Evaluation of the physician’s acceptance to clinical pharmacy interventions after antibiotic stewardship implementation in the ICU in a general hospital in Egypt

Abstract Background Clinical pharmacy interventions (CPI) usually require prior medical authorization. Physicians approve 80% of CPI and reject 20%. If pharmacists show that physicians should authorize all 100% CPI, the profession will step closer to a fully independent prescriber status. This study used an artificial neural network (ANN) model to determine whether clinical pharmacy (CP) may improve outcomes associated with rejected CPI. Method This is a non-interventional, retrospective analysis of documented CPI in a 100-bed, acute-care private hospital in Amman, Jordan. Study consisted of 542 patients, 574 admissions, and 1694 CPI. Team collected demographic and clinical data using a standardized tool. Input consisted of 54 variables with some taking merely repetitive values for each CPI in each patient whereas others varying with every CPI. Therefore, CPI was consolidated to one rejected and/or one accepted per patient per admission. Groups of accepted and rejected CPI were compared in terms of matched and unmatched variables. ANN were, subsequently, trained and internally as well as cross validated for outcomes of interest. Outcomes were length of hospital and intensive care stay after the index CPI (LOSTA & LOSICUA, respectively), readmissions, mortality, and cost of hospitalization. Best models were finally used to compare the two scenarios of approving 80% versus 100% of CPI. Variable impacts (VI) automatically generated by the ANN were compared to evaluate the effect of rejecting CPI. Main outcome measure was Lengths of hospital stay after the index CPI (LOSTA). Results ANN configurations converged within 18 s and 300 trials. All models showed a significant reduction in LOSTA with 100% versus 80% accepted CPI of about 0.4 days (2.6 ± 3.4, median (range) of 2 (0–28) versus 3.0 ± 3.8, 2 (0–30), P-value = 0.022). Average savings with acceptance of those rejected CPI was 55 JD (~ 78 US dollars) and could help hire about 1.3 extra clinical pharmacist full-time equivalents. Conclusions Maximizing acceptance of CPI reduced the length of hospital stay in this model. Practicing Clinical Pharmacists may qualify for further privileges including promotion to a fully independent prescriber status.

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Knowledge and attitude of health care professional’s towards clinical pharmacy services in Nedjo General Hospital, Western Ethiopia

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20192798 ◽

2019 ◽

Vol 5 (7) ◽

pp. 172 ◽

Cited By ~ 1

Author(s):

Ginenus Fekadu ◽

Busha Gamachu ◽

Teklie Mengie ◽

Mudasir Maqbool

Keyword(s):

Health Care ◽

General Hospital ◽

Clinical Pharmacy ◽

Health Care Professionals ◽

Positive Attitude ◽

Good Knowledge ◽

Clinical Pharmacy Service ◽

Pharmacy Services ◽

Clinical Pharmacy Services ◽

Significant Difference

Background: Clinical pharmacy service (CPS) is an expanding patient-oriented, hospital role with the potential for encroachment on the physician's role. In large part, the success of CPS will depend on the degree to which other health professionals accept the concept and are willing to cooperate with its disciples. Unfortunately, our information about the degree of knowledge regarding acceptance and reaction toward clinical pharmacy by other health workers is meager.Methods: A cross sectional study design was carried out by using self–administered questionnaires on 110 health care professionals (HCP) in Nedjo General Hospital 10th March to 10th April, 2018.Results: From the total respondents 91 (82.7%) were males and majority of them were nurses 46 (41.8%) followed by midwifes 23 (20.9%). This study showed that 67 (60.9%) of the HCPs had a good knowledge and 67.3% of the HCPs had a positive attitude about CPS. There was no significant difference between the HCPs knowledge of clinical pharmacy services in relation to their sex (p=0.744), age (p=0.313), profession (p=0.997), level of education (p=0.509), and experience (p=0.553). Regarding HCPs’ attitude of CPs role, there was no significant difference in relation to their sex (p=0.588), age (p=0.144), profession (p=0.059) and experience (p=0.394). However, the study revealed that there was a significant difference (p=0.009) between HCPs attitude and level education of HCPs.Conclusions: Majority of the HCPs had a good knowledge and a positive attitude towards CPS. Attention should focus to hospitals to implement ward based CPS and increasing inter-professional relationships between HCPs and pharmacists.

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