Cost savings and avoidance from clinical interventions.

A method that lets a pharmacy department collect data on cost savings and avoidance achieved through pharmacist interventions is described. The pharmacist intervention program at an 849-bed institution is based on the pharmacist's evaluation of the patient, the disease or condition, and the appropriateness of the drug therapy selected. The pharmacist records the recommendation, the rationale, and the intervention outcome, and the data are entered into the medication order-entry system. An assigned code indicates the potential severity of consequences had the intervention not been made. The information is forwarded to the clinical interventions and financial assessment committee (CLIFAC) for analysis of cost savings and potential cost avoidance. To calculate savings, CLIFAC determines the drug acquisition and relevant laboratory costs that would have been charged, as well as the cost of a change in therapy. A method was developed that allows CLIFAC to use hospital-specific diagnosis-related-group data to determine potential cost avoidance as a function of hospital days prevented. From July 1994 through April 1995, 4648 interventions were documented by the 50-member inpatient and ambulatory care pharmacist staff and evaluated and quantified. Of these interventions, 87% were accepted by the medical staff. The accepted interventions represent a net therapy cost saving of $487,833, as well as a cost avoidance of $158,563 achieved by prevention of a potential net 371.9 additional hospital days. A pharmacy department's financial assessment committee evaluated pharmacist interventions by determining changes in the cost of therapy and estimating potential changes in the length of stay.

Designing drug-usage evaluation to meet Joint Commission requirements.

Strategies for influencing prescribing practices utilizing the drug-usage evaluation (DUE) process are described. Our DUE program has evolved into a collaborative program that provides significant pharmacy involvement while maintaining medical staff responsibility, as outlined by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). A multidisciplinary approach is utilized to identify prescribing problems, develop prescribing criteria, and provide educational initiatives. Pharmacists provide drug therapy monitoring, engage in clinical interventions, and document the outcomes of these interventions. DUE pharmacists report results of these initiatives to the medical staff and quality assessment program. Physician performance compliance is incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics Subcommittee, with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs, while meeting Joint Commission standards.

Use of decision analysis to evaluate the costs and benefits of filgrastim (G-CSF) therapy.

The FDA's approval of filgrastim (granulocyte colony-stimulating factor [G-CSF]) for accelerated recovery of neutrophil counts following chemotherapy has prompted discussions regarding the cost and benefits associated with such expensive new therapies. One method to evaluate the cost effectiveness of a therapy is decision analysis, which provides a quantitative method of cost analysis. Using the principles of decision analysis, we created a decision-analysis tree for evaluating the cost effectiveness of G-CSF therapy. Based on data gathered from a retrospective review of ambulatory oncology patients, we found that routine administration of G-CSF to all outpatients receiving chemotherapy is not cost effective, although it would be justifiable for some patients.

Influencing prescribing practices and associated outcomes utilizing the drug use evaluation process.

Influencing prescribing practices and the implementation of pharmaceutical care utilizing the drug use evaluation (DUE) process at a 891-bed teaching hospital are described. The DUE program has been structured to provide for significant pharmacy involvement while maintaining medical staff responsibility as outlined by the Joint Commission on Accreditation of Healthcare Organizations. A multidisciplinary approach is used to identify problems and develop prescribing criteria and educational initiatives. Pharmacists provide drug therapy monitoring and engage in clinical interventions and documentation of outcomes on a daily basis. DUE program pharmacists help target possible interventions, assure monitoring and outcome documentation, and compile results of all initiatives for reporting purposes to the medical staff and quality assessment program. Specific performance compliance and problems are identified and incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics (P&T) Subcommittee with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs and improves patient outcomes.