Outpatient Pharmacists' Cognitive Service and its Impact on Drug Expenditure at a Regional Hospital
Date Issued
2007
Date
2007
Author(s)
Lin, Chii-Shan
DOI
zh-TW
Abstract
The purposes of this study were (1) to determine the major contents of cognitive services while pharmacists review prescriptions; and (2) its impact on drug expenditures (fee) via cognitive service, as a references of future health insurance reimbursement. The research materials were the records of cognitive services collected in the eight branches of Taipei City Hospital from March to December, 2005. Total 1,676 valid records of cognitive services were collected during the study period to analyze contents of services and changes of drug fees.
The cognitive service records reveal that the major medication problem that pharmacists found was shorter interval between two doses (17.8%), followed by repetition medication (15.1%) and unlabeled use (13.0%). Changing doses, changing intervals of doses, and changing other medicines were the main pharmacists’ interventions. Of all suggestions, forty percent were related to doses. However, the most situations of changing other drugs were resulted from doctors selecting wrong medicines on computers when they prescribed. Above problems could be solved by a well-designed computer program. When a physician prescribed, the program could screen unusual situations and inform or warn the doctor. Ninety-four percent of prescriptions were revised because of pharmacists’ interventions. The major changes were changing another medicine and changing the interval of doses. If those prescriptions were not revised, it has probably caused invalid therapy or result in side effects.
For cost perspective, this study showed that pharmacists’ interventions have successfully decreased drug expenditure in 63% of cases and only increased drug expenditure in 18% of cases. In average, each time a pharmacist offered cognitive services could help National Health Insurance to save drug fees of $ 189 NTD. Pharmacists executing cognitive services in outpatient pharmacy department can indeed reduce drug expenditure. With the decreasing financial availability of National Health Insurance, if giving enough time to pharmacists, encouraging them to execute cognitive services, and offering enough information (eg. abnormal level of renal function, history of drug allergy, complete drug files, and etc.) to them, pharmacists can find out more problems associated with drug interactions, repetition medication, and dose adjustments. It not only can save drug expenditures, but also can assure patients’ safety of drug use, can improve effectiveness of drugs, and can avoid damage of drug use. All these inestimable benefits – total medical expenses eliminated – could be even higher than drugs fees saved.
According to analysis of case report, this study was to determine the drug fees’ fluctuation that caused by pharmacists’ interventions. The results of study can be references for applying the subsidy of cognitive services that may be included in reimbursements from the Bureau of National Health Insurance (BNHI) in the future. BNHI authorities can select different types of hospitals to execute the services. The data can be collected from uploading the records of cognitive services via the Internet, in order to investigate entirely cognitive services offered by pharmacists in outpatient pharmacy department. It hopes that more and more hospitals can contribute more information to help claiming reimbursements from BNHI in the future.
Subjects
藥師
用藥適當性評估
判斷性服務
藥師介入服務
pharmacist
drug use review
cognitive services
Type
thesis
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