Pharmacist Managed Aminoglycoside or Vancomycin Therapy
Purpose: The associations between pharmacist-managed aminoglycoside or vancomycin therapy for hospitalized Medicare patients who had diagnoses indicating probable treatment with these antibiotics and the major health care outcomes of death rate, length of stay, Medicare charges, hearing loss, and renal impairment were explored.
Methods: Pharmacist management of drug therapy was evaluated in a study population composed of 199,082 Medicare patients treated in 961 hospitals.
Results: In hospitals that did not have pharmacist-managed aminoglycoside or vancomycin therapy, death rates were 6.71% higher (1,048 excess deaths [χ (1) = 43.801, p < 0.0001]), length of stay was 12.28% higher (131,660 excess patient days [U = 4.701 × 10, p < 0.0001]), total Medicare charges were 6.30% higher ($140,745,924 in excess total Medicare charges [U = 4.864 × 10, p < 0.0001]), drug charges were 8.15% higher ($34,769,250 in excess drug charges [U = 4.785 × 10, p < 0.0001]), laboratory charges were 7.80% higher ($22,530,474 in excess laboratory charges [U = 4.860 × 10, p < 0.0001]), hearing loss was 46.42% higher (134 more patients with hearing loss [χ = 54.423, df = 1, p < 0.0001]), renal impairment was 33.95% higher (2,801 more patients with renal impairment [χ = 118.13, df = 1, p < 0.0001]), and the death rate in patients who developed complications was 10.15% higher (231 excess deaths [χ = 22.345, df = 1, p < 0.0001]) than in hospitals with pharmacists managing these drugs.
Conclusion: The presence of pharmacist-managed aminoglycoside or vancomycin therapy was associated with significant improvement in health care and economic outcomes for Medicare patients who received these drugs.
The 2003 ASHP National Survey of Pharmacy Practice in Hospital Settings found that the two drugs most often monitored by hospital pharmacists were aminoglycosides and vancomycin. In addition, pharmacists ordered laboratory tests of serum levels and adjusted the dosage of aminoglycosides or vancomycin in over 63% of hospitals that provided pharmacist-managed drug therapy. While great strides have been made in advancing the reach of pharmacy services, the results of a nationwide study revealed that Americans receive about half of the recommended medical care processes (i.e., health care). For example, only 58% of women with uncomplicated urinary tract infections received recommended antibiotics, 37% of women with pelvic inflammatory disease received the recommended antibiotics, and patients with pneumonia received only 39% of the recommended care, including antibiotics.
The Institute of Medicine has stated that the American health care system must improve the quality of care provided to patients to ensure that everyone receives evidenced-based care. Some of the suggested improvements to our health care system involve a more systematic and standardized approach to the delivery of health care. In 1995, 730,328 Medicare patients admitted to U.S. hospitals had diagnoses indicating that they probably received an aminoglycoside or vancomycin. We describe here an exploration of the associations between pharmacist-managed aminoglycoside or vancomycin therapy of Medicare patients who had diagnoses indicating the probable use of one of these antibiotics and major health care outcomes, including mortality rates, length of hospital stay, total Medicare charges, drug charges, laboratory charges, hearing loss, and renal impairment.
The benefits of pharmacists and clinical pharmacy services in individual practice sites have been well documented, as have the benefits of pharmacists' involvement in the management of patients receiving aminoglycoside or vancomycin, including therapeutic outcomes; decreased costs, hospitalizations, and complications; and other outcomes. However, no studies have been published evaluating the effect of pharmacist-managed aminoglycoside or vancomycin across multiple hospitals or large patient populations. Studies involving large numbers of patients are critical for several reasons. First, they are not subject to bias of patient populations, physical facilities, structure, and process that may confound studies conducted at individual sites. Second, they significantly reduce intervener bias when investigators evaluate the effect of pharmacists on patient care outcomes at individual sites (because the pharmacists know they are being evaluated, they are more diligent). Third, they provide objective data that are most likely to influence physicians, hospital administrators, health care policy experts, and government officials and are more effective in objectively supporting provider status for pharmacists, thus helping the profession gain reimbursement for clinical services.
In previous studies, we found that clinical pharmacist staffing and specific clinical pharmacy services resulted in reduced mortality rates, reduced drug costs per occupied bed, reduced total cost of care per occupied bed, decreased length of hospital stay, decreased medication errors, and decreased medication errors that adversely affect patient care outcomes in a large number of U.S. hospitals. Pharmacist-managed drug therapy has been shown to significantly reduce drug costs per occupied bed, reduce total cost of care per occupied bed, decrease length of hospital stay, decrease medication errors, and decrease medication errors that adversely affect patient care outcomes. While not significant, mortality rates were lower in hospitals that had pharmacist-managed drug therapy. While these studies have demonstrated the positive effect of clinical pharmacy services and hospital pharmacy staffing on health care outcomes, they do not tell us what types of patients can benefit most from clinical pharmacy services, nor do they provide information on what specific drugs pharmacists should manage to promote optimal care for patients.
This is the first study to evaluate health care outcomes in a large government program (Medicare) for patients receiving aminoglycoside or vancomycin therapy. The effect of clinical pharmacy services on patient care is also explored.
Purpose: The associations between pharmacist-managed aminoglycoside or vancomycin therapy for hospitalized Medicare patients who had diagnoses indicating probable treatment with these antibiotics and the major health care outcomes of death rate, length of stay, Medicare charges, hearing loss, and renal impairment were explored.
Methods: Pharmacist management of drug therapy was evaluated in a study population composed of 199,082 Medicare patients treated in 961 hospitals.
Results: In hospitals that did not have pharmacist-managed aminoglycoside or vancomycin therapy, death rates were 6.71% higher (1,048 excess deaths [χ (1) = 43.801, p < 0.0001]), length of stay was 12.28% higher (131,660 excess patient days [U = 4.701 × 10, p < 0.0001]), total Medicare charges were 6.30% higher ($140,745,924 in excess total Medicare charges [U = 4.864 × 10, p < 0.0001]), drug charges were 8.15% higher ($34,769,250 in excess drug charges [U = 4.785 × 10, p < 0.0001]), laboratory charges were 7.80% higher ($22,530,474 in excess laboratory charges [U = 4.860 × 10, p < 0.0001]), hearing loss was 46.42% higher (134 more patients with hearing loss [χ = 54.423, df = 1, p < 0.0001]), renal impairment was 33.95% higher (2,801 more patients with renal impairment [χ = 118.13, df = 1, p < 0.0001]), and the death rate in patients who developed complications was 10.15% higher (231 excess deaths [χ = 22.345, df = 1, p < 0.0001]) than in hospitals with pharmacists managing these drugs.
Conclusion: The presence of pharmacist-managed aminoglycoside or vancomycin therapy was associated with significant improvement in health care and economic outcomes for Medicare patients who received these drugs.
The 2003 ASHP National Survey of Pharmacy Practice in Hospital Settings found that the two drugs most often monitored by hospital pharmacists were aminoglycosides and vancomycin. In addition, pharmacists ordered laboratory tests of serum levels and adjusted the dosage of aminoglycosides or vancomycin in over 63% of hospitals that provided pharmacist-managed drug therapy. While great strides have been made in advancing the reach of pharmacy services, the results of a nationwide study revealed that Americans receive about half of the recommended medical care processes (i.e., health care). For example, only 58% of women with uncomplicated urinary tract infections received recommended antibiotics, 37% of women with pelvic inflammatory disease received the recommended antibiotics, and patients with pneumonia received only 39% of the recommended care, including antibiotics.
The Institute of Medicine has stated that the American health care system must improve the quality of care provided to patients to ensure that everyone receives evidenced-based care. Some of the suggested improvements to our health care system involve a more systematic and standardized approach to the delivery of health care. In 1995, 730,328 Medicare patients admitted to U.S. hospitals had diagnoses indicating that they probably received an aminoglycoside or vancomycin. We describe here an exploration of the associations between pharmacist-managed aminoglycoside or vancomycin therapy of Medicare patients who had diagnoses indicating the probable use of one of these antibiotics and major health care outcomes, including mortality rates, length of hospital stay, total Medicare charges, drug charges, laboratory charges, hearing loss, and renal impairment.
The benefits of pharmacists and clinical pharmacy services in individual practice sites have been well documented, as have the benefits of pharmacists' involvement in the management of patients receiving aminoglycoside or vancomycin, including therapeutic outcomes; decreased costs, hospitalizations, and complications; and other outcomes. However, no studies have been published evaluating the effect of pharmacist-managed aminoglycoside or vancomycin across multiple hospitals or large patient populations. Studies involving large numbers of patients are critical for several reasons. First, they are not subject to bias of patient populations, physical facilities, structure, and process that may confound studies conducted at individual sites. Second, they significantly reduce intervener bias when investigators evaluate the effect of pharmacists on patient care outcomes at individual sites (because the pharmacists know they are being evaluated, they are more diligent). Third, they provide objective data that are most likely to influence physicians, hospital administrators, health care policy experts, and government officials and are more effective in objectively supporting provider status for pharmacists, thus helping the profession gain reimbursement for clinical services.
In previous studies, we found that clinical pharmacist staffing and specific clinical pharmacy services resulted in reduced mortality rates, reduced drug costs per occupied bed, reduced total cost of care per occupied bed, decreased length of hospital stay, decreased medication errors, and decreased medication errors that adversely affect patient care outcomes in a large number of U.S. hospitals. Pharmacist-managed drug therapy has been shown to significantly reduce drug costs per occupied bed, reduce total cost of care per occupied bed, decrease length of hospital stay, decrease medication errors, and decrease medication errors that adversely affect patient care outcomes. While not significant, mortality rates were lower in hospitals that had pharmacist-managed drug therapy. While these studies have demonstrated the positive effect of clinical pharmacy services and hospital pharmacy staffing on health care outcomes, they do not tell us what types of patients can benefit most from clinical pharmacy services, nor do they provide information on what specific drugs pharmacists should manage to promote optimal care for patients.
This is the first study to evaluate health care outcomes in a large government program (Medicare) for patients receiving aminoglycoside or vancomycin therapy. The effect of clinical pharmacy services on patient care is also explored.
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