To the best of our knowledge, this is the first prospective study describing the prevalence of drug-related problems in patients admitted to Key Monitoring Drugs in mainland China. DRPs are common in this patient population. This highlights the needs for clinical pharmacy service in the use of Key Monitoring Drugs. The causes of the DRPs identified were mainly at the drug selection, dose selection, treatment duration, this demonstrates the necessity of medication reconciliation by pharmacists. The interventions of the DRPs identified were mainly at the prescriber level, including prescriber informed only, prescriber asked for information, intervention proposed to prescriber, intervention discussed with prescriber. At drug level, most DRPs were drug changed to..., Dosage changed to …, Drug paused or stopped, Drug started. The intervention acceptance rate was increased from 73.5% to 88.99%, the rate of solved problem was increased from 54% to 75.23%.
We should make full use of evidence-based medicine to scientifically manage all the drugs that meet the definition of Key Monitoring Drugs to improve the safety of drug use, to put an end to the use of contraindications, and to reduce the phenomenon of unreasonable drug use, such as over-indications. The exploration and formation of an Key Monitoring Drugs information management platform to improve the work efficiency and coverage, and the formation of a new management modehave been realized. Meanwhile, we compared the pharmaco-therapeutics and pharmaco-economics of the same kind of Key Monitoring Drugs with large dosage, so as to provide more scientific references for clinical drug selection .
This study focussed on how to evaluate the drug use scientifically and reasonably in the management of Key Monitoring Drugs. On one hand,through the use of evidence-based medicine to evaluate the rationality of drug use, it can provide cutting-edge safe and rational drug use services for clinical use and resolve the issues facing the multiple drug delivery schemes at present, which can not be evaluated in terms of efficacy and economics. On the other hand, it can strengthen the medical practice around the use of Key Monitoring Drugs and improve the comprehensive level and effect ontheir management[18,19]. Finally, through the collection of drug efficacy cases for the purposes of economic comparison, if a scientific and orderly evaluation standard for the same types of drugs can be formed, the selection of clinical drugs can provide more suitable suggestions for clinical needs and gradually achieve the ultimate goal of individualized drug use and refined drug treatment.
In April 2019, China’s Health Commission issued the notice on drug use monitoring and clinical comprehensive evaluation, which requires comprehensive evaluation of drug use and applies the evaluation results to the improvement of local medical support system,clinical diagnosis, and treatment service quality. Key Monitoring Drugs are the agents that aid or increase the action of the principal drug (drugsynergism) or that affect the absorption, mechanism of action, metabolism, or excretion of the primary drug (pharmaco-kinetics) in such a way as to enhance its effects. It is commonly used in the prevention or treatment of cancer, and liver, cardiovascular, and cerebrovascular diseases. If the proper use of Key Monitoring Drugs is beneficial forthe recovery of patients fromthe disease, it can not only shorten the time of hospitalization, but can also reduce the cost of hospitalization so that the country’s medical resources can be more effectively allocated. Conversely, it canincrease the risk of having adverse drug reactions due to increased use of combination of drugs or the unnecessary use of drugs. It canincrease the risk of having new adverse effects, prevent the rehabilitation of the original diseases, prolong the length of stay, and increase the economic burden on patients and the healthcare system.
How to strengthen the management of rational drug use and reduce the economic burden of patients has become a problem of public concern. The management of adjvant drugs has become an important part of the management of rational drug use. The current excessive use of Key Monitoring Drugs not only can easily lead to an increased incidence of adverse drug reactions and bodily damage, butcan alsoincrease the economic burden on patients, resulting in wastage of medical resources. In 2017, the Chinese State Council issued a number of opinions on further reforming and improving the policy ondrug production and circulation. The document requires monitoring the use of antibiotics, Key Monitoring Drugs, and nutritional drugs, publicizing the limits on irrational prescriptions, and establishing an interview system.
This is the first study to document clinical pharmacist-led interventions in identifying and solving DRPs in the Key Monitoring Drugs. The impact of the clinical pharmacists’ long-term interventions on reducing the number of hospital readmission or financial saving was also evaluated compared with past studies [20-24]. However, this study is only conducted in one hospital, and the sample size is not large enough.