Levels of agreement among clinical pharmacists on the impact of pharmaceutical interventions in Oman: A retrospective analysis

Main Article Content


Clinical pharmacist, Level of agreement, Interventions, Efficacy, Toxicities


Objectives: Disagreement between health care providers on medication-related interventions can affect clinical outcomes. We aimed to study the outcomes and significance of clinical pharmacists’ interventions and evaluate the levels of agreement between different clinical pharmacists on the impact of pharmaceutical interventions. Methodology: A retrospective study was conducted at a tertiary care hospital in Oman. The study included all documented interventions by clinical pharmacists for all categories of admitted patients that met the inclusion criteria. Results: The originator clinical pharmacists interjected to improve the efficacy of treatment in (58%, n=1740) of the interventions, followed by toxicity reduction (24%). The level of agreement in the clinical significance resulted in substantial Scotts’ kappa (k) between the originator and the first reviewer, the first and second reviewers, and the second reviewer and supervisor (86%; k=0.77; P<.001), (77%; k=0.63; P<.001), (84%; k=0.77; P<.001), respectively. In terms of grading of clinical significance, the originator clinical pharmacists recorded moderate significance in 50% of the interventions, followed by major (30%), not applicable (8.4%), and minor (7.3%). The level of agreement in the clinical significance resulted in substantial Scotts’ k between the originator and the first reviewer, and between the second reviewer and supervisor (82%; k=0.72; P<.001), (84%; k=0.77; P<.001), respectively. The level of agreement between the first and second reviewer was fair (55%; k=0.28; p<0.001). Conclusion: Clinical pharmacists’ interventions have a crucial impact on patient safety, improving efficacy and reducing toxicities. Overall, there was a substantial agreement among clinical pharmacists on the clinical significance and grading of the interventions..

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1. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923-33. https://doi.org/10.1097/mlr.0b013e3181e57962
2. Koshman SL, Charrois TL, Simpson SH, et al. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687-94. https://doi.org/10.1001/archinte.168.7.687 
3. Santschi V, Chiolero A, Burnand B, et al. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171(16):1441-53. https://doi.org/10.1001/archinternmed.2011.399
4. Benavides S, Rodriguez JC, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. Ann Pharmacother. 2009;43(1):85-97. https://doi.org/10.1345/aph.1K612
5. Saberi P, Dong BJ, Johnson MO, et al. The impact of HIV clinical pharmacists on HIV treatment outcomes: a systematic review. Patient Prefer Adherence. 2012;6:297-322. https://doi.org/10.2147/PPA.S30244
6. Shull MT, Braitman LE, Stites SD, et al. Effects of a pharmacist-driven intervention program on hospital readmissions. Am J Health Syst Pharm. 2018;75(9):e221-e30. https://doi.org/10.2146/ajhp170287
7. Kilcup M, Schultz D, Carlson J, et al. Postdischarge pharmacist medication reconciliation: impact on readmission rates and financial savings. J Am Pharm Assoc. 2013;53(1):78-84. https://doi.org/10.1331/JAPhA.2013.11250 
8. Qin SB, Zhang XY, Fu Y, et al. The impact of the clinical pharmacist-led interventions in China: A systematic review and Meta-Analysis. Int J Clin Pharm. 2020;42(2):366-77. https://doi.org/10.1007/s11096-020-00972-y
9. Rodrigues CR, Harrington AR, Murdock N, et al. Effect of Pharmacy-Supported Transition-of-Care Interventions on 30-Day Readmissions: A Systematic Review and Meta-analysis. Ann Pharmacother. 2017;51(10):866-89. https://doi.org/10.1177/1060028017712725
10. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging.2003;20(11):817-32. https://doi.org/10.2165/00002512-200320110-00003
11. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. 
12. Bech CF, Frederiksen T, Villesen CT, et al. Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients. Int J Clin Pharm. 2018;40(1):119-25.
13. Tilly-Gratton A, Lamontagne A, Blais L, et al. Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma. Int J Pharm Pract. 2017;25(5):335-42. https://doi.org/10.1111/ijpp.12320
14. Yailian AL, Revel E, Tardy C, et al. Assessment of the clinical relevance of pharmacists’ interventions performed during medication review in a rheumatology ward. Eur J Intern Med. 2019;59:91-6. https://doi.org/10.1016/j.ejim.2018.08.017
15. Kuo GM, Touchette DR, Marinac JS. Drug errors and related interventions reported by United States clinical pharmacists: the American College of Clinical Pharmacy practice-based research network medication error detection, amelioration and prevention study. Pharmacotherapy. 2013;33(3):253-65. https://doi.org/10.1002/phar.1195
16. Salman B, Al-Hashar A, Al-Khirbash A, et al. Clinical and Cost Implications of Clinical Pharmacist Interventions on Antimicrobial Use at Sultan Qaboos University Hospital in Oman. Int J Infect Dis. 2021;109:137-41. https://doi.org/10.1016/j.ijid.2021.07.002
17. Vo HT, Charpiat B, Chanoine S, et al. CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists’ interventions. Eur J Hosp Pharm. 2021;28(4):193-200. https://doi.org/10.1136/ejhpharm-2020-002642
18. Fleiss JL. Measuring nominal scale agreement among many raters. Psychological Bulletin. 1971;76(5):378-82.
19. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
20. Eiland LS. Characteristics of Pediatric Clinical Interventions Documented by a School of Pharmacy. J Pediatr Pharmacol Ther.2017;22(3):186-92. https://doi.org/10.5863/1551-6776-22.3.186
21. Chen PZ, Wu CC, Huang CF. Clinical and economic impact of clinical pharmacist intervention in a hematology unit. J Oncol Pharm Pract. 2020;26(4):866-72. https://doi.org/10.1177/1078155219875806 
22. Li Q, Qu HJ, Lv D, et al. Drug-related problems among hospitalized patients with COPD in mainland China. Int J Clin Pharm. 2019;41(6):1507-15. https://doi.org/10.1007/s11096-019-00913-4
23. Garau J, Bassetti M. Role of pharmacists in antimicrobial stewardship programmes. Int J Clin Pharm. 2018;40(5):948-52.https://doi.org/10.1007/s11096-018-0675-z
24. Fay LN, Wolf LM, Brandt KL, et al. Pharmacist-led antimicrobial stewardship program in an urgent care setting. Am J Health Syst Pharm. 2019;76(3):175-81. https://doi.org/10.1093/ajhp/zxy023
25. Parente DM, Morton J. Role of the Pharmacist in Antimicrobial Stewardship. Med Clin North Am. 2018;102(5):929-36. https:// 
26. Tian J, Wang MM, Jiang X, et al. Effect of pharmacist interventions on antibiotic use in the general pediatric ward. Pak J Pharm
Sci. 2020;33(3(Special)):1389-95.
27. Sapozhnikov J, Huang A, Revolinski S, et al. Impact of an Antimicrobial Stewardship Program Pharmacist During Microbiology
Rounds. Am J Clin Pathol. 2021;155(3):455-60. https://doi.org/10.1093/ajcp/aqaa132
28. Yang S. Impact of pharmacist-led medication management in care transitions. BMC Health Serv Res. 2017;17(1):722. https://doi.org/10.1186/s12913-017-2684-3
29. Hailu BY, Berhe DF, Gudina EK, et al. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatr. 2020;20(1):13. https://doi.org/10.1186/s12877-020-1413-7
30. Pfister B, Jonsson J, Gustafsson M. Drug-related problems and medication reviews among old people with dementia. BMC Pharmacol Toxicol. 2017;18(1):52. https://doi.org/10.1186/s40360-017-0157-2
31. Modesto ACF, Ribeiro AM, Pereira JL, et al. Evaluation of a method for drug-related problems identification and classification in hospital setting: applicability and reliability. Int J Clin Pharm. 2020;42(1):193-200. https://doi.org/10.1007/s11096-019-00957-6
2. Su YJ, Yan YD, Wang WJ, et al. Drug-related problems among hospitalized cancer pain patients: an investigative single-arm intervention trial. Ann Palliat Med. 2021;10(2):2008-17. https://doi.org/10.21037/apm-20-1458
33. Drovandi A, Robertson K, Tucker M, et al. A systematic review of clinical pharmacist interventions in paediatric hospital patients. Eur J Pediatr. 2018;177(8):1139-48. https://doi.org/10.1007/s00431-018-3187-x
34. Umar RM, Apikoglu-Rabus S, Yumuk PF. Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients. Int J Clin Pharm. 2020;42(2):652-61. https://doi.org/10.1007/s11096-020-00992-8
35. Belaiche S, Goulois S, DeBerranger E, et al. Clinical pharmacist and pharmaceutical interventions in HBH unit: a French observational study. Acta Clin Belg. 2021;76(4):258-63. https://doi.org/10.1080/17843286.2020.1716148
36. Bosma L, Jansman FG, Franken AM, et al. Evaluation of pharmacist clinical interventions in a Dutch hospital setting. Pharm World Sci. 2008;30(1):31-8. https://doi.org/10.1007/s11096-007-9136-9
37. Tangiisuran B, Auyeung V, Cheek L, et al. Inter-rater reliability of the assessment of adverse drug reactions in the hospitalised  elderly. J Nutr Health Aging. 2013;17(8):700-5. https://doi.org/10.1007/s12603-013-0011-1

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