Pharmacists’ perceptions of the impact of care they provide
Limitations on health care resources necessitate careful focus on activities that lead to the greatest improvement in patient outcomes. Despite the importance of aligning pharmacists’ time with activities deriving the most impact, there is a paucity of literature on the correlations between pharmacists’ perceptions of the impact of their activities, how they actually spend their time and how these align with published evidence of impacts on patient outcomes.
Objective: To reveal hospital pharmacists’ perceptions of the impacts of their clinical activities and to characterize the correlation between the activities performed and both their perceptions of and the published evidence for their impacts on patient care.
Methods: Observational qualitative interviews and quantitative questionnaires were conducted with each participant (N=21) to characterize their work day and determine their perceptions of the impact of their activities. A systematic literature review catalogued pharmacists’ activities with impact on patient outcomes. Primary endpoint: degree of correlation in three pair-wise comparisons between pharmacists’ perceptions of impact, time allotted to activities, and published evidence of impact.
Results: Pharmacists’ time spent was positively and significantly correlated with their perception of impact (P=0.037) but not with the published evidence of impact (in either of the two analytical scenarios). The correlation between published evidence and pharmacists’ perceptions of impacts was on the threshold of statistical significance with a moderate strength of association in one of the two analytical scenarios used.
Conclusions: Pharmacists dedicate more of their clinical time to activities they perceive to have greater impact. However, these perceptions and their time allocation does not correlate well with published evidence, and some misperceptions about impacts deserve correction. More rigorous research is needed to quantify the value of pharmacist services to the health care system, however designing such studies to isolate the value of specific activities will be challenging.
2. Bond CA, Raehl CL. Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. Am J Health Syst Pharm. 2007;64(18):1935-42.
3. Bond CA, Raehl CL, Franke T. Clinical pharmacy services and hospital mortality rates. Pharmacotherapy. 1999;19(5):556-64.
4. Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacist staffing, and drug costs in united states hospitals. Pharmacotherapy. 1999;19(12):1354-62.
5. Bond CA, Raehl CL, Franke T. Interrelationships among mortality rates, drug costs, total cost of care, and length of stay in united states hospitals: Summary and recommendations for clinical pharmacy services and staffing. Pharmacotherapy. 2001;21(2):129-41.
6. Torchinsky A, Landry D. An analysis of pharmacist interventions. Can J Hosp Pharmacy. 1991;44(5):245,-248,270.
7. Crook M, Ajdukovic M, Angley C, Soulsby B, Doecke C, Stupans I, Angley M. Eliciting comprehensive medication histories in the emergency department: the role of the pharmacist. Pharm Pract (Internet) 2007;5(2):78-84.
8. Stuchbery P, Kong DCM, Desantis GN, Lo SK. Identification by observation of clinical pharmacists' activities in a hospital inpatient setting. Pharm Pract (Internet) 2007;5(1):10-16.
9. Cohen, J. Statistical power analysis for the behavioral sciences. Hillsdale (NJ): Erlbaum; 1988.
10. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: A systematic review. Arch Intern Med. 2006;166(9):955-64.
11. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27(4):481-93.
12. Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and adverse drug reactions in united states hospitals. Pharmacotherapy. 2006;26(6):735-47.
13. Bond CA, Raehl CL. Pharmacist-provided anticoagulation management in united states hospitals: Death rates, length of stay, medicare charges, bleeding complications, and transfusions. Pharmacotherapy. 2004;24(8):953-63.
14. Wu JY, Leung WY, Chang S, Lee B, Zee B, Tong PC, Chan JC. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: Randomised controlled trial. BMJ. 2006;333(7567):522.
15. Zermansky AG, Alldred DP, Petty DR, Raynor DK, Freemantle N, Eastaugh J, Bowie P. Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial. Age Ageing. 2006;35(6):586-91.
16. Boockvar KS, Carlson LaCorte H, Giambanco V, Fridman B, Siu A. Medication reconciliation for reducing drug-discrepancy adverse events. Am J Geriatr Pharmacother. 2006;4(3):236-43.
17. Stiegler KA, Yunker NS, Crouch MA. Effect of pharmacist counseling in patients hospitalized with acute exacerbation of asthma. Am J Health Syst Pharm. 2003;60(5):473-6.
18. López Cabezas C, Falces Salvador C, Cubí Quadrada D, Arnau Bartés A, Ylla Boré M, Muro Perea N, Homs Peipoch E. Randomized clinical trial of a postdischarge pharmaceutical care program vs regular follow-up in patients with heart failure. Farm Hosp. 2006;30(6):328-42.
19. Gattis WA, Hasselblad V, Whellan DJ, O'Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: Results of the pharmacist in heart failure assessment recommendation and monitoring (PHARM) study. Arch Intern Med. 1999;159(16):1939-45.
20. Bond CA, Salinger RJ. Fluphenazine outpatient clinics: A pharmacist's role. J Clin Psychiatry. 1979;40(12):501-3.
21. Kuti JL, Le TN, Nightingale CH, Nicolau DP, Quintiliani R. Pharmacoeconomics of a pharmacist-managed program for automatically converting levofloxacin route from i.v. to oral. Am J Health Syst Pharm. 2002;59(22):2209-15.
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