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SCALING UP A CLINICAL PHARMACISTS’ SERVICE TO IMPROVE MEDICATION ADHERENCE IN POLAND: FROM PILOT TO NATIONAL STRATEGY

European Statement

Clinical Pharmacy Services

Author(s)

Kamila Urbańczyk1,2, Przemysław Kardas3, W. Witkiewicz1, A. Hogg4, M. Scott4, A. Wiela-Hojeńska2
1) Department of General, Vascular and Oncological Surgery, Regional Specialist Hospital in Wroclaw
2) Department of Clinical Pharmacology, Wroclaw Medical University
3) Medication Adherence Research Center, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
4) Medicines Optimisation Innovation Centre, Antrim, Northern Ireland

Why was it done?

Clinical pharmacy services are poorly developed in Central and Eastern Europe [1]. One of the consequences of this fact is that medication adherence remains insufficiently addressed in these countries. This leads to poorer health outcomes, preventable hospitalisations, and significant costs. In Poland, legislative change is needed to introduce such services, but decisions require solid evidence. Therefore, a pilot clinical pharmacists’ service was launched to provide an objective assessment of its value.

What was done?

A pilot randomised controlled trial was carried out at the Regional Specialist Hospital in Wroclaw. Patients admitted to vascular and general surgery wards were assigned to either standard care or an integrated medicines management (IMM) service. The IMM model comprised medicines reconciliation and review at admission, inpatient monitoring and counselling, and reconciliation with education at discharge, followed by post-discharge follow-up at 1, 3, and 6 months.

How was it done?

Sixty patients were randomised, and 58 completed follow-up. Clinical pharmacists identified drug related problems, intervened, and collaborated with physicians to optimise pharmacotherapy. Outcomes included unplanned healthcare visits, length of stay, appropriateness of treatment, and economic impact.

What has been achieved?

Patients in the IMM group had significantly fewer additional healthcare visits (6 vs. 39; p<0.05) and shorter hospital stays (median 5 vs. 7 days; p=0.0372). Pharmacists identified 273 drug- related problems, and all interventions were accepted by physicians. Medication appropriateness improved markedly during hospitalisation. Economic analyses showed substantial savings through reduced hospitalisations, shorter stays, and optimised treatment, with a favourable cost–benefit ratio. Patients and healthcare professionals valued the service positively.

What next?

The pilot demonstrated clinical, economic, and organisational benefits of pharmacist-led services in Poland. These results confirmed their feasibility and relevance. The findings are currently being used by the Parliamentary Group for Improving Medication Adherence. There is an intention to incorporate the services of clinical pharmacists into the national strategy for the management of medication adherence currently being designed in Poland. Proposed legislative alterations are expected to create political and professional momentum to scale up the initiative nationally.

PAUSING NON-CRITICAL MEDICATION DURING SHORT HOSPITALIZATION

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European Statement

Clinical Pharmacy Services

Author(s)

Arnela Boskovic
Gitte Stampe Hansen

Why was it done?

To ensure rational use of medicines during the acute phase of illness, an interdisciplinary group consisting of physicians, nurses, pharmacists, and the Hospital Pharmacy was initiated to determine if some medicines could be paused during shorter hospital admissions at The Medical Acute Care Unit, Bispebjerg Hospital.

What was done?

Patients in acute phase of illness may experience fatigue, nausea, swallowing difficulties, and cognitive challenges when faced with large amounts of oral medicine. Therefore, prioritizing life-critical medicines during hospitalization is essential, while non-critical medicines could temporarily be paused. Additionally, there is often medicine waste, where drugs are assumed to be administered but remain untouched on the bedside table. In acute care units with complex patients, optimizing nursing time, shelf space in the medicine room and managing costs is crucial for appropriate medication.

How was it done?

Information about the new practice was given via newsletters, oral presentations, and signs at the doctor offices and in the medicine room. The group identified statins, multivitamins and calcium supplements as non-critical, and these were hereafter removed from the shelves in the medicine room. The interdisciplinary division of roles were as follows; Physicians: Prescribe critical medicine and temporarily pause non-critical medicine; Nurses: Do not administer statins, multivitamins, or calcium supplements. If the prescription has not been paused, request the physician to do so; Pharmacists: Assist in pausing non-critical medicines; Hospital Pharmacy: Ensure availability of the correct medicine in the medicine room.

What has been achieved?

Temporarily pausing statins, multivitamins, and calcium supplements during short hospitalization led to minimizing medicine waste and freed up time for the nurses to do other nurse-specific tasks. Medicine administrations by nurses were reduced by 87-96%. It also resulted in optimized space in the medicine room, making space for more critical medicine such as medicines to treat epilepsy and Parkinson’s disease.

What next?

Expanding the list of non-critical medicine during short hospitalizations is in the pipeline. This will be done by interdisciplinary collaboration and will free up time for the nurses and doctors to focus on the acute care of the patient.