Promoting Parenteral-Oral Drug Switching for Hospitalized Patients

Abstract

A quasi experiment was conducted at Lampang Hospital during October 2003 - November 2004 to determine the effectiveness of the multifaceted group interventions in promoting parenteral oral (IV-PO) drug switching for hospitalized patients and to survey an attitude of physician towards IV-PO switching program. Medical charts of inpatients who were prescribed target IV drugs more than 24 hours were reviewed prospectively by a clinical pharmacist for two weeks in each phase; phase I as a baseline period, phase II as 2 months after intervention, and phase III as six months after intervention. Candidates for the switching were identified according to the hospital guideline. Excess days, durations of IV drug use, and potentially avoidable costs were determined. The generalized linear model was used to adjust relevant factors in the multivariate analysis.

Of all reviewed hospitalized patients, 629, 647 and 593 were prescribed the target IV medications that comprised 940, 1,007 and 917 prescriptions in phases I, II and III, respectively. According to the switching guideline, 25.7 percent, 19.7 percent and 24.2 percent of prescriptions were identified as the candidates in phases I, II and III, respectively. The multifaceted group interventions could significantly reduce only an incidence of switching candidate in short-term period (p<0.05), but not the other expected outcomes both in short-term and long-term periods. After six months, significant improvement could no longer be observed. Based on the physician opinions, more than 90 percent agreed with the implementing of IV-PO switching program in the hospital, more than 80 percent thought that the most effective strategy in promoting IV-PO drug switching was clinical practice guideline. implementation whereas about 20 percent thought that the most effective was policy implementation. The physicians preferred communication with pharmacists via direct contact (44.2%) to via written form (28.9%). Since the multifaceted group interventions could reduce only incidence of switching candidates for a short while, it should be implemented along with a specific reminder system to increase the effectiveness of the IV-PO switching program in the hospital.