General Hospital Psychiatry 79 (2022) 189–190
Contents lists available at ScienceDirect
General Hospital Psychiatry
journal homepage: www.elsevier.com/locate/genhospsych
Letter to the editor
An analysis of clinical pharmacist interventions at a Czech psychiatric hospital: A two-year
prospective study
Psychiatric Hospital Bohnice is the largest psychiatric setting in the
Czech Republic with a capacity of 6600 patient admissions per year. The
average daily cost of an acute care admission was approximately USD
178 in 2020 and USD 256 in 2021, and in the subacute aftercare portion
of the hospital it was USD 128 (2020) and USD 134 (2021).
The objective of this study was to quantify the economic and clinical
outcomes of a clinical pharmacy service (CPS) conducting at compre­
hensive medication reviews (CMRs) at Psychiatric Hospital Bohnice
from 1 January 2020 to 31 December 2021. The performance of CMRs
resulted a written conclusion of the medication review with a drug
therapy recommendation (DTR). Each recommendation consisted of one
or more clinical pharmacist interventions (CPIs), always related to a
specific drug.
We hypothesized that such an intervention could prevent drug-
related problems (DRPs), adverse drug events (ADEs), and adverse
drug reactions via the CMRs, which have had a positive economic and
clinical impact in prior work [1]. The primary aim of this work was to
evaluate the cost-benefit analysis of the CPS at Psychiatric Hospital
Bohnice during the two-year study period by the quantification of USD
saved for unrealized days of hospital stay due to prevented DRPs. Based
on previously published case-control studies, ADEs are associated with
prolongation of hospital stays by 1.75 [2] or 2.9 days [3], (i.e., a mean of
2.33 days).
During the two-year study period, a total of 2938 patients underwent
a medication review, representing approximately 22% of all hospital
admissions. From these CMRs, 1049 DTRs were performed (70% in
acute care units, 30% in subacute/aftercare units). The majority
(89%) of these recommendations were enacted by physicians, 6%
were partially enacted, and 5% were not enacted (usually due to
sudden patient discharge or a change in health condition).
Of the total 2938 evaluated patients, 9.9% had polypharmacy.
During the study period, 2035 CPIs were suggested. Each case requiring
a written evaluation from a clinical pharmacist had approximately two
specific recommendations/CPIs on average. The most common CPI was
a query on the use of a specific drug (n = 901, 44%).
During the study period, 2035 CPIs were performed and resulted in
1049 DTRs. Considering 40% preventability of DRPs based on prior
literature [3,4], a total of 814 DRPs were prevented by the activity of a
clinical pharmacist at Psychiatric Hospital Bohnice during the two-year
study period. These events could have led to an annual prolongation of
length of stay by 792 days (using 2.33 days per event,) indicating an
annual savings of USD 150,222 in total, (USD 119,196 for acute care
Abbreviations: ADE, adverse drug event; CMR, comprehensive medication review; CPI, clinical pharmacist intervention; CPS, clinical pharmacy service; DRP, drug-
related problem; DTR, drug therapy recommendation; FTE, full-time equivalent; USD, US Dollars.
https://doi.org/10.1016/j.genhosppsych.2022.10.006
Received 18 August 2022; Received in revised form 6 October 2022; Accepted 11 October 2022
Available online 13 October 2022
0163-8343/© 2022 Elsevier Inc. All rights reserved.
and USD 31,126 for subacute). No additional or indirect costs were
included, e.g. permanent disability, workplace absenteeism, reduced
productivity or reduced quality of life. Clinical pharmacist labor costs
(1.0 FTE) amounting to USD 35,000 per annum indicate that the cost-
benefit ratio of a CPS at Psychiatric Hospital Bohnice is 4.3 (i.e. the
monetary return for every USD invested in a clinical pharmacist is USD
$4.30).
The secondary outcome was to express the number of patients in
whom the occurrence of life-threatening or significant drug events were
prevented. Corresponding with the results of a Japanese study in a
psychiatric population [5], out of all ADEs, 1.4%, 28% and 71% were
life-threatening, serious and significant, respectively. Out of a total of
814 prevented DRPs (considering 40% preventability) and according to
Ayani's data, it is possible to estimate that there were 11 life-threatening,
228 serious and 578 significant ADEs prevented at Psychiatric Hospital
Bohnice during the two-year study period.
Additional work is needed to confirm these data in other settings and
potentially to utilize and randomized trial to assess the bene­
fits—financial and clinical—of such a program.
Declaration of Competing Interest
The authors have no conflicts of interest to declare.
Acknowledgments
The authors would like to thank Bc. Blanka Novotná for the prepa­
ration of economic records from the study period.
References
[1] Gregorová J, Rychlíčková J, Šaloun J. Standardization of clinical pharmacist’s ac­
tivities: methodology. Saudi Pharmac J 2017;25(6):927–33. https://doi.org/
10.1016/j.jsps.2017.02.005.
[2] Classen DC, et al. Adverse drug events in hospitalized patients: excess length of stay,
extra costs, and attributable mortality. JAMA 1997;277(4):301–6. https://doi.org/
10.1001/jama.1997.03540280039031.
[3] Rottenkolber D, et al. Cost of adverse drug events in German hospitals – a micro­
costing study. Value Health 2012;15:868–75. https://doi.org/10.1016/j.
jval.2012.05.007.
[4] Davies CE, et al. Adverse drug reaction in hospital in-patients: a prospective analysis
of 3695 patient-episodes. PLoS One 2009;4(2):e4439. https://doi.org/10.1371/
journal.pone.0004439.
[5] Ayani N, Sakuma M, Morimoto T, et al. The epidemiology of adverse drug events
and medication errors among psychiatric inpatients in Japan: the JADE study. BMC
Psychiatry 2016;16(1):303. https://doi.org/10.1186/s12888-016-1009-0.
Letter to the editor General Hospital Psychiatry 79 (2022) 189–190

Ivana Taškováa,b,*, Jana Michalcováa,b, Jan Šalounb *

Corresponding author at: Psychiatric Hospital Bohnice, Prague, Czech
a
Psychiatric Hospital Bohnice, Prague, Czech Republic Republic.
b
Faculty of Pharmacy, Department of Applied Pharmacy, Masaryk E-mail address: taskova.ivana@gmail.com (I. Tašková).
University, Brno, Czech Republic

190