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Implementation of Ward-Based Clinical Pharmacy Services in Belgium—Description of the Impact on a Geriatric Unit

Research Fellow Center for Clinical Pharmacy, School of Pharmacy, Université catholique de Louvain, Brussels, Belgium

Soraya Dhillon, PhD MRPharmS

Foundation Professor and Head School of Pharmacy, University of Hertfordshire, UK

Louise Mallet, PharmD

Associate Clinical Professor and Clinical Pharmacist in Geriatrics, Faculty of Pharmacy, Université de Montréal, and McGill University Health Center, Montréal, QC, Canada

Paul M Tulkens, MD PhD

Professor of Pharmacology and Pharmacotherapy, Center for Clinical Pharmacy, School of Pharmacy, Université catholique de Louvain

Léon Wilmotte, MPharm

Chief Pharmacist, Center for Clinical Pharmacy and Cliniques Universitaires Saint-Luc, Université catholique de Louvain

Christian Swine, MD

Professor in Geriatrics and Gerontology, Center for Clinical Pharmacy and Department of Geriatric Medicine, Mont-Godinne University Hospital, Yvoir, Belgium

Reprints: Ms. Spinewine, Center for Clinical Pharmacy, School of Pharmacy, Université catholique de Louvain, UCL 73.70 Avenue E. Mounier, 73, 1200 Bruxelles, Belgium, fax 32/2/764.73.73, anne.spinewine{at}facm.ucl.ac.be

BACKGROUND: Patient-centered clinical pharmacy services are still poorly developed in Europe, despite their demonstrated advantages in North America and the UK. Reporting European pilot experiences is, therefore, important to assess the usefulness of clinical pharmacy services in this specific context.

OBJECTIVE: To report the results of the first implementation of Belgian clinical pharmacy services targeting patients at high risk of drug-related problems.

METHODS: An intervention study was conducted by a trained clinical pharmacist providing pharmaceutical care to 101 patients (mean age 82.2 y; mean ± SD number of prescribed drugs 7.8 ± 3.5) admitted to an acute geriatric unit, over a 7 month period. All interventions to optimize prescribing, and their acceptance, were recorded. An external panel (2 geriatricians, 1 clinical pharmacist) assessed the interventions' clinical significance. Persistence of interventions after discharge was assessed through telephone calls.

RESULTS: A total of 1066 interventions were made over the 7 month period. The most frequent drug-related problems underlying interventions were: underuse (15.9%), wrong dose (11.9%), inappropriate duration of therapy (9.7%), and inappropriate choice of medicine (9.6%). The most prevalent consequences were to discontinue a drug (24.5%), add a drug (18.6%), and change dosage (13.7%). Acceptance rate by physicians was 87.8%. Among interventions with clinical impact, 68.3% and 28.6% had moderate and major clinical significance, respectively. Persistence of chronic treatment changes 3 months after discharge was 84%.

CONCLUSIONS: Involving a trained clinical pharmacist in a geriatric team led to clinically relevant and well-accepted optimization of medicine use. This initiative may be a springboard for further development of clinical pharmacy services.

Key Words: Belgium, clinical pharmacy, drug-related problems, frail elderly, pharmaceutical care

Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G515

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