HPE HPE 85 – Spring 2017 - Page 31

Pharmacy practice Issue 85 | Spring 2017 As a complex intervention, that is, the inclusion of a wide range of elements within its delivery, then effective process evaluation would be required to tease out which elements of the service are effective. If MR is shown to be cost- effective then the same amount of resources used within the trial need to be available for service roll out. Introduction of simple non-patient focussed targets to ensure that the service is delivered may however be counterproductive and therefore need to be carefully considered before introduction. transition points may be preferable to provision at one transition point. Furthermore, an additional phone call post-discharge may be warranted. Perhaps of greater concern is the limited amount of high-quality evidence for the effectiveness of MR provided by hospital pharmacists within European hospitals. With heterogeneity in MR delivery with respect to the service provider and location of the service within the admission cycle, differences in service recipients, and the addition of other elements alongside MR that are known to be effective in themselves, it is also currently not possible to describe the best model of MR delivery. As MR delivery by pharmacists becomes ubiquitous and hospital pharmacy services become more sophisticated, the ability to perform high quality studies with clean well-defined interventions and true control arms diminishes. When evidence is pooled regarding very different MR services from a variety of healthcare systems, significant reductions in unnecessary post- hospitalisation resource utilisation are seen. The question, however, is not whether MR is required or works but whether the amount of resource that is required to effectively deliver the intervention justifies the outcome. Within all resource limited healthcare systems, it is important that services are provided to those with greatest need and not ubiquitously to all patients if this is likely to significantly increase costs without significantly improving outcomes. While it would seem to be common sense to strive towards providing MR within 24 hours to all patients to limit the amount of time that any patient is exposed to potential drug errors, setting of the target itself may result in unintended consequences. As with many government targets for healthcare providers, these are frequently chosen because they are easy to measure objectively, not because they are the most appropriate patient-oriented outcome. Targets of this nature can result in inappropriate local allocation of resources because service providers tasked to meet them may choose to focus the limited resources on all newly admitted patients which may include low-risk patients. If resources are focussed in this manner, then complex patients who are most likely to benefit may be missed or only receive limited amount of time from the pharmacist who is more focussed on seeing everyone and therefore must ration time accordingly. The effect of a target for 24 hours MR by hospital pharmacists for all patients may therefore be detrimental rather than helpful. The curr VB7FFRb"&W6V&6WW&V7F227V6FBvVƗGVF6FR&F֗6VB6G&V@G&2&Rv'&FVBBFB67BЦVffV7FfVW72bFffW&VBFV2`FVƗfW'6VB&RFWFW&֖VB&VfW&V6W0v&BVF&v旦FvW2f7B6VWCFPvW277W&rVF6F67W&7BG&6F0b6&SVF6W2&V66ƖF7FF&BW&Fp&6VGW&RwwrvBFVG6fWGVVFF6WF2vW2W2f7B6VWBFcV66W76VB&#r"VV"WBVffV7FfVW72b&67BV@VF6F&V66ƖF&w&W26Ɩ6WF6W2B7FG&6F377FVF2&WfWpBWFǗ62$ԢV#cb"S22"WBWrG&6fW"b6&RFFfR`VV7G&2&VfW'&g&7FF6VG&7VvCf&FfR6W'f6RWfVF$ԢV#cbS#S3"B6&VbWB77FVF2&WfWrbFPVffV7FfVW72B67BVffV7FfVW72bFW'fVF0VBB&WfVFrVF6FW'&"VF6W0&V66ƖFB7FF֗76FRVfW'6G`6VffVB6%%2F7FGWFRf"VF@6Ɩ6W6VV6R#wwrW&W67&&wFƶB6w6FVBWG2#2FVE6fWGVG077FVF5&WfWrFb66W76VB&#rRF&BWBf&W'BFWFfW7FvFF6W6W2b&W67&&rW''&'2'fVFFG&VW2&VFFFV"VF6VGV6FUT7GVGvVW&VF66V6ð#wwrv2V&rd&W'E&WfV6UE6W6W5e&W67&&uW'&'2Fe#3SSF`66W76VB&#rbw&RWB&W67&FW'&'2FVG27WFRVF676W76VBVB"62VF #s3s3^( 3r4VB4RVR֗F6V2fVRbVF6F&V66ƖF&VGV6rVF6FW'&'2F֗76F7F&&7B&W2#32n( 3ࣂ6VRWB7F7FVF6FF67&W6W3&WfV6RB6G&'WFrf7F'2&6FW&VB#ScRbC.( 3r࣒6&6WBVFVFVBVF6FF67&W6W2BFRFRb7FF֗76&6FW&VB#ScRBC#N( 32"WB676grB&VF7FrW'&'2`FVBVF6F&V66ƖFvVFW&V@##2CN( 3#"FRVFB6֗767gVb7Vv#VF6W2vVVB27F2F#wwrW&W67&&wFƶB6w6FVBWG2#2'7gV7Vv#Fb66W76V@&#r"FV"WB&W67&&rW'&'27FFVG3FV"6FV6RB6Ɩ66vf66RV6bVF6&R##B3C( 3B2FW'FVBbVFvVVBbVF6W2&W6W&6RF7W'BVVFFbFRvFW 7V7G2bVF6W2vVVBf"FRF6W'f6Rg&Wv&2f"F&WFW2&V6W'f6W2@rFW&6FF2#BB&WBFVƖrFRWV7FVBWB&VVfG0bFW'fVF2F&VGV6RFR'W&FVbVF6FW'&'2VF6W'b&W2Ɩ7#2"^( 3RF7FGWFRf"VFB6&RW6VV6RFV66FVB6fWG6WF2f"VF6W07F&7WW&R6У#