# Medication stewardship by clinical pharmacists in acute ischemic stroke care: a retrospective analysis of drug-related problem reduction and cost-saving outcomes

## TL;DR

Clinical pharmacists in China's stroke care reduced medication issues and hospital costs by optimizing drug use and shortening treatment durations.

## Contribution

Demonstrates that pharmacist-led medication stewardship in stroke care reduces drug-related problems and hospital costs under China's DIP payment system.

## Key findings

- Pharmacist care reduced antibiotic and PPI therapy durations and Ginkgolide injection use in AIS patients.
- Total hospitalization costs decreased by 10.4% with pharmacist intervention, alongside improved DIP settlement amounts.
- Regression analysis confirmed pharmacist intervention as an independent predictor of cost reduction and shorter hospital stays.

## Abstract

In China’s evolving Diagnosis-Intervention Packet (DIP) payment system, suboptimal medication practices in acute ischemic stroke (AIS) care exacerbate healthcare costs and antimicrobial resistance. This study evaluates the clinical and economic impacts of integrating clinical pharmacists into stroke care teams.

A single-center retrospective cohort study (May–September 2024) included 439 AIS patients (clinical pharmacist care group: n = 223, standard care group n = 216). The pharmacist care group received pharmacist-led medication stewardship, including therapy optimization, adverse drug reaction (ADR) monitoring, and DIP-aligned cost management.

Pharmacist care significantly shortened antibiotic therapy (6.83 vs. 8.93 days, P = 0.019) and proton pump inhibitor (PPI) duration (7.29 vs. 9.50 days, P < 0.001), while reducing Ginkgolide injection use (47.53% vs. 55.56%, P = 0.043). Total hospitalization costs decreased by 10.4% ($1,403 ± 595.2 vs. $1,566 ± 496.0), with improved DIP settlement amount ($660.2 vs. $554.4, P = 0.001). Regression confirmed pharmacist intervention as an independent predictor of reduced costs and shorter stays. Medical staff reported high satisfaction with pharmacists’ roles in medication safety (84.84%) but lower recognition of cost-saving efforts (64.19%).

Integrating clinical pharmacists into AIS care teams reduces drug-related problems (DRPs), shortens therapy duration and hospital stays, and lowers costs, supporting broader implementation in stroke management.