Outcomes of a Pharmaceutical Care Program via the KPHIS Paperless System in Elderly Patients with Pneumonia in a Hospital

Abstract

            Pneumonia is a leading cause of hospitalization among older adults, and inappropriate meropenem use contributes to antimicrobial resistance, prolonged hospitalization, and increased costs. This study evaluated a pharmaceutical care program implemented through the KPHIS paperless system for optimizing meropenem use in older adults hospitalized with pneumonia at Phukieo Chalermphrakiat Hospital, Thailand. A quasi-experimental before-and-after study with a historical comparison group was conducted, in which 86 patients aged 60 years and older were assigned to a pre-intervention group (August-November 2025; n=43; paper-based documentation) or a post-intervention group (December 2025-March 2026; n=43; KPHIS paperless documentation). Outcomes were analyzed using Generalized Estimating Equations, negative binomial regression, and log-linear regression, adjusted for age, physician type, and diagnosis type.

            Baseline characteristics did not differ significantly between groups. Physician acceptance of pharmacists' recommendations increased significantly from 39.1% to 60.4% (adjusted OR 2.35, 95% CI 1.02, 5.38). Pharmaceutical care episodes increased without statistical significance (adjusted IRR 1.14, 95% CI 0.64, 2.05). Duration of therapy, antimicrobial cost, and vial usage all decreased significantly (adjusted ratios 0.71, 0.58, and 0.71; all p<0.05). The 30-day readmission rate decreased from 9.3% to 7.0% without statistical significance (corrected OR 0.76, 95% CI 0.18, 3.28).

            The KPHIS paperless program was associated with improved physician acceptance and reduced meropenem-related resource use, even after adjustment for confounders. Given the historical control design and limited sample size, findings should be regarded as preliminary. Larger, multicenter studies with concurrent controls are warranted before broader implementation.