1: Ann Pharmacother. 2006 Apr;40(4):720-8. Epub 2006 Mar 28. 

Implementation of ward-based clinical pharmacy services in belgium--description
of the impact on a geriatric unit.

Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C.

School of Pharmacy, Universite catholique de Louvain, Brussels, Belgium.

BACKGROUND: Patient-centered clinical pharmacy services are still poorly
developed in Europe, despite their demonstrated advantages in North America and
the UK. Reporting European pilot experiences is, therefore, important to assess
the usefulness of clinical pharmacy services in this specific context.
OBJECTIVE: To report the results of the first implementation of Belgian clinical
pharmacy services targeting patients at high risk of drug-related problems.
METHODS: An intervention study was conducted by a trained clinical pharmacist
providing pharmaceutical care to 101 patients (mean age 82.2 y; mean +/- SD
number of prescribed drugs 7.8 +/- 3.5) admitted to an acute geriatric unit,
over a 7 month period. All interventions to optimize prescribing, and their
acceptance, were recorded. An external panel (2 geriatricians, 1 clinical
pharmacist) assessed the interventions' clinical significance. Persistence of
interventions after discharge was assessed through telephone calls. RESULTS: A
total of 1066 interventions were made over the 7 month period. The most frequent
drug-related problems underlying interventions were: underuse (15.9%), wrong
dose (11.9%), inappropriate duration of therapy (9.7%), and inappropriate choice
of medicine (9.6%). The most prevalent consequences were to discontinue a drug
(24.5%), add a drug (18.6%), and change dosage (13.7%). Acceptance rate by
physicians was 87.8%. Among interventions with clinical impact, 68.3% and 28.6%
had moderate and major clinical significance, respectively. Persistence of
chronic treatment changes 3 months after discharge was 84%. CONCLUSIONS:
Involving a trained clinical pharmacist in a geriatric team led to clinically
relevant and well-accepted optimization of medicine use. This initiative may be
a springboard for further development of clinical pharmacy services.

PMID: 16569792 [PubMed - in process]