A systematic review of the costs and cost-effectiveness of clinical pharmacists on hospital ward rounds.

ABSTRACT

Introduction: There is a lack of good quality economic evidence for the inclusion of pharmacists on hospital ward rounds in addition to, or as an alternative to, traditional ward-based clinical pharmacy services. There has been no systematic review of the cost or cost-effectiveness of pharmacists attending and contributing on ward rounds.

Areas covered: A literature search was conducted in Medline, Embase, Cochrane, and CINAHL and reported in accordance with the PRISMA guidelines in May 2019. As well, a search using Google Scholar and a targeted hand search were undertaken. Studies that reported any estimate of the cost or cost-effectiveness were included if pharmacist participation on inpatient hospital ward rounds was the predominant focus of the intervention. The identified studies were subsequently screened by three reviewers who extracted data on their clinical and economic design. A bias assessment was completed using the ROBINS-I tool.

Expert opinion: Seven studies were identified investigating a clinical pharmacist’s inclusion on hospital ward rounds where there was a cost estimated. However, none were deemed to be a full economic evaluation and all were found to be open to a serious risk of bias. Future evaluations should include a comparator group and investigate the cost and cost savings of the service, alongside their clinical outcomes.

KEYWORDS:

• Pharmacy
• cost
• cost effectiveness
• hospital
• pharmacist
• ward round
• medication
• clinical care

Article Highlights

• Evidence indicates that clinical pharmacy services in hospital settings, and specifically on ward rounds, improves clinical care.

• This systematic review identified few studies that provide economic evidence indicating the value of clinical pharmacy services on hospital ward rounds, highlighting a lack of research related to the costs or cost-effectiveness of this intervention.

• Future evaluations should include a comparator group and investigate the cost and cost savings of the service, alongside its outcomes. Early input to study protocols by a health economist may support this to occur.

Acknowledgments

Gold Coast Hospital and Health Service library staff for assisting with search strategy development.

Author contribution statement

All co-authors made a significant contribution to the initiation and development of the study design and research goals. BM, IC, and JW participated in the systematic review, interpretation and preparation of the manuscript. All co-authors contributed to writing, editing, and approval of the final paper.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Search Strategy May 2019

Medline Ovid

1     Pharmacy Service, Hospital/

2     Pharmacy/

3     Pharmacists/

4     exp Pharmaceutical Services/

5     pharmac*.tw.

6     or/1-5

7     exp Patient Care Team/

8     (“patient care” adj3 team*).tw.

9     Teaching Rounds/

10     (round* adj3 (attending or grand or morning or bedside or interdisciplinary or ward or teaching or team)).tw.

11     or/7-10

12     6 and 11

13     exp “Costs and Cost Analysis“/

14     Economics, Pharmaceutical/

15     economics, hospital/ or hospital costs/

16     (economic* or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic*).tw.

17     (value adj3 money).tw.

18     budget*.tw.

19     or/13-18

20     12 and 19

21     limit 20 to english language

22     remove duplicates from 21

Cochrane

#1 MeSH descriptor: [Pharmacy Service, Hospital] explode all trees

#2 MeSH descriptor: [Pharmacy] explode all trees

#3 MeSH descriptor: [Pharmacists] explode all trees

#4 MeSH descriptor: [Pharmaceutical Services] explode all trees

#5 pharmac*:ti,ab,kw (Word variations have been searched)

#6 #1 or #2 or #2 or #4 or #5

#7 MeSH descriptor: [Patient Care Team] explode all trees

#8 “patient care” near/2 team*:ti,ab,kw (Word variations have been searched)

#9 MeSH descriptor: [Teaching Rounds] explode all trees

#10 round* near/2 (attending or grand or morning or bedside or interdisciplinary or ward or teaching or team):ti,ab,kw (Word variations have been searched)

#11 #7 or #8 or #9 or #10

#12 #6 and #11

#13 MeSH descriptor: [Costs and Cost Analysis] explode all trees

#14 MeSH descriptor: [Economics, Pharmaceutical] explode all trees

#15 MeSH descriptor: [Economics, Hospital] explode all trees

#16 MeSH descriptor: [Hospital Costs] explode all trees

#17 economic* or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic*:ti,ab,kw (Word variations have been searched)

#18 “value” near/2 money:ti,ab,kw (Word variations have been searched)

#19 budget*:ti,ab,kw (Word variations have been searched)

#20 #13 or #14 or #15 or #16 or #17 or #18 or #19

#21 #12 and #20

CINAHL

Table

EMBASE

Additional information

Funding

This paper was not funded.