title: A prospective, randomized trial to assess the cost impact of pharmacist-initiated interventions.
abstract: BACKGROUND
  Hospital pharmacists make many recommendations that improve patients' quality of care and/or reduce drug costs. While the impact of quality-of-care interventions is difficult to quantify, those limited to cost savings could be assessed in a prospective, randomized fashion.
  
  
  OBJECTIVE
  To assess the impact of pharmacist-initiated interventions on cost savings.
  
  
  METHODS
  Six pharmacists at a large university hospital recorded patient-specific recommendations for 30 days. All quality-of-care interventions were completed by the pharmacists, but those strictly aimed at reducing costs were stratified by drug class and randomized to an intervention or control group. Pharmacists contacted physicians with cost-saving recommendations in the intervention group, while control group patients were simply observed.
  
  
  METHODS
  Drug costs after randomization.
  
  
  RESULTS
  Most (n=967 [79%]) of the 1226 interventions recorded were aimed at improving quality of care. The remaining 259 (21%) provided equivalent quality of care, but at less expense. These cost-saving interventions typically involved streamlining therapy to less expensive agents (39%), discontinuing an unnecessary medication (25%), or modifying the route of administration (24%). The group randomized to receive a pharmacist's intervention had drug costs that were 41% lower than those in the control group (mean, $73.75 vs $43.40; P<.001). Interventions involving anti-infective agents had the greatest cost savings (mean, $104.08 vs $58.45; P<.001). For our institution, this extrapolates to an annual savings of approximately $394,000 (95% confidence interval, $46,000-$742,000). As expected, these interventions had no impact on length of hospital stay, in-hospital mortality, 30-day readmissions, or the need to readminister the targeted medication or restart intravenous therapy.
  
  
  CONCLUSIONS
  While interventions solely aimed at reducing costs represent a small portion of a pharmacist's activities, they can result in significant savings for an institution.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO 63110, USA. mcmullin@informatics.wustl.edu
authors.forename: S T
authors.initials: ST
authors.lastname: McMullin
authors.forename: J A
authors.initials: JA
authors.lastname: Hennenfent
authors.forename: D J
authors.initials: DJ
authors.lastname: Ritchie
authors.forename: W Y
authors.initials: WY
authors.lastname: Huey
authors.forename: T P
authors.initials: TP
authors.lastname: Lonergan
authors.forename: R A
authors.initials: RA
authors.lastname: Schaiff
authors.forename: M E
authors.initials: ME
authors.lastname: Tonn
authors.forename: T C
authors.initials: TC
authors.lastname: Bailey
mesh_terms: D003363:Cost Control; D016527:Drug Costs / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D011446:Prospective Studies; D014481:United States