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Impact of medical and pharmaceutical interventions on anti-infective prescriptions: an observational study
Emma Pinet1, P Sabatier2,3, M P Fernandez-Gerlinger4
1Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 75015, Paris, France. emma.pinet@wanadoo.fr.
Abstract:
Appropriate prescribing of anti-infectives is a public health challenge. In our hospital, clinical microbiologists (clinical microbiology mobile unit, UMMc) and clinical pharmacists (clinical pharmacy, PHAc) carry out interventions on anti-infective prescriptions to improve practices. Our main objective was to evaluate the acceptance of UMMc and PHAc interventions on anti-infective prescriptions by quantifying the rate of prescription change 24 h after intervention. The secondary objective was to characterize the type of intervention and associate the rate of change for each. All prescriptions are computerized, and interventions traced via DxCare® software, which feeds a local data warehouse (HEGP-CDW). This descriptive, retrospective, single-center, uncontrolled study was conducted from January 2015 to December 2018. The data were extracted over this period from the data warehouse and analyzed using R software. UMMc interventions were accepted 72.2% of the time and PHA interventions 87.3%. The types of interventions found were mostly dose adjustments (61.1% for the UMMc and 54.2% for the PHAc) and proposals to change or stop a drug. Interventions have an impact on anti-infective prescriptions and are generally followed by clinicians. For the category "discontinuation of a molecule", almost half of the advice from the UMMc was refused. The collaboration between the UMMc and PHAc should be reinforced to improve acceptance.
Insights
Clinical pharmacists
Area of Science:
- Pharmacology
- Infectious Diseases
- Public Health
Background:
- Appropriate anti-infective prescribing is a critical public health concern.
- Clinical microbiologists (UMMc) and clinical pharmacists (PHAc) implement interventions to optimize anti-infective use.
- Intervention acceptance rates are crucial for evaluating their effectiveness.
Purpose of the Study:
- To assess the acceptance rate of interventions made by UMMc and PHAc on anti-infective prescriptions.
- To characterize intervention types and their impact on prescription changes.
- To identify factors influencing intervention acceptance.
Main Methods:
- A retrospective, single-center study analyzing computerized prescriptions from January 2015 to December 2018.
- Data extracted from a local data warehouse (HEGP-CDW) and analyzed using R software.
- Quantified prescription changes 24 hours post-intervention and intervention types.
Main Results:
- UMMc interventions were accepted 72.2% of the time; PHAc interventions achieved 87.3% acceptance.
- Dose adjustments constituted the majority of interventions for both UMMc (61.1%) and PHAc (54.2%).
- Refusal rates were higher for 'discontinuation of a molecule' recommendations from UMMc.
Conclusions:
- Clinical pharmacist and microbiologist interventions significantly impact anti-infective prescribing practices.
- Higher acceptance rates for PHAc suggest potential for improved collaboration.
- Reinforcing collaboration between UMMc and PHAc is recommended to enhance intervention acceptance and optimize anti-infective therapy.
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