Clinical pharmaceutical services in Bundeswehr Hospitals - a mixed-methods analysis

Background and aim: Clinical pharmaceutical services (CPS) have a proven benefit. A mixed-methods analysis was performed to investigate which CPS are currently implemented in all Bundeswehr hospitals and how those CPS are prioritized. Investigations: (i) Qualitative approach: CPSs were defined based on focus group interviews with clinical pharmaceutical representatives from Bundeswehr hospitals. (ii) Quantitative approach: A questionnaire was created based on the CPS defined. The questionnaire was used in structured individual interviews in the focus group. The interview addressed benefits, barriers, initiators, implementation, prioritization, and resources for CPS. Results: (i) Qualitative approach: Altogether, 162 CPS were defined. (ii) Quantitative approach: "Clear evidence of benefit" was the most frequently reported benefit. "Structural aspects" was the most frequently mentioned barrier. The pharmacy department mainly initiated CPS. In admission, CPS were implemented with a median level of "0" ("0"=none to "4"=full implementation) and prioritized with a median level of "3" ("0"=none to "4"=highest priority), during inpatient care/hospitalization with "3" vs. "3" and in "discharge" with "2" vs. "2". CPS in "critical care", "surgical medicine", and "internal medicine" where implemented with "4", "4", and "0" and prioritized with "4", "3", and "3". From a median of n=9 personal resources per hospital, n=3 were located in CPS with n=1 exclusively in the units. Apart from "therapeutic drug monitoring" only databases were mentioned as required material resources. Conclusions: In a mixed-methods analysis, we defined CPS and had a clinical-pharmaceutical focus group evaluate those CPS comparing the current implementation and their prioritization. Numerous CPSs were identified that were not adequately implemented based on their prioritization.