Clinical pharmacist contribution to the quality of ambulatory patient pharmacotherapy at the pharmacotherapy counseling unit of a tertiary care university hospital
Clinical pharmacists enhance safe and high-quality patient care through effective interprofessional collaboration. This study aimed to evaluate pharmacotherapy counseling services provided by clinical pharmacists, assess physician acceptance of recommendations, and determine their impact on patients and the healthcare system. A retrospective observational study was conducted at the University Hospital’s Pharmacotherapy Counseling Unit over a 15-month period. Pharmacotherapy plans of 61 ambulatory patients were analyzed, and therapy modifications were classified according to PCNE V9.1. After clinical pharmacist intervention, the median (IQR) number of prescribed medications significantly decreased from 7.5 (8) to 3 (9) ( p < 0.05) and drug-related problems (DRPs) from 2 (4) to 0 (4) ( p < 0.05). Among patients aged ≥65 years ( n = 22), potentially inappropriate medications were significantly reduced ( p < 0.05). Most DRPs were related to inappropriate drug selection. This study demonstrates the positive impact of clinical pharmacists in improving pharmacotherapy quality in ambulatory care in Bosnia and Herzegovina.