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Health Expenditures has been increasing as a percentage of the nations Gross Domestic Product (GDP) (Accounts for 15-20

%).
In USA, Sales of nonprescription drugs have increased from $700 millions in the 1950s to well into the billions of dollars ($287 billion in 2007). Thus, for half a century clinical pharmacy has been succeeding to set its feet strongly and thoroughly through its activities in the healthcare services.

Whereas substantial numbers of studies have reported improved patient care and, in some cases, reduced costs at individual clinical sites, none have evaluated the impact of clinical pharmacy services and pharmacy staffing on the total cost of care in our health care system.

Of 104 studies published between 1988 and 1995, 89% described positive financial benefits of these services, with a mean cost: benefit ratio of 16.70:1 (every dollar invested in clinical pharmacy services resulted in a cost reduction of $16.70).

Through clinical pharmacy services, pharmacists promote rational drug therapy. And that results in

Improved drug therapy should have a profound impact on the total cost of care by decreasing: 1. Lengths of hospital stays. 2. Adverse drug reactions. 3. Infection rates. 4. Law suits. 5. Number of personnel to care for patients. and so on.

Thus, clinical pharmacy services may increase the efficiency of health care and reduce costs.

There are a lot of clinical pharmacy services that work on that, including but not exclusive to: 1. Centrally delivered services:
1. 2. Medical treatment evaluation. Drug and poison information.

2. Patient-specific services:
1. 2. 3. 4. Adverse drug reaction (ADR) monitoring. Drug therapy monitoring. Drug counseling. Medical rounds participation.

The explosion of medical technology has expanded the diagnostic and therapeutic modes of medical care, thus necessitating the continuous evaluation of commonly used therapeutic decision. That clinical activity was applied in the past through conventional wisdom.

For instance, until the mid-1950s, conventional wisdom dictated complete bed rest for several months for heart attack patients. This was accompanied by a high mortality rate, due to inactivity, from deep vein thrombosis and pulmonary embolism. By the 1960s, however, hospitals had begun to encourage first-day ambulation and subsequent hospital discharge within one to three days, following a heart attacka remarkable medical and economic accomplishment.

During that time period, hospital mortality for acute myocardial infarction patients dropped from 47% in 1954, to currently less than 510% range.

Thus Medical Treatment Evaluation helps in:


1. Decreasing Mortality rates. 2. Limiting hospital stays. 3. Limiting readmission rates. It is estimated that in this process each dollar of pharmacist salary cost was associated with $31.92 reduction in total cost of care.

An unbiased source of drug information may promote better patient care and thus reduce total cost of care. This service may contribute to lower total cost of care, as up to 28% of all hospital admissions which were attributed to drug-related morbidity and mortality.

Having trained personnel to provide information could reduce these costs. In addition, ADRs in hospitals are often preventable if detected early, and could be reduced with better information systems. The presence of this service may also indicate medical staff open to input from pharmacists and likely to accept recommendations on drug therapy, which may result in lower costs.

Since the drug information service is often the process for formulary management coordination in the hospital, it is important in controlling drug costs that are a component of the total cost of care.

In the process, Each dollar of pharmacist salary cost was associated with $602.16 reduction in total cost of care. It also resulted averagely in 10.3 fewer deaths/hospital/year.

Thus, Pharmacist-provided drug information should be considered one of the foundation clinical pharmacy services for hospitals.

Adverse drug reactions are the most common untoward events occurring in hospitals and significantly increase the cost of care. The presence of this service indicates a hospital that has an active program to detect and prevent ADRs, and thus may reduce the cost of care associated with these problems.

This service has a profound effect on health care cost savings, as it limits:
1. Hospital Readmissions. 2. Extensive drug use. 3. Hospital stay period.

In the process, each dollar of pharmacist salary cost was associated with $2988.57 reduction in total cost of care.

Since medical rounds is where key decisions are made regarding patient care, pharmacists' participation may prospectively ensure optimum drug therapy, thus improving patient care and reducing health care costs. It may also indicate a hospital wide system that allows many health care professionals to have direct input into decision making, thus improving health care and reducing costs.

Although this was one of the more expensive clinical pharmacy services (total salary), it was associated with the greatest reduction in total cost of care/hospital. (Around $ 8,000,000/hospital/year) In the process, each dollar of pharmacist salary cost was associated with $252.11 reduction in total cost of care.

Clinical Pharmacy has become a trend at the developed countries in the light of the hard pressing economical crises and political conflicts. By its activities and services, it contributes a lot to alleviating the burden on the annual medical budget. Its cost savings luster persuaded the governments to invest a lot in it and give greater roles to the clinical pharmacists, thus improving the general healthcare service.