Clinical and economic benefits of hospital drug management rationalization

Introduction

Hospitals are health care facilities where significant drug expenditures are observed [1]. At the same time, the scale of medical and drug errors recorded in hospitals should be emphasized [2]. This phenomenon is observed in various parts of the world and is global in nature [3]. Pharmacotherapy errors have medical and economic consequences. Therefore, it is extremely important to highlight and address this issue.

In our earlier article, published in the Journal of Medical Economics, we outlined the areas of hospital drug management and how it can be optimized [4]. We have indicated there several solutions that may significantly influence the rationalization of the economy with drugs. However, it is important to pay attention to the medical and economic benefits of rationalizing hospital drug management, which is the aim of this article.

Rational use of drugs

The World Health Organization (WHO) defines the rational use of a drug as a guarantee that the patient will receive the drug appropriate for his clinical condition, in the right dose, at the right time, taking into account the global costs of therapy [5]. The global cost of therapy is influenced not only by the final price of the drug, but also by the costs of its storage, preparation, administration, and the costs of possible side effects. Each of these areas requires careful analysis to identify potentially ineffective activities carried out in hospitals. These activities can be improved using 5 methods identified by ours in the previous article:

1. Pharmacists and Drug and Therapeutics Committees (DTCs);

2. Clinical guidelines;

3. Drug and pharmacoeconomic analyses;

4. Hospital formulary and antibiotic policy;

5. Inventory management and technologies [4].

Importantly, these activities can be undertaken in various medical entities, regardless of the principles of the health care systems. Many of them are universal in character. In our opinion, such an approach to hospital drug management indicates that the main goal of the hospital in this area should be to increase the quality of pharmacotherapy, which at the same time will lead to a reduction in the costs of patients' treatment.

However, the provision of high-quality health services is an especially difficult task due to the unmet needs of patients. It results, in particular, from the increased number of chronic diseases and their complications, and at the same time from the limited resources of health care [5]. These situations are a challenge for healthcare, where it is especially important to make rational decisions aimed at obtaining the best effect for the patient (high-quality therapy) while minimizing the expenses incurred for the treatment.

Clinical benefits

Clinical outcomes

Rationalization of hospital drug management translates to a large extent into minimizing the risk of drug errors [6,7]. This is mainly related to the optimization of the selection of therapy for patients (based on diagnostic tests or identified comorbidities), greater readability of prescriptions and labels, reduction of errors at the stage of medical prescription, minimization of drug interactions, or the introduction of the principles of rational antibiotic therapy.

Many of these activities result from the implementation of specific procedures for the preparation, administration and monitoring of drug effects in patients. Automation of these activities is also of great importance, e.g. with the use of systems and devices supporting hospital drug management. Linkage of the system to Electronic Medical Records (EMRs) is necessary to fully use many functionalities of this type of system. Some of them are based on robotization and Artificial Intelligence (AI) algorithms. For example, a Danish study shows that the introduction of technologies to improve drug management reduced the number of medical errors by 57%, as a result of electronic prescription control, automatic preparation of drugs and their scanning before administration to the patient [8]. Another French study shows that the mere use of electronic medical orders, which are fully controlled by an advanced IT system, reduces the number of drug errors by 55% [9].

Numerous studies show that optimization of the selection of a drug for a particular patient based on its individual characteristics, test results and health condition leads to a reduction in the incidence of complications, shortening the hospitalization time of patients, or a reduction in the number of hospitalizations [10].

Importantly, it should also be emphasized that the introduction of standards or devices/systems that allow for at least partial automation of drug preparation, significantly affects the safety of the personnel preparing drugs, which is of particular importance, for example, in cytotoxic drug laboratories [11,12].

Humanistic outcomes

Surveys of patient satisfaction with medical services indicate that the most important elements providing high-quality care for patients is the time devoted to patients by the doctor or nurse. However, nearly 40% of patients in hospitals estimate that doctors do not spend enough time with them [13]. Rationalization of hospital drug management, in particular with the use of technologies supporting drug management, contributes significantly to the optimization of staff work. These activities allow nurses and doctors to devote more time to direct patient care, including care directly at the patient's bedside, and clinical pharmacists to start working in hospital wards as physicians' advisers. Many studies show that pharmaceutical care carried out by highly qualified pharmacists significantly contributes to the optimization of the effects of patient therapy [14].

Economic benefits

Irrational use of medicinal products, resulting both from improperly used medicine for a specific patient, errors in prescribing or administering drugs affects not only the medical aspects of the patient's treatment, but also entails additional costs of treatment, among others:

• additional costs related to extending hospitalization time;

• costs of treating the consequences of the occurring side effects associated with drug therapy and drug interactions (e.g. inflammation of the gastrointestinal tract);

• costs related to the need to extend the therapy, eg due to the use of mutually incompatible drug substances in the first-line treatment;

• costs of improperly administered antibiotic therapy, including unjustified use of these products (the so-called costs of wastage in health care) or costs related to the occurrence of antibiotic resistance in patients;

• costs resulting from incorrect planning of patients' therapy or the lack of treatment plans (e.g. in relation to medicinal products used in children, for which there is usually a need to use a lower dose of the drug (e.g. dividing a tablet), which in turn leads to the waste of a large amount of drugs).

Inadequately used pharmacotherapy may lead to the lack of the expected health effects in patients, often resulting in deterioration of health or death. In this context, it is necessary to emphasize the burden on health care systems (including public payers or insurers), which is associated with the need to incur additional costs due to improperly conducted pharmacotherapy, including the need for additional medical visits, re-hospitalizations or the purchase of additional medications [15]. As in the case of clinical benefits, when analyzing economic benefits, apart from the burden on the health care system, attention should be paid to the overall costs for the economy. These costs are associated with a reduction in productivity due to additional health problems for patients, or the burden on the social sector due to the payment of benefits as a consequence of longer incapacity for work.

Due to the use of safe and effective therapy, the rationalization of drug management can have significant economic benefits. For example, the ideal selection of drugs for patients allows for faster achievement of the expected effects of therapy, minimizing, for example, the risk of antibiotic resistance. In addition, it should be emphasized that savings resulting from, among others, by tightening the drug distribution chain, or reducing drug waste, e.g. due to expiry of the products [16].

It is also important to reduce fixed costs related to the purchase of drugs, reduce inventory levels, strictly control drug consumption (including control of drug consumption in hospital wards), achieve economies of scale as a result of centralizing drug preparation. Preparation of drugs by specialists, in appropriate conditions, using standards, and if possible, automatic or semi-automatic drug preparation allows not only to minimize mistakes in the field of pharmacotherapy, but also shortens the time of preparation of the drug. Attention should also be paid to the role of information systems that can determine the exact costs of treating patients in different therapeutic options, which provides the basis for making further rational case-cost decisions [17].

Hillestad et al. indicate, for example, that the use of information technologies increases the effectiveness of the functioning of medical entities and leads to an increase in savings in approximately 90% of entities [18].

Rational drug management, leading to savings, from which new investments can be financed, may therefore contribute to the development of medical entities. For example, it is possible to expand and equip departments, renovate admission rooms, etc., but also to hire highly qualified staff.

Conclusions

Care for providing clinically and cost-effective therapy should take place at every level of health care. However, the rationalization of pharmacotherapy in hospitals, where drugs are often administered routinely, without taking into account the costs or obtaining the best therapeutic effect in relation to the expenditure incurred, may be of particular importance.

The main strength of this article is to collect the clinical and economic effects of rationalizing drug management in one place, which, to our knowledge, has not been done so far. However, it seems to us that a significant benefit would be the presentation of specific data, e.g. savings resulting from the implementation of various types of solutions in various healthcare systems, which, due to the small amount of literature data, was not possible at this stage.

There are many methods of rationalizing hospital drug management. Many of them are aimed at reducing the number of potential drug errors. The effects of rationalization methods for hospital drugs relate to both clinical and economic benefits. Thus, the beneficiaries of these activities are both patients, as well as staff and managers of medical facilities. Identifying the benefits of rationalizing hospital drug management and disseminating this issue gives medical institutions a chance to motivate and take appropriate action.

Transparency

Declaration of funding

No funding was received to produce this article.

Declaration of financial/other relationships

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

Acknowledgements

None stated.