According to the data there is app. 5-10 % of hospital admissions because of inappropriate prescribing (IP). For example at admissions to the psychiatric hospitals about 20 % drugs are not prescribed (missed). Within the hospitals about 5-10 % drugs are prescribed in an IP way. Due to the many research in last decade, which have been done in many western countries, there are still many EU hospitals without appropriate systems, which would be protect patients from being treated with IP. In many hospitals there are still no teams of health care professionals (clinicians, clinical pharmacists, nurses, nurses with prescribing rights) which would discussed about IP every day at clinical rounds. In my opinion, this step should be done on behalf of the patients and the appropriate systems should be established by governments. However, there is important to establish e-prescribing but to include a well-teached clinical pharmacist to this system is the best option. What do you think?
I think that the answer is quite simple. Hospital have no money for such system. Although they do appreciate the need.
Dear Tomasz, i agree with you, however ... Clinical pharmacists are necessary in this process, otherwise many mistakes have not been seen. If many mistakes have not been seen there is a high risk of treatment failure, which can have life-threatening consequences.
General opinion (often written and heard):
- there are no inappropriate prescribing within the hospitals,
- prescribers know everything and do not need team-based support,
- there is no necessary to accept clinical pharmacists,
- patients do not know why are the medications,
- there are no adverse drug reactions, because we treated very well,
- all drugs are administered and dispensed according to the regulations,
- eminence-based prescribing is more important than evidence-based prescribing,
- guidelines are written in ideal conditions and should not be respected very well.
- the price for inappropriate prescribing is low.
However, the reality is totally different:
- Almost 10 % of patients are admitted to the hospitals, because of inappropriate medications.
- More than 50 % of elderly psychiatric patients are treated with at least one psychotropic drug, which is prescribed inappropriately.
- Almost every second antibiotic is written inappropriately.
- Almost every fifth prescribed medication is inappropriate.
- Almost 50 % of patients are treated with antipsychotic polypharmacy, which is used inappropriately.
- About 50 % patients who need antidepressants and statins are treated inappropriately (not reach treatment goals).
- Inappropriate prescribing is one of the highest burden in medicine, with its annual cost more than 1 billion in USA.
- There are many errors in drug administering and dispensing (almost every fifth medication is administrating inappropriately).
- Almost every fifth medication is missed (forgotten) on the admission to the hospitals.
- Well designed clinical trials and meta-analysis should be respected. Their evidence level is much higher than opinions of individuals. EBM should be always first. EBM supports an inclusion of clinical pharmacists and this should be respected.
- The inclusion of clinical pharmacists next to the patients' beds can reduce overall inappropriate prescribing by 50 %, ADR by 50 % and total cost five times more than is salary for clinical pharmacists (1 $ for 5 $).
Are given reasons and not enough support to employ clinical pharmacists next to the patients' beds and establish this service within your country? Is not a common goal to reduce those mistakes?
Many hospitals within Europe don't have their own data. Why they do not have? Because they think that they are perfect. But unfortunately ... They just think ...
Regards!
Matej, i couldn t agree more. I am a pharmaceutical student in Uruguay. It Is exactly that kind of job i would love to do, but neither in my country, nor in the most of others Is It possible. Particularly here, for prívate hospitals It Is not due to money. I hope one day, not far from now, they will be aware of the importance of interdisciplinary work!!
How about planning a study to address this beliefs? Several hospital from different countries?
There are many studies done within this field, especially in U.S. In Texas many studies were published by Bond et al. See the Pubmed's searching bellow. Especialy important paper has been published in 2003 (Clinical pharmacy services, pharmacy staffing, and adverse drug reactions in United States hospitals; Pharmacotherapy. 2006 Jun;26(6):735-47.) These studies highlighted the importance of clinical pharmacists involvement next to the patients' beds and many U.S. countries adopted prescribing rights for clinical pharmacists. In the field of psychiatry many studies were published in the last decade, especially important for collaborative care model was published in the Pharmacotherapy by Patrick Finley et al. (Pharmacotherapy. 2003 Sep;23(9):1175-85.). In psychiatric hospitals many drugs are missed at admission and after discharge from the hospitals. I have reviewed the following paper:
Medication Discontinuation in Patients After Discharge From a Psychiatric Hospital.
Abdullah-Koolmees H, Gardarsdottir H, Yazir D, Stoker LJ, Vuyk J, Egberts TC, Heerdink ER.
Ann Pharmacother. 2015 Oct;49(10):1085-95.
Yes, I agree with You Tomasz, it would be a great option! Another important issue is recognizing of inappropriate prescribing and resolving. This system should be without names. Person who report problem should not be known for the prescriber/dispenser. This is one of the key step towards prudent prescribing. After many data is available there can be step or move towards guidelines within this field (e.g. for example why antipsychotic polypharmacy is used instead of monotherapy with clozapine or combinations with amisulpride etc...). Regards
http://www.ncbi.nlm.nih.gov/pubmed/?term=Bond+and+pharmacotherapy.+and+clinical+pharmacy+and+texas
http://www.ncbi.nlm.nih.gov/pubmed/?term=finley+and+pharmacotherapy.+and+clinical+pharmacy
In addition to the high associated costs of program implementation, I believe that providers are afraid of repercussions from negative patient satisfaction.
I agree with you Kelly. This is a big 'black-box', especially in many European countries. This topic should we move forward better clinical outcomes and patients' safety, because it is our obligation. Mixed teams of health care professionals should be establish to protect patients by inappropriate treatment. Appropriate strategy in communication should be established in a way of evidence-based medicine. In addition, next to these important issue, an issue how to communicate with colleagues about their mistakes should be implemented. However, medical errors are very expensive and can lead to serious harms for the patients. According to the data these mistakes are paid by millions in U.S. (see Medicaid statistics for further details)
Regards
-Health System and the health ministry avoided to prevent polypharmacy because they consider that it costs a lot of money and they do not have it enough!
-I think that has to change, and a way of studying pharmacists and specialization of clinical pharmacology and more in the base insert the patient and the clinic and, less theory! With this education (I'm talking about my country, Bosnia and Herzegovina, the same situation and the former state formed after the dissolution of Yugoslavia, except Slovenia, because I do not know the best situation there),) students of pharmacy pharmacology do not have enough skills to cooperate with teams of doctors clinicians because they do not have enough knowledge of clinical pharmacy and farmakologije1
-Here We should not rule out the influence of big pharmaceutical companies, the transcription prescribe their drugs!
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