Evaluation of the Effect of Management of Drug-Related Problems on Clinical Outcomes of Pulmonary Embolism Outpatients: A Randomized Controlled Trial

Abstract

Background: Pulmonary embolism (PE) poses significant morbidity and mortality risks, necessitating tailored anticoagulant therapy. Limited studies investigate the drug-related problems (DRPs) in PE. This study aims to evaluate the impact of clinical pharmacist (CP) interventions on drug-related problems (DRPs) and clinical outcomes in outpatients with PE. By addressing DRPs in this specific population, the study seeks to assess the role of CP-led interventions in enhancing patient safety and optimizing treatment outcomes. Methods: A randomized controlled trial was conducted on PE patients at a pulmonology outpatient clinic over the period of 15 January 2022 to January 2023. In this trial, the intervention group (IG) benefited from CP recommendations targeting DRPs, while the control group (CG) was observed without any additional interventions. Follow-ups were conducted at 90 and 180 days post-discharge. The study focused on DRPs, CP interventions, and patient outcomes. Data were systematically recorded and analyzed, adhering to ethical standards and employing the PCNE v9.1 classification system. Results: The study followed 50 PE patients, with 26 in the IG and 24 in the CG. DRPs, mostly in drug and dose selection, affected 84% of participants (3.34 DRPs/patient). In the IG, the CP made 76 recommendations (91.5%) for 83 DRPs at the prescribing physician level. Majority of these recommendations (94.7%) were accepted. At the 90-day follow-up, bleeding occurred in 16.6% of the CG, with none in the IG (odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.654–3.198, p = 0.046). As indicated by Cramér’s V (0.307), the effect size demonstrated a moderate association between the intervention and the absence of bleeding events in the IG. At the 180-day follow-up, bleeding was 33.3% in the CG and 16.6% in the IG (p = 0.443). Conclusions: PE patients experience common and frequent DRPs, especially in anticoagulation therapy. CP recommendations are widely accepted but need to be better implemented. No bleeding events were observed in the IG where a CP was involved at 90 days, unlike the CG. Including a CP in the PE treatment team seems to influence outcomes positively.