Clinical outcomes

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Chapter: Hospital pharmacy : Clinical pharmacy

In 1966 Donabedian published his seminal work that described three distinct aspects of quality in healthcare: (1) outcome; (2) process (healthcare technologies); and (3) structure (resources for delivery of care).


Clinical outcomes

 

In 1966 Donabedian published his seminal work that described three distinct aspects of quality in healthcare: (1) outcome; (2) process (healthcare technologies); and (3) structure (resources for delivery of care). He concluded that: ‘Outcomes, by and large, remain the ultimate validation of the effectiveness and quality of medical care’. Standardised mortality rates have become a crude outcome measure but are used to describe a healthcare organisation’s overall success. Other recent outcome measures include meticillinresistant Staphylococcus aureus bacteraemia rates and Clostridium difficile infections which have a direct relevance to antimicrobial stewardship (AMS). More recently, patient-reported outcome measures (PROMs) have been advocated as a relevant outcome measure to describe patients’ satisfaction in their healthcare provider. Four elective procedures were initially proposed for PROMS data evaluation – hernia repair, hip and knee replacement and varicose veins – but a growing range of long-term conditions including diabetes, asthma, chronic obstructive pulmonary disease, epilepsy, heart failure and stroke are being added. These long-term conditions have medication effectiveness at their core and will offer considerable potential for clinical pharmacy involvement. At the time of writing, in England, consultation has begun on how an outcomes-based approach can be built into the routine running of the NHS. It will be interesting to see how medicines use and the role of clinical pharmacists can contribute to this agenda.

 

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