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Clinical pharmacist impact on care, length of stay, and cost in pediatric cystic fibrosis (CF) patients
Author(s) -
Cies Jeffrey J.,
Varlotta Laurie
Publication year - 2013
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22745
Subject(s) - medicine , cystic fibrosis , dosing , pharmacokinetics , retrospective cohort study , cohort , therapeutic drug monitoring , pharmacist , clinical pharmacy , gastroenterology , pharmacodynamics , pharmacy , family medicine
Abstract Background Cystic fibrosis (CF) patients are often treated with aminoglycoside (AG) antibiotics during infective pulmonary exacerbations. Achieving pharmacokinetic and pharmacodynamic (PK/PD) targets to improve outcomes and counteract resistance is paramount. Purpose The primary objective was to compare the number of pediatric CF patients achieving AG PK/PD targets when a clinical pharmacist (CP) managed therapeutic drug monitoring (TDM) compared with usual care (UC). Methods A retrospective cohort study was conducted on the records of 40 CF patients that received AGs and ≥2 serum samples between 1/2007 and 5/2009. Chi‐square and Student's t ‐test were used to analyze nominal and continuous variables, respectively. Results Twenty‐nine patients with 52 courses of AGs were included the CP group, and 22 patients with 42 courses were included the UC group. Ninety‐eight percent of patients in the CP group reached AG PK/PD targets compared with 71% in the UC group, P < 0.001. Patients in the CP group reached the AG PK/PD target in a mean of 1.9 ± 0.8 days compared with 4.8 ± 3.4 days in the UC group, P < 0.0001. The average LOS in the CP group was 9 ± 5 days compared with 12 ± 7.5 days in the UC group, P = 0.033. The mean number of levels per patient was 2.7 in the CP group compared with 5.2 (range of 2–20) in the UC group, P < 0.001. Resource utilization associated with drug levels, dosing adjustments and LOS were $26,549, $14,069, and $1,680,000 in the CP group as compared with $40,683, $27,812, and $1,940,000, respectively, in the UC group. Conclusion CP managed TDM resulted in a significantly higher percentage of pediatric CF patients achieving AG PK/PD targets 3 days sooner with an average LOS that was 3 days shorter. CP managed TDM resulted in significantly fewer dosage adjustments, drug levels, and cost associated with serum sampling, drug wastage, and LOS. Pediatr Pulmonol. 2013; 48:1190–1194. © 2012 Wiley Periodicals, Inc.