Implementation and evaluation of clinical pharmacy services through quality improvement in a Tertiary Hospital in Malawi

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JACCP Journal of the American College of Clinical Pharmacy


Background: Clinical pharmacy services have been shown to improve patient outcomes, cost savings, and rational use of medications, yet there has been a slow transition from product-focused to patient-focused pharmacy practice in many low-income countries. Objective: The purpose of this study was to describe the implementation of a ward-based clinical pharmacy program using quality improvement methods in a 1000-bed tertiary hospital in Malawi and measure its associated impact on prescribing practices. Methods: This was a post-test only design with a nonequivalent control group evaluating the impact of a ward-based clinical pharmacy program. The program was implemented in the female adult medical ward using 1-month Plan-Do-Study-Act cycles. Data were collected on the number of clinical pharmacy recommendations and acceptance rate. Outcome measures were collected in the intervention ward and a corresponding control ward and evaluated changes in prescribing habits across rational prescribing and antimicrobial prescribing. Data were collected over time and plotted on run charts. Logistic regression was used to examine differences in the trend in probability of rational prescribing and antimicrobial prescribing. Results: Over 5 months, 321 clinical pharmacy recommendations were made and 67% were adopted by the medical team for implementation. For the intervention ward compared with the control ward, there was a significantly greater increase in probability of rational prescribing (P =.04), but no significant differences in antimicrobial prescribing (P =.48). Conclusions: This study demonstrated a positive impact on rational prescribing as a result of ward-based clinical pharmacy services in a low-income country. This study can be used to inform development or improvement of clinical pharmacy services in other low-income settings.

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