Integrated pharmaceutical care model by unit-based clinical pharmacists: Implementation and clinical impact

TL;DR

This paper introduces a new model for clinical pharmacists in China to improve medication safety and reduce antibiotic use despite staffing shortages.

Contribution

The study proposes a scalable hybrid model for unit-based clinical pharmacists to address staffing gaps and improve antimicrobial stewardship.

Findings

Antimicrobial use density decreased by 9.3% after implementation of the hybrid model.

Pharmacist-patient interactions increased 3.3-fold, and adverse drug reaction reports rose by 79.4%.

Seven cases demonstrated the model's effectiveness in resolving critical drug therapy issues.

Abstract

In response to China's National Health Commission mandates promoting unit-based clinical pharmacists, healthcare institutions face severe workforce shortages, creating a critical policy-resource disparity.

This study aimed to implement and evaluate a hybrid unit-based clinical pharmacist model in respiratory wards to address this gap.

A structured workflow was implemented, integrating morning clinical activities (joint physician-pharmacist rounds, medication reconciliation, and real-time interventions) with afternoon analytical tasks (medication order surveillance). The model was evaluated quantitatively from 2021 to 2024.

Post-implementation, antimicrobial use density dropped from 114.43 to 103.82 DDDs/100 patient-days (a 9.3 % reduction), dual antimicrobial therapy fell from 29.89 % to 11.34 % (a 62.1 % reduction), and pharmacist-patient interactions rose 3.3-fold. Medication safety was enhanced, with adverse drug reaction reports growing from 34 to 61 (a 79.4 % increase). Seven representative cases illustrated the resolution of critical drug therapy issues, demonstrating the framework's capacity to augment stewardship and safety despite staffing constraints.

The hybrid model provides a scalable framework for hospitals addressing the clinical pharmacy staffing gap in China. By strategically allocating limited pharmacist resources, it enhances antimicrobial stewardship and medication safety while complying with national reforms.

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