Category: Federal Forum Posters
Purpose: Cognitive pharmaceutical services have been considered as one of the sustainable interventions by the efficient use of resources with the provision of satisfied outcomes for patients with complicated conditions, such as hospital-acquired infections in ICU worldwide. To encourage the comprehensive engagement by the pharmacists, the fee for cognitive pharmaceutical services in ICU have been covered by the reimbursement trial scheme for the first time in Taiwan on 2019/01. The purpose of this study was to elucidate whether the new reimbursement improves the patient and financial outcomes via clinical pharmacists' performances in an ICU level from the hospital perspective in Taiwan.
Methods: A Markov decision model with six different states, including (1) critical patients in ICU ≥ 2 days, (2) HAI in ICU (transit state), (3) adverse drug reactions (ADR) in ICU, (4) ward patients, (5) discharge with out-patient services, (6) death, was developed to model the HAI among critically-ill patients, transferred from ICU to ward, in a Taiwanese medical center. Because of the clinical consideration, each cycle for this Markov decision model is 7 days and run for a year (52 cycles). The comparative probabilities and effects, such as mortality rate (12.78% and 9.62%), HAI (0.36% and 0.32%), length of stay (6.91 days and 7.32 days) and ADR (7.01% and 7.04%), were received from the Database of Taipei Veterans General Hospital (VGHTPE) between 2018/01-03 and 2019/01-03. The numbers of medication errors, ADR and types of pharmacy notes were evaluated as clinical pharmacists’ performances. In addition, both of the direct and indirect medical costs were received from the National Health Insurance Administration (NHIA), Taiwan. All costs and effects were discounted at a rate of 3%. The Incremental Cost Effectiveness Ratio (ICER) for the new reimbursed cognitive pharmaceutical services compared to previous services. The Microsoft Excel 2019 is used to build the model.
Results: A cost-effectiveness analysis was performed for comparison between the new reimbursed cognitive pharmaceutical services and previous services for critical patients stayed in ICU more than 2 days. During the surveyed period of time, our pharmacists have increased their volume of bed-side services by documenting pharmacy notes in our electronic medical record system by 4 times with structured format as SOAP (n1=36 vs. n2=144). The medication problems, including medication errors and ADRs, that can be prevented by reimbursed cognitive pharmaceutical services (11 NTD per ICU patient-day) were about 6 cases during the surveyed period of time. After we evaluated the ICER, it showed that in order to prevent a medication problem by involving the clinical pharmacists in an ICU level would cost around 1157.6 NTD, which is significantly lower than the willing-to-pay threshold in Taiwan. In addition, when the clinical pharmacists are involved in the integrated medical team in ICU, patient outcomes can also be significantly improved by reducing the mortality rate from 12.78% to 9.62% as well as the HAI risk from 2.51% to 2.38%.
Conclusion: The Reimbursement for the cognitive pharmaceutical services is a successful strategy to enhance patent safety and to achieve sustainably cost-effective intervention for critically-ill patients in an ICU level. With aggressively approaches by the clinical pharmacists, it can significantly improve the patients’ clinical outcomes from mortality rates, risk of HAI and also the financial burden to the hospital. Thus, based on the experiences in VGHTPE, it should be taken in account as a regular reimbursement for these services in the future.