J Am Pharm Assoc (2003). 2021 Mar-Apr;61(2):198-205.e1. doi: 10.1016/j.japh.2020.11.009. Epub 2020 Dec 22.
Ambulatory care pharmacists have a unique opportunity to identify and prevent adverse drug events (ADEs) throughout a patient's treatment course. These interventions can reduce unexpected clinic visits or hospitalizations, which may lead to decreased health care costs. However, research on this topic has not been conducted in the pediatric population. This study explored the economic impact of pharmacist interventions related to ADEs in pediatric ambulatory care clinics. The primary objective was to determine the total cost avoidance of pharmacist interventions associated with the prevention or management of ADEs in pediatric ambulatory care clinics. The secondary objectives were to describe and quantify pharmacist interventions related to the prevention and management of ADEs in pediatric ambulatory care clinics.
Pharmacist interventions from pediatric ambulatory care clinics were collected from an electronic health record. These interventions were categorized into 1 of 4 categories: Drug interaction, drug not indicated, prevent or manage ADE, or prevent or manage drug allergy. A review panel consisting of ambulatory care pharmacists reviewed the interventions. The expected probability of the event occurring was classified according to the Nesbit method (0-0.6), and the level of care necessary to treat the potential ADE was determined. The levels of care included hospitalization, ambulatory care, and self-care. The cost avoidance associated with each prevented ADE was calculated by multiplying the probability of the ADE occurring by the average charge of the expected level of care.
Of the 8755 interventions documented, 212 were included, leading to a total cost avoidance of $307,210 (range $76,802-$1,071,053). The estimated cost avoidance from each ADE subtype was $128,283 from drug interaction, $20,727 from drug not indicated, $157,993 from prevent or manage ADE, and $207 from prevent or manage drug allergy.
Pediatric ambulatory care pharmacists optimize health care cost savings through the prevention and management of ADEs as integrated members of the health care team.
门诊药师有独特的机会在患者的整个治疗过程中识别和预防药物不良事件（ADE）。这些干预措施可以减少不必要的诊所就诊或住院治疗，从而降低医疗保健成本。然而，在儿科人群中尚未进行过此类研究。本研究探讨了在儿科门诊护理诊所中与 ADE 相关的药师干预措施的经济影响。主要目标是确定与儿科门诊护理诊所中 ADE 的预防或管理相关的药师干预措施的总成本避免。次要目标是描述和量化与儿科门诊护理诊所中 ADE 的预防和管理相关的药师干预措施。
从电子健康记录中收集儿科门诊护理诊所的药师干预措施。这些干预措施分为 4 类之一：药物相互作用、药物不适用、预防或管理 ADE 或预防或管理药物过敏。一个由门诊药师组成的审查小组审查了干预措施。根据 Nesbit 方法（0-0.6）对事件发生的预期概率进行分类，并确定潜在 ADE 所需的治疗水平。护理级别包括住院、门诊和自我护理。通过将 ADE 发生的概率乘以预期护理水平的平均费用，计算每个预防 ADE 相关的成本避免。
在所记录的 8755 项干预措施中，有 212 项被纳入，总节省成本为 307210 美元（范围为 76802 美元至 1071053 美元）。每种 ADE 亚型的估计节省成本分别为药物相互作用 128283 美元、药物不适用 20727 美元、预防或管理 ADE 157993 美元和预防或管理药物过敏 207 美元。
儿科门诊药师作为医疗保健团队的整合成员，通过预防和管理 ADE，优化医疗保健成本节约。
