estimate that the annual costs attributable to all ADEs and preventable ADEs for a 700-bed teaching hospital are $5.6 million and $2.8 million, respectively. The substantial costs of ADEs to hospitals justify investment in efforts to prevent these events. Moreover, these estimates are conservative because they do not include the costs of injuries to patients or malpractice costs.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                March 2022
                : 32
                : 1
                : 43-49
                Affiliations
                [2] Buenos Aires orgnameUniversidad de Buenos Aires orgdiv1Farmacéutica Clínica orgdiv2Servicio de Farmacia Argentina
                [1] Buenos Aires orgnameUniversidad de Buenos Aires orgdiv1Farmacia Clínica orgdiv2Servicio de Farmacia Argentina
                Article
                S1699-714X2022000100008 S1699-714X(22)03200100008
                10.4321/s1699-714x2022000100008
                6ef99b48-cece-4a83-b87b-97f3fbd8f011

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 13 October 2020
                : 07 September 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 7
                Product

                SciELO Spain

                Categories
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                economic impact,clinical impact,clinical pharmacy,pharmacotherapeutic follow-up,Pharmaceutical intervention,impacto económico,impacto clínico,farmacia clínica,seguimiento farmacoterapéutico,Intervención farmacéutica

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