title: Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency.
abstract: OBJECTIVE
  Compared to the general population, chronic kidney disease patients are more vulnerable to gastrointestinal haemorrhage and its morbidity and mortality. Due to the fear of gastrointestinal bleeding consequences in these patients on the one hand, and the perception of general safety of acid suppressive medications on the other hand, inappropriate stress ulcer prophylaxis (SUP) seems to be encountered in nephrology wards. The objectives of this study were to evaluate appropriateness of acid suppression therapy in kidney disease patients and to assess the role of clinical pharmacists to decrease inappropriate SUP prescribing and related costs for these patients.
  
  
  METHODS
  All inpatients at nephrology wards of a teaching hospital were assessed regarding appropriate SUP prescribing during a 6-month pre-intervention phase of the study without any clinical pharmacists' involvement in patients' management. Thereafter, during a 6-month post-intervention phase clinical pharmacists provided local SUP protocol and educational classes for physicians regarding appropriate SUP prescribing and participated actively in the patient-care team.
  
  
  RESULTS
  The results showed significant relative reduction in inappropriate SUP prescribing and related cost in patients with renal insufficiency by about 44% and 67% respectively.
  
  
  CONCLUSIONS
  This study showed that implementing institutional guidelines, and active involvement of clinical pharmacists in the nephrology healthcare team, could reduce inappropriate SUP prescribing and related costs for these patients.
authors: School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors: Maryam
authors: M
authors: Mousavi
authors: Simin
authors: S
authors: Dashti-Khavidaki
authors: Hossein
authors: H
authors: Khalili
authors: Amir
authors: A
authors: Farshchi
authors: Mansoor
authors: M
authors: Gatmiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010437:Peptic Ulcer / Q000191:economics / Q000517:prevention & control*; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D024382:Professional Role; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000191:economics; D055815:Young Adult
chemical_list: D000897:Anti-Ulcer Agents
keywords: acid suppressive therapy; chronic kidney disease; clinical pharmacy; cost; stress ulcer prophylaxis