The role of clinical pharmacist in the clinical pathway of acute
exacerbations of chronic obstructive pulmonary disease (AECOPD)
Abstract
Background: Clinical pharmacists play a significant role in clinical
practice, but their work in the clinical pathway (CP) of acute
exacerbations of chronic obstructive pulmonary disease (AECOPD) remains
undefined. Objective: To study the role of clinical pharmacists in the
CP of AECOPD. Methods: This prospective study included patients who met
the discharge criteria during hospitalization at the department of
respiratory medicine of the Second Affiliated Hospital of Fujian Medical
University from March to December 2017 (no pharmacists involved) and
from March 2018 to January 2019 (pharmacists involved). The Adverse Drug
Reaction (ADR) reporting rate, antimicrobial use intensity, the per
capita cost of pharmaceutical services, and the benefit-cost ratio (B/C)
were analyzed. Results: Eighty participants were enrolled during the
traditional period and 85 during the clinical pharmacist period. The
average hospital stays (9.2±0.4 vs. 10.7±0.6 days, P=0.032), the total
cost of treatment (14,058±826 vs. 18,765±1434yuan, P=0.004), the total
cost of drugs (5717±449 vs. 8002±755yuan, P=0.004), and cost of
antimicrobial drugs (3639±379 vs. 5636±641yuan, P=0.007) were all lower
in the clinical pharmacist group than in the traditional group. The B/C
was 10.38 and 5.05 in the intervention and traditional groups,
respectively. The clinical pharmacists’ participation was independently
associated with the total hospitalization expenses (β=-0.201, 95%
confidence interval: -0.390-0.055, P=0.010). Conclusion: The
participation of the clinical pharmacist in the implementation of an
AECOPD CP significantly reduces patients’ hospitalization days,
healthcare expenses, and antibiotic use and improves the B/C of AECOPD
management. The clinical pharmacists’ participation was independently
associated with the total hospitalization expenses.