Pharmacists go beyond the counter to help hospitalized patients

Getting hospital-based pharmacists out from "behind the counter" to work directly with inpatients and health care teams reduces medication errors and problems, according to a University of Iowa and Department of Veterans Affairs review of previously published studies.

The change in pharmacists' roles also has helped patients understand and follow their drug regimes. Previously, pharmacists did not often see hospitalized patients firsthand. However, in the last 20 years, pharmacists have become more involved in collaborative care for patients.

"Pharmacists play an incredibly important role in caring for hospitalized patients in terms of medication safety and helping determine that patients are on the most appropriate medications," said Peter Kaboli, who led the review study and is an investigator with the Center for Research in the Implementation of Innovative Strategies at the Veterans Affairs Iowa City Health Care System and assistant professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine.

"Hospitals and health systems are seeing the value of putting pharmacists in direct contact with patients and having the pharmacists interact with other health care providers on a daily basis," added Kaboli, who also is a hospitalist.

The team analyzed 36 studies that were published between 1985 and 2005 in English-language, peer-reviewed journals. The review appears in the May 8 issue of the Archives of Internal Medicine.

Kaboli said earlier studies of pharmacy care in hospitals usually focused on specific drugs, such as blood thinners, or specific diseases. "That's important," Kaboli said, "but it's also important to look at the bigger picture." The later studies analyzed by the team point to a systems-approach and how pharmacists care for inpatients by meeting with them at admittance, visiting during "rounds" and meeting again at discharge.

At both UI Hospitals and Clinics and within the VA Health Care Systems, pharmacists play a critical role in managing disease for inpatients, and it is not only about delivering drugs but also information.

Over the past several decades, the number of medications and the complexity of drug therapy has grown enormously, said Paul Abramowitz, director of Pharmaceutical Care at UI Hospitals and Clinics, where approximately 90 pharmacists provide clinical care.

"Pharmacists focus on all aspects of the patient's drug therapy. They work with the patient, physician, and nurse to help maximize the benefits and outcomes of medications and to minimize adverse effects," Abramowitz said.

"This also includes a significant amount of attention to medication safety in every step in the medication use process" added Abramowitz, who also is a professor and an assistant dean at the UI College of Pharmacy.

As part of a patient's hospital stay, the Joint Commission on Accreditation of Healthcare Organizations mandates a "medication reconciliation." Health care providers review with the patient the drugs taken from admission through discharge to ensure appropriateness. The reconciliation also helps a patient understand costs, conveniences and other factors that might affect the intended use of the medication.

For patients with dementia, health illiteracy or other problems that could affect use of medications, the pharmacist also can meet with family members or other helpers for medication planning.

Carl Hensely II, pharmacy benefits manager for VA hospitals in Veterans Integrated Service Network 23, which covers five states including Iowa, said pharmacists' efforts help decrease costs and improve quality of life.

"Patients are more satisfied if they have more contact with a pharmacist or at least are given the opportunity to do so," Hensley said. "For example, they can better understand what might happen if they miss a dose or why they need to take a medication even if it has a short-term negative side effect."

Some of the studies reviewed also indicated greater degrees of job satisfaction for pharmacists who interacted more with patients and physicians, Kaboli said.

Pharmacists currently complete six years of post-high school education, including two in pre-pharmacy and four professional years in a college of pharmacy. Pharmacists who choose to work in hospitals or health care systems may also complete one to two years of residency training.

Kaboli said the review of pharmacy care for inpatients helped the team design a study looking at outpatient care and pharmacist-physician team interventions. Those results will be available at a later date.

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The review study was supported by a VA grant. In addition, Kaboli is supported by a VA Research Career Development Award, and one of the study co-authors, Jeffrey Schnipper, M.D., with Harvard Medical School, is supported by a Mentored Clinical Scientist Development Award from the National Institutes of Health.

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178


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