The Economic Outcomes of Pharmacist Interventions at Critical Care Services of Private Hospital in Riyadh City, Saudi Arabia

Yousef Ahmed Alomi* , The Former General Manager of General Administration of Pharmaceutical Care. Former Head, National Clinical Pharmacy and Pharmacy Practice. Former Head, Pharmacy R&D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. Manal El-Bahnasawi, Head, Pharmacy Services Sulaiman Al-Habib Medical Group, Riyadh, SAUDI ARABIA. Alaa Elemam, Clinical Pharmacy Staff, Pharmacy Services, Sulaiman Al-Habib Medical Group, Riyadh, SAUDI ARABIA. Tasneem Shaweesh, Clinical Pharmacy Staff, Pharmacy Services, Sulaiman Al-Habib Medical Group, Riyadh, SAUDI ARABIA. Edmarie Janine Antonio, Clinical Pharmacy Staff, Pharmacy Services, Sulaiman Al-Habib Medical Group, Riyadh, SAUDI ARABIA.


INTRODUCTION
In the past several years during pharmacy strategic plan at the Ministry of Health (MOH) in Saudi Arabia. 1 There were several pharmacy practice programs established. 2 There were several measures tools to follow up the programs and measure clinical outcomes and cost avoidance in pharmacy and healthcare system. 1 Several previous studies across the world showed the reduction of the economic burden and save cost through pharmacist interventions with an emphasis on critical care services. [3][4][5][6][7] The pharmacist can prevent medications errors and reduce adverse drug reactions and consequences the cost avoidance. 5,6 Besides, the current site country conducted several investigations about the economic impact of the pharmacist at clinical services. They showed with drug information services, total parental nutrition services, critical care services, poisoning services. [8][9][10][11] The majority of the studies done at the governmental hospital. It is hard to find a study conducted at private institutions. 12 The aim of the study is to explore the economic outcome of pharmacist interventions at critical care department at the most prominent private hospital in Riyadh city, Saudi Arabia.

METHODS
It was a prospective cohort analysis from January to June 2016 in adults critical care unit. It was a thirty-bed critical care unit that consisted of trauma, medical, surgical and maternity critical care cases. Dr. Sulaiman Al-Habib Medical Group (HMG) is one of the largest healthcare providers in the Gulf Cooperation Council (GCC) Countries; currently there are 14 medical which are located in Saudi Arabia (Riyadh and Qassim) and in the UAE (Dubai). HMG is also developing one of the largest private medical cities in Saudi Arabia. In 1995, the core of the Medical Group of Dr. Sulaiman Al Habib was built in Olya area in the Saudi capital, Riyadh, with accordance to an advanced vision that applies the highest international healthcare standards; in providing fully integrated premium health services with a capacity of 241 beds. Furthermore, the complex comprises premium hospitals and clinics of fully integrated maternity hospital, bone, joint and spine surgery hospital, dermatology and plastic surgery centre, ophthalmology and laser/vision correction surgical centre, specialized infertility treatment and reproduction assistance centre. The pharmacies of HMG apply the new technological methods at all work phases. HMC Pharmacies have 4 in-patient pharmacy satellites and 3 outpatient pharmacies including the main. Pharmacies work 24/7 with an integrated team of 97 pharmacists with mutiple specialities. The pharmacy's work depends on the patient's medical record system as it helps the pharmacist to provide greater care and protection against the conflict between medicines, especially concerning chronic diseases. The pharmacist monitored all patients through daily medical round and documents any pharmacist intervention. The pharmacist intervention system used an international study model, measure level of activity, rational of clinical intervention, recommendation, patient outcome and pharmacoeconomic impact. The estimated cost avoidance of prevents drug-related problems. 13,14 The data was gathered and analyzed using the Monkey survey system.

RESULTS
The total number of pharmacist interventions were (1,222) provided to (1,124)

DISCUSSION
Many pharmacy practice programs founded during Pharmacy strategic plan. 1,15 That has included drug information services, medication safety program, pain management program, stewardship antimicrobial program and critical care program programs. [16][17][18][19] All those programs need to measure the impact and validate the cost requirement. The pharmacy administration at the ministry of health released key performance indicators to follow up and measure the clinical and economic impact of the program. The pharmacy strategic plan started implementation at private hospitals. Authors working at the most prominent private hospital in Riyadh city wish to measure the economic outcome of critical care pharmacy services. The findings should very high cost avoidance as the impact of pharmacist intervention at critical care services.  4 There are not any differences in the cost avoidance among gender because both of them received the same service without differences in the numbers. The majority of cost avoidance related to Saudi patient because most of the patients were Saudi. The findings showed high-cost avoidance from elderly patients that's would be excepted because the geriatrics had several diseases and needed medications and may be exposed to several mistakes and demand for close monitoring for prevention of them. Most of the cost avoidance as results from senior registrar prescriber more than consultant one. That is related to lower level of credential need more education and training related drug therapy. The highest cost avoidance of medications was from anti-infective agent, nutrition product and cardiovascular medications.                  That is similar what reported by Aljbouri TM. 12 Those medications highly interpreted by the pharmacist at critical care services with highly consequences problems and additional cost if they happened. The highest cost avoidance of type of interventions after other types was inappropriate dosing and TPN consultation. That is related to use of high-risk medications and expecting serious complications with the further incremental hospital of stay and high economic burden. The majority of cost avoidance leas to patients improved conditions that's a clear economic outcome of a pharmacist working at critical care services. The results showed that is most of the cost avoidance due to drug therapy cost related mistake prevention and reduced complications with the sequencing of reduction of hospitals stay. The type of cost calculation used was dosing adjustments related cost because of interventions related change dose or therapy duplication. The critical care pharmacist had a high economic impact of from very simple of pharmacy work-related interventions. We excepted higher cost if we include other services related setting guidelines, answering drug information inquiries and patients counseling services. The proving of a clinical pharmacist to critical care services at a private hospital is highly recommended in Riyadh city, Saudi Arabia.

CONCLUSION
The pharmacist plays a significant role at critical care services of the private hospital. The pharmacist condition improved, decrease drug therapy cost and patient length hospital stay. Expanding critical care pharmacist at a private hospital is highly recommended and appreciated in the Kingdom of Saudi Arabia.