دراسة أهمية مداخلات الصيدلة الإكلينيكية فى علاج مرضى السرطان

"THE IMPORTANCE OF CLINICAL PHARMACY INTERVENTIONS AMONG CANCER PATIENTS.

                                "A report from Institute of Medicine indicated that 44.000-98.000 patients die in hospitals each year as the result of medication errors.     Medication errors during cancer chemotherapy have led to tragic consequences and toxicities because of their low therapeutic index or a less than optimal therapeutic response.

To our knowledge, no studies have addressed the road to detecting and preventing medication errors by clinical pharmacy interventions in Egyptian cancer patients, so the Primary aims of this study were implementing pharmaceutical care service through developing a pharmaceutical care plan for each patient using DTAW sheet, determining the medication errors which necessitate clinical pharmacists’ interventions and evaluating the impact of clinical pharmacists’ interventions on the health care outcomes (clinical and economic outcomes).

While the study trying to achieve its primary aims a secondary aims were appeared which are; determining the medical staff’s response to drug information service, implementing patient education service and evaluating the clinical pharmacy service which was initiated at 1997, at National Cancer Institute, Cairo University.

A total of 200 patients were enrolled in these study 86 males and 114 females, 178 of the patients were adults and 22 were pediatrics.The patients were divided to two groups: Group A: is a control group, consists of 100 patients admitted to NCI for receiving their chemotherapy cycles without clinical pharmacy interventions and Group B: is the studied group, consists of 100 patients admitted to NCI for receiving their chemotherapy cycles with clinical pharmacy interventions.

This study was succeeded in detecting 3504 medication errors, 1956 of them detected in the control group and did not subjected to correction by clinical pharmacist. The other 1948 medication errors were detected in the studied group and subjected to clinical pharmacy corrections. The means of medication errors showed no statistically significant difference between the 2 groups before clinical pharmacy interventions.

The clinical pharmacy interventions reduced the number of medication errors from 1548 to 444 in the studied group and the difference of medication errors means before and after initiating the clinical pharmacy interventions was statistically significant (p=0.004).

A total of 1104 clinical pharmacy interventions were documented in this present study, 240 of them had an economic impact and led to reduction in the cost of treatment.

Forty two percent of clinical pharmacy interventions have led to increase in the efficacy of chemotherapy regimen, 36.5% have led to decrease in the chemotherapy toxicity, 3.2% have led to decrease in the cost of treatment and 18.5% have led to decrease in both toxicity and cost together.

The physician compliance to clinical pharmacy interventions was also detected by the present study. Ninety eight percent of clinical pharmacy recommendations were accepted by physicians 64.8% of them accepted directly, 4.2% accepted with notification, 28.9% accepted but couldn't be applicable and 2 % were rejected.

This study implemented pharmacist consultation's service through providing drug information service to the working staff detected the effectiveness of implementing patient education service to cancer patients and evaluated to what extent the clinical pharmacy service at NCI was succeeded in providing a real pharmaceutical care role."