Clinical pharmacology consultations and their implementation in clinical decision making

One of the key roles of clinical pharmacologists is to work as consultants for other medical specialties. We wanted to investigate the characteristics of clinical pharmacology consultations, compare the types of consultations from different specialties, and evaluate how well the recommendations given were followed.

Patient data files were assessed to collect demographic data, to determine the consulting medical specialty, origin of consultation, and to evaluate the characteristics of consultations. In a further analysis, subsequent actions were compared with recommendations provided in the consultation responses.

Of the 269 consultations queries, the majority originated from Helsinki University Hospital (57%). They mostly came from psychiatry (49%), general medicine (19%), and from other specialties (32%). The most frequent topic was adverse drug reactions (ADRs) in psychiatry and general medicine and drug interactions in other specialties. The proportion of ADR topics differed between psychiatry (50%) and other specialties (30%, p = 0.004) and drug interaction topics between other specialties (40%) and psychiatry (20%, p = 0.010). Questions related to the Anatomical Therapeutic Chemical class N (nervous system) appeared in 68% of cases. Consultation instructions were followed in 86% of cases, with only 3.3% classified as 'Instructions were not followed'. In the remaining consultation cases, it was not possible to evaluate adherence (8.6%) or the circumstances had changed so that the recommendation was not implemented (1.5%).

Analysis of patient data files indicates that clinical pharmacology consultations substantially affect how patients are treated. Furthermore, this service offers valuable clinical and scientific support for clinicians working independently.