the role of the pharmacist in optimising patient care ... · adverse drug reactions leading to an...

The Role of the Pharmacist in Optimising Patient Care Lessons to be Learned both Clinically and Economically

Prof Stephen Byrne Chair in Clinical Pharmacy Practice amp Head of School

Declaration

Prof Stephen Byrne ndash Pharmaceutical Care Research Group School of Pharmacy University College Cork Ireland Co-inventorauthor of STOPPSTART criteria Have recevied Funding from the HRB and EU-FP7 EU-H2020 to investigate the impact of STOPPSTART v2 in older patients None other relevant to this talk

Internationally

Pharmacy in the 21st century

bull Chronic Disease Management in Pharmacy

bull Community Pharmacy and Health Screening

bull Re-Categorisation of Medicines

bull Pharmacist Vaccination Clinics

Future Roles

The Patient

Chronic Disease

Management

Minor Ailment Scheme

Electronic Healthcare

Records

Health Screening

Pharmacist Prescribing

Extension to Vaccinations

New Roles within

Primary Healthcare

Centers

Future of Pharmacy Report

Elderly

Co-agulation

Anti-microbials

Medicines Management - Appropriate Use of Medicines

Greying population

Exponential increase in the prevalence of diseases with increasing age

Unique medication needs of older people

Increased prevalence of adverse drug reactions leading to an increase in drug related morbidity and mortality

The older Person

Inappropriate Prescribing

Inappropriate prescribing in the elderly

Potential Risk (ADR) gt Potential Benefitopriate drug choice

Over-prescribing Dose and frequency that exceeds what is clinically indicated

Polypharmacy bull Drug-drug interactions bull Drug-disease interactions

Under-prescribing

MAI tool

Hanlon J et al Am J Med 1996 100 428-637

2003 First draft of STOPP criteria

2004 First draft of START criteria

First published abstract on STOPP

ldquoSTOPP ndash a new screening tool of elderly patientsrsquo prescriptionsrdquo OrsquoReilly V et al Ir J Med Sci 2004 173 Suppl 2 p12

2005 First published abstract on START

START (Screening Tool to Action Right Treatment) ndash a new explicit evidence

based screening tool to detect prescribing omissions in elderly patients

Barry P et al Ir J Med Sci 2005 174 Suppl 2 p72

2006 Refinement of STOPPSTART criteria

2007 First full paper on START criteria

START (Screening Tool to Alert doctors to the Right Treatment) ndash an evidence


Barry PJ et al Age Ageing 2007 36 632-38

Refinement of STOPPSTART criteria (evidence base)

Delphi validation of STOPPSTART criteria and preparation of manuscript for publicatio

Origins of STOPPSTART

Ryan C et al Br J Clin Pharmacol 2009 Dec68(6)936-47


Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637

The rates of PIP calculated per cohort by STOPP

Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571

The rates of PPO calculated per cohort by START

bull 263 of Admission due to ADEs

bull 109 the prime cause of hospital admission

bull 556 significantly contributed to hospital

admission

bull 517 were listed in STOPP (OR = 183 95 CI

149 ndash 224 p lt 0001)

The Impact of a Structured Pharmacist Intervention on the appropriateness of

prescribing in Older Hospitalised Patients

Objectives

bull Evaluate the impact of a SPRM care intervention using CDSS on the appropriateness of prescribing in older Irish hospitalised inpatients

bull We prospectively studied 361 patients aged ge65 years who were admitted to an Irish University Teaching Hospital over a 13 month period

OrsquoSullivan David PhD Thesis 2014 ndash under review

Outcomes

Primary outcome

bull Appropriateness of prescribing as defined by the medication appropriateness index (MAI) and a modified subset of the ACOVE criteria

Secondary outcome

bull Uptake and acceptance of interventions by the hospital physicians

bull The prevalence of PIP as defined by STOPP Beers 2003 and Priscus criteria and the combined PIP at admission and follow-up

OrsquoSullivan David PhD Thesis 2014

bull 1000 medicines reconciliations issues were identified in 296 (820) patients

bull 548 (n=548) of the pharmacists recommendations were accepted

Medicines Reconciliations Issues

OrsquoSullivan David PhD Thesis 2014 UCC

Breakdown of Medicines Reconciliations Recommendations

Type of Recommendations No of

Recommendations

Recommendatio

ns accepted N

()

Appropriateness Issues 577 222 (385)

bull Indication 47 18 (383)

bull Interactions 73 29 (397)

bull Renal Adjustment 25 13 (52)

bull Appropriateness Tools (STOPP Beers

PRISCUS START criteria) 297 135 (455)

Underprescribing assessment tool

(START criteria) 44 13 (295)

bull Miscellaneous Appropriateness Issues 91 27 (297)

Reconciliation Issues 423 326 (771)

bull Dosage 95 69 (726)

bull Missing Medications 322 252 (783)

bull Miscellaneous Reconciliation Issues 6 5 (833)


Medication appropriateness

Admissio

n

Follow-

up

Significance

(p)

Median MAI score for

medications (IQR) 15 (7-21) 12 (6-18) 0000


regular medications (IQR) 13 (6-20) 9 (4-16) 0000

Median MAI score for ldquoprnrdquo

medications (IQR) 0 (0-1) 1 (0-3) 0000

IQR interquartile range PRN pro re nata (lsquowhen requiredrsquo)

Wilcoxon Signed Rank Test


Prevention of ADRs in hospitalised older patients using a CDSSSPRM intervention a cluster RCT


Primary outcome

The proportion of patients in either group who experienced a non-trivial ADR during their hospital stay

Secondary outcomes

bull Median hospital LOS (in days)

bull Hospital mortality rate

Outcomes


Intervention patients

bull 61 ADRs occurred in 50 patients (139)

bull 33 ADRs as lsquoprobablersquo bull 28 ADRs as lsquopossiblersquo bull 31 were classified as

definitely avoidable

bull 23 as possibly avoidable bull 7 as unavoidable

Control patients

bull 91 ADRs were recorded in 78 patients (207)

bull 1 was defined as certain

bull 65 were deemed probable

bull 25 were deemed possible

bull 62 were classified as definitely avoidable

bull 20 possibly avoidable and

bull 9 unavoidable

ADR Detection


bull There was a statistically significant difference in ADR incidence between the two groups

bull 139 in the intervention group versus 207 in the control group (plt 0001)

bull An ADR absolute risk reduction of 68 (95 CI 15-123)

bull A relative ADR risk reduction of 333 (95 CI 77-517)

bull The number of patients needed to screen with the intervention to avoid one ADR was 15 (95 CI 8-68)

Primary Outcomes


Secondary Outcomes

bull There was no significant difference in the median length of stay of the two groups

bull 9 days (5-16) versus 8 days (5-135) p=0444

bull There was no significant difference found in all-cause mortality rate between the two groups

bull 17 patients (47) versus 17 (45) patients


Drugs Aging 2016 Apr33(4)285-94

BMC Health Serv Res 2014 Apr 1714177

Method ndash Trial data

bull Trial based evaluation

bull June 2011 ndash June 2012

bull CHEERS guidelines [2]

bull Healthcare payer perspective

bull Analysis on intention to treat basis

Method ndash Cost data

Cost

Component

Description Unit Cost

Pharmacist Per application of

SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506

Inpatient day Cost of care per

hospital in

patient day

euro850

Software costs One off

installation of

software

programme

euro1000

Method ndash Cost effectiveness analysis

bull Outcome ndash Incremental cost-effectiveness ratio (ICER)

bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

bull Incremental analysis ndash Multi-level mixed effect regression models

bull Uncertainty ndash Cost-effectiveness acceptability curves

Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)

COST ANALYSIS Mean (SD) Mean (SD)

Total Cost (euro) 13242 (15530) 15465 (19310)

EFFECTIVENESS ANALYSIS N () N ()

ADR Event 50 (1385) 78 (2074)

No of ADR Events N () N ()

0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes

Incremental Analysis

Intervention versus Control

Incremental Cost

Mean cost difference

(95 CIrsquos) (p-value)

-815

(-3451 1820) (0544)

Incremental Effect

ADR Event Odds Ratio


0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)

Cost-effectiveness Plane

Cost-effectivehellipdepending on threshold

Incremental cost-effectiveness ratio of SPRMCDSS

(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs

Fleming et al IJCP 201436(2)377-83

bull Best practice recommends a multidisciplinary Antimicrobial Management Team (AMT) to conduct Antimicrobial Stewardship (AMS) in hospitals

bull Important to compare performance to other countries

bull Donabedian Framework

Structure rarr Process rarr Outcome

Background

bull The aim was to compare the profile of AMT membership amp the AMS activities between Ireland amp the United Kingdom

bull Conduct a nationwide survey of Irish hospitals

bull Conduct a nationwide survey of UK hospitals

Compare the findings

Aim amp Objectives

bull Ethical approval obtained

bull Self-completion postal questionnaire developed amp piloted in the UK 2 reminders

bull Irish survey issued Mar-Apr 2012 to all hospital Antimicrobial Pharmacists or Chief Pharmacist

bull UK survey issued Nov 2011 ndash Jan 2012 to all NHS hospital Antimicrobial Pharmacists

bull Results analysed amp published independently

bull Comparison conducted using Chi squared tests for categorical variables plt 005 significant

Methods

bull Response rates bull 73 (n=51) Ireland (15 private 36 public)

bull 33 (n=273) UK (all NHS)

bull 57 (2951) have an AMT in Ireland

bull 82 (186226) have an AMT in the UK

bull Majority of hospitals have Antimicrobial prescribing Policy (88 Irl 98 UK)

Results

Parameter Ireland UK p value

Antimicrobial Management Team (AMT)

57 (2951)

82 (186273)

lt 0001

Antimicrobial prescribing policy

88 (4551)

98 (222226)

= 0001

Antimicrobial Pharmacist on the AMT

69 (2029)

95 (177186)

lt 0001

Consultant Infectious Diseases on the AMT

24 (729)

67 (97145)

lt 0001

Results Antimicrobial Management Team

Activity Ireland UK p value

Audit volume of antibiotic prescribing

86 (3642)

73 (162222)

= 0057

Audit appropriateness of antibiotic prescribing

58 (2441)

76 (169222)

= 0019

Audit appropriateness of restricted antibiotic prescribing

52 (2242)

64 (143222)

= 0140

Results Antimicrobial Stewardship activities

Irish Public hospitals more likely to audit volume of antibiotic prescribing (p = 0021) amp appropriateness of restricted antibiotic prescribing (p = 0003) than Private hospitals

Feedback Ireland UK p value

Antimicrobial resistance

33 (1751)

29 (66226)

056

Antimicrobial prescribing to ward teams

29 (1551)

62 (138222)

lt 0001

Antimicrobial prescribing to individual doctors

25 (1351)

33 (74222)

0278

Comparing institutions

24 (1251)

24 (53222)

-

Results Feedback to prescribers

bull Aims of policy similar bull Promote appropriate prescribing narrow spectrum

microbiological investigation reduce MDR infections

bull Content of policy largely similar bull Empirical prescribing surgical prophylaxis

gentamicin protocol

bull Irish hospitals more likely to have surgical prophylaxis included (p = 0014)

bull UK hospitals more likely to have automatic stop orders for restricted antibiotics (p lt 0001)

Results Antimicrobial Prescribing Policy

ldquoLocally we need to finalise guidelines and then begin to develop our audit and

feedback processesrdquo

ldquoElectronic prescribing would make monitoring much easier and feedback immediate and effective in changing

prescribing patternsrdquo

(SHA = Strategic Healthcare Authority DoH = Department of Health)

Results Key strategic issues UK

Process issues

ldquodespite repeated attempts to put an Antimicrobial Stewardship team in place it has

not happened We need a Microbiologist to push things forwardrdquo

ldquoIt will be difficult to progress programs without ring-fencing of resources needed to implement

and develop antibiotic programmesrdquo

Results Key strategic issues Ireland

Structure amp Process issues

bull Important differences found between Ireland amp UK bull Due to lower numbers of antimicrobial pharmacists on Irish AMTs

bull Lack of resources dedicated to AMS Economic impact

bull Only some of the SARI amp HIQA guidelines have come to fruition

bull Impact of Antimicrobial Pharmacists has been shown a euro3 return for every euro1 spent on salary (IAPG 2010)

Discussion

bull Continuous support for antimicrobial pharmacists amp audit activities essential

bull Improve reporting on Antimicrobial Resistance

bull Improve feedback to teams amp doctors

bull Regulation will the inspection of hospitals against the Infection Prevention amp Control Standards (HIQA) lead to change

bull Future research must investigate in greater detail the Outcomes of AMT amp AMS

Implications for practice

bull Donabedian A The criteria and standards of quality Ann Arbor Mich Health Administration Press 1982

bull Fleming A Tonna A OConnor S Byrne S Stewart D A cross-sectional survey of the profile and activities of Antimicrobial Management Teams in Irish Hospitals International journal of clinical pharmacy 201436(2)377-83

bull Tonna AP Gould IM Stewart D A cross-sectional survey of antimicrobial stewardship strategies in UK hospitals Journal of clinical pharmacy and therapeutics 201439(5)516-20

bull SARI Hospital antimicrobial stewardship working group Guidelines for antimicrobial stewardship in hospitals in Ireland 2009

bull Health Information and Quality Authority National Standards for the Prevention and Control of Healthcare Associated Infection2009 Available from httpwwwhiqaiesystemfilesNational_Standards_Prevention_Control_Infectionspdf

bull The impact of a structured pharmacist intervention on the appropriateness of prescribing in older hospitalized patients OrsquoSullivan et al Drugs Aging 2014 Jun31(6)471-81 doi 101007s40266-014-0172-6

bull Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement Husereau D1 et al Value Health 2013 Mar-Apr16(2)e1-5 doi 101016jjval201302010

bull Health Service Executive Consolidated salary scales in accordance with Financial Emergency Measures in the Public Interest Act 2013

bull National Casemix Programme Ready Reckoner of Acute Hospital inpatient and daycase activity and costs (summarised by DRG) relating to 2011 costs and activity Health Service Executive 2013

References

SENATOR is a Collaborative Project funded by the European Commission under the 7th Framework Programme

Research GrantsAwards

stephenbyrneuccie

References Bereznicki LR Jackson SL Peterson GM Jeffrey EC Marsden KA Jupe DM Accuracy and clinical utility of the CoaguChek XS portable international normalised ratio monitor in a pilot study of warfarin home-monitoring J Clin Pathol 2007 60(3)311-314

Byrne S OrsquoMahony D Kennedy J and Ryan C The use of screening tools to identify potential inappropriate prescribing in the elderly in primary care British Pharmaceutical Conference Manchester - To be presented Sept 2008 International Journal of Pharmacy Practice 2008 (In Press)

Byrne S Ryan C OrsquoMahony D Weedle P Kennedy J and Aherne E Inappropriate Prescribing in the elderly a review of primary care and nursing home prescriptions Health Services Research and Pharmacy Practice Annual Meeting Liverpool 2008 International Journal of Pharmacy Practice 2008 Supp 1 No 16 A36-37

Fitzmaurice DA Gardiner C An evidence-based review and guidelines for patient self-testing and management of oral anticoagulation Br J of Haematol 2005 131156-165

Gallagher J OSullivan D McCarthy S Gillespie P Woods N OMahony D Byrne S Structured Pharmacist Review of Medication in Older Hospitalised Patients A Cost-Effectiveness Analysis Drugs Aging 2016 Apr33(4)285-94

Gallagher J Byrne S Woods N Lynch D McCarthy S Cost-outcome description of clinical pharmacist interventions in a university teaching hospital BMC Health Serv Res 2014 Apr 1714177

Gallagher P Ryan C Byrne S Kennedy J and OrsquoMahony D STOPP (Screening Tool of Older Personsrsquo potentially inappropriate Prescriptions) and START (Screening Tool to Alert doctors to Right ie appropriate indicated Treatment) Validation of new criteria for inappropriate prescribing in the elderly International Journal of Clinical Pharmacology and Therapeutics 2008 Vol 46 No 2 72-83

Gardiner C Williams K Mackie IJ Machin SJ Cohen H Patient self-testing is a reliable and acceptable alternative to laboratory INR monitoring British Journal of Haematology 2005 128(2)242-247

Hentrich DP Fritschi J Muller PR Wuillemin WA INR comparison between the CoaguChek(R) S and a standard laboratory method among patients with self-management of oral anticoagulation Thrombosis Research 2007 119(4)489

Ryan C OrsquoMahony D Kennedy J Weedle P Barry P Gallagher P and Byrne S Appropriate prescribing in the elderly An investigation of two screening tools Beers Criteria (Considering Diagnosis (CD) and Independent of Diagnosis (ID)) and Improved Prescribing in the Elderly Tool (IPET) to identify inappropriate use of medicines in the elderly in primary care in Ireland Journal of Clinical Pharmacy and Therapeutics 2008 (In Press)

Ryan F OrsquoShea S and Byrne S Managing Oral Anticoagulation Therapy Improving Clinical Outcomes A Review Journal of Clinical Pharmacy and Therapeutics 2008 (In Press)

Ryan F OrsquoShea S and Byrne S The reliability of point-of-care prothrombin time testing A comparison of CoaguChek Sreg and XSreg INR measurements with hospital laboratory monitoringrdquo International Journal of Laboratory Hematology 2008 (In Press)

Medication Optimisation in Older People

Structured pharmicist

intervention amp feedback

to prescribers

STOPPSTART

criteria

Routine monitoring

of high-risk patients

eg polypharmacy

(as with anticoagulation

Diabetes)

Structured monitoring

for ADErsquos in hospital and

community Patient education

information

Mandatory undergraduate

postgraduate education

in Geriatric Therapeutics

Cost containment

Best value drug

selection Electronic prescribing

mandatory audit of

prescribing practice

Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques

Medication Use Review

by pharmacist with full

access to patientsrsquo electronic

medical records

Declaration

Prof Stephen Byrne ndash Pharmaceutical Care Research Group School of Pharmacy University College Cork Ireland Co-inventorauthor of STOPPSTART criteria Have recevied Funding from the HRB and EU-FP7 EU-H2020 to investigate the impact of STOPPSTART v2 in older patients None other relevant to this talk

Internationally






Future Roles

The Patient

Chronic Disease

Management



Records

Health Screening



New Roles within

Primary Healthcare

Centers


Elderly

Co-agulation

Anti-microbials


Greying population




The older Person






Under-prescribing

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Internationally






Future Roles

The Patient

Chronic Disease

Management



Records

Health Screening



New Roles within

Primary Healthcare

Centers


Elderly

Co-agulation

Anti-microbials


Greying population




The older Person






Under-prescribing

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records






Future Roles

The Patient

Chronic Disease

Management



Records

Health Screening



New Roles within

Primary Healthcare

Centers


Elderly

Co-agulation

Anti-microbials


Greying population




The older Person






Under-prescribing

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records


Elderly

Co-agulation

Anti-microbials


Greying population




The older Person






Under-prescribing

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Greying population




The older Person






Under-prescribing

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records






Under-prescribing

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

MAI tool




















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



















Tool No of

instances

of PIP

No of

PIMs

of PIMs Mean

No Of

PIMs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

STOPP 1280 1140 137 16 518 708

STOPP (Excludin

g as required

medicines)

995 836 142 11 466 637


Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Tool No of

instances

of PPO

Mean

No Of

PPOs per

Resident

s

No Of

Residents

with PIP

Residents

with at

least one

instances

of PIP

START 614 08 419 571





admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records




admission


149 ndash 224 p lt 0001)



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



Objectives




Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Outcomes

Primary outcome


Secondary outcome










Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records







Recommendations

Recommendatio

ns accepted N

()
















Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records


Admissio

n

Follow-

up

Significance

(p)


medications (IQR) 15 (7-21) 12 (6-18) 0000




medications (IQR) 0 (0-1) 1 (0-3) 0000






Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



Primary outcome


Secondary outcomes



Outcomes







Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records






Control patients







bull 9 unavoidable

ADR Detection







Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records






Primary Outcomes


Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Secondary Outcomes















Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records










Cost

Component



SPRMCDSS

euro40

Non-consultant

hospital doctor

Per review of

pharmaceutical

care plan

euro506


hospital in

patient day

euro850


installation of

software

programme

euro1000



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



bull ICER= 119863119894119891119891119890119903119890119899119888119890 119894119899 119888119900119904119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752

119863119894119891119891119890119903119890119899119888119890 119894119899 119893119890119886119897119905119893 119890119891119891119890119888119905119904 119887119890119905119908119890119890119899 119901119903119900119892119903119886119898119898119890119904 1198751 119886119899119889 1198752



Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Outcomes

INTERVENTION

(N = 361)

CONTROL

(N = 376)


Total Cost (euro) 13242 (15530) 15465 (19310)


ADR Event 50 (1385) 78 (2074)


0

1

2

3

311 (8615)

40 (1108)

9 (249)

1(028)

298 (7926)

65 (1729)

12 (346)

0 (000)

Mean (SD) Mean (SD)

0169 (0456) 0242 (0503)

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

Outcomes



Incremental Cost



-815

(-3451 1820) (0544)

Incremental Effect



0655

(0431 0994) (0047)

Incremental Effect

No of ADR Events

Difference in Mean


-0064

(-0135 0008) (0081)




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records




(euro5000)

(euro4000)

(euro3000)

(euro2000)

(euro1000)

euro0

euro1000

euro2000

euro3000

euro4000

euro5000

-0200 -0150 -0100 -0050 0000 0050 0100 0150 0200 0250

Dif

feren

ce i

n e

ffects

Difference in costs






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records






Background





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records





Aim amp Objectives







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records







Methods






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records






Results



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



57 (2951)

82 (186273)

lt 0001


88 (4551)

98 (222226)

= 0001


69 (2029)

95 (177186)

lt 0001


24 (729)

67 (97145)

lt 0001




86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



86 (3642)

73 (162222)

= 0057


58 (2441)

76 (169222)

= 0019


52 (2242)

64 (143222)

= 0140





33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



33 (1751)

29 (66226)

056


29 (1551)

62 (138222)

lt 0001


25 (1351)

33 (74222)

0278


24 (1251)

24 (53222)

-





gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records




gentamicin protocol










Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records







Process issues











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records











Discussion
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records
















References



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records



stephenbyrneuccie
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records
















to prescribers

STOPPSTART

criteria

Routine monitoring


eg polypharmacy


Diabetes)




information




Cost containment

Best value drug


mandatory audit of


Clear overtly

documented

therapeutic

targets

Compliance

enhancement

techniques




medical records

the role of the pharmacist in optimising patient care ... · adverse drug reactions leading to an...

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