Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy

Purpose. The associations between pharmacist-managed aminoglycoside or vancomycin therapy for hospitalized Medicare patients who had diagnoses indicating probable treatment with these antibiotics and the major health care outcomes of death rate, length of stay, Medicare charges, hearing loss, and renal impairment were explored. Methods. Pharmacist management of drug therapy was evaluated in a study population composed of 199,082 Medicare patients treated in 961 hospitals. Results. In hospitals that did not have pharmacist-managed aminoglycoside or vancomycin therapy, death rates were 6.71% higher (1,048 excess deaths [chi(2) (1) = 43.801, p < 0.0001]), length of stay was 12.28% higher (131,660 excess patient days [U = 4.701 x 10(9), p < 0.0001]), total Medicare i charges were 6.30% higher ($140,745,924 in excess total Medicare charges [U = 4.864 x 10(9), p < 0.0001]), drug charges were 8.15% higher ($34,769,250 in excess drug charges [U = 4.785 x 10(9), p < 0.0001]), laboratory charges were 7.80% higher ($22,530,474 in excess laboratory charges [U = 4.860 x 10(9), p < 0.0001]), hearing loss was 46.42% higher (134 more patients with hearing loss [chi(2) = 54.423, df = 1, p < 0.0001]), renal impairment was 33.95% higher (2,801 more patients with renal impairment [chi(2) = 118.13, df = 1, p < 0.0001]), and the death rate in patients who developed complications was 10.15% higher (231 excess deaths [chi(2) = 22.345, df= 1, p < 0.0001]) than in hospitals with pharmacists managing these drugs. Conclusion. The presence of pharmacistmanaged aminoglycoside or vancomycin therapy was associated with significant improvement in health care and economic outcomes for Medicare patients who received these drugs.