CLEO: a multidimensional tool to assess clinical, economic and organisational impacts of pharmacists' interventions

Abstract

Objectives: Clinical pharmacists' interventions (PIs) are an important element in ensuring good pharmaceutical care. We aimed to develop and validate a comprehensive multidimensional tool for assessing the potential impact of PIs for daily practice of medication review.

Methods: Experts of the French Society of Clinical Pharmacy (SFPC) developed the CLinical, Economic and Organisational (CLEO) tool, consisting of three independent dimensions concerning clinical, economic and organisational impact. They were asked to analyse 30 scenarios of PIs, and re-rated 10 PIs with a washout of 1 month (internal validation). Then, seven external experts not involved in the development of the tool rated 60 scenarios collected when using the CLEO in daily practice. Inter- and intra-rater reliabilities were determined by calculation of the intra-class correlation (ICC_A,1). Users' satisfaction and acceptability of the tool were assessed on a 7-level Likert scale with a 17-item questionnaire.

Results: For internal reliability, the inter-rater reliability for the CLEO tool was good for clinical dimensions (ICC_A,1=0.693), excellent for economic dimensions (ICC_A,1=0.815) and fair for organisational dimensions (ICC_A,1=0.421); and the intra-rater reliability was good for clinical dimensions (ICC_A,1=0.822), excellent for economic dimensions (ICC_A,1=0.918) and good for organisational dimensions (ICC_A,1=0.738). For external reliability, the inter-rater reliability was good for clinical dimensions (ICC_A,1=0.649), excellent for economic dimensions (ICC_A,1=0.814) and fair for organisational dimensions (ICC_A,1=0.500). CLEO was viewed as relevant (mean±SD 4.93±1.27), acceptable (4.81±1.78), practicable (5.56±1.45) and precise (5.38±1.47).

Conclusions: CLEO is a comprehensive tool assessing clinical, economic and organisational impacts of PIs which has been developed, validated and was reliable and feasible for use in routine clinical practice.

Keywords: documentation; hospital; pharmacy service; professional competence; quality of health care; safety.

Figure 1

The CLinical, Economic and Organisational (CLEO) tool. PI, pharmacist intervention.

Figure 2

Examples of assessment of impacts of pharmacist interventions using the CLinical, Economic and Organisational (CLEO) tool.

Figure 3

Raters' judgements on appropriateness, acceptability, practicability and precision of the CLinical, Economic and Organisational (CLEO) tool with mean (SD) scores on the 7-point Likert scale (completely disagree=1, disagree=2, more or less disagree=3, undecided=4, more or less agree=5, agree=6, completely agree=7). Q01, the CLEO includes all dimensions needed to evaluate a PI; Q02, the CLEO is an appropriate instrument for evaluating Pis; Q03, I did not have issues to evaluate the PIs with the CLEO; Q04, I could imagine to use CLEO in my work in the future; Q05, in general I am satisfied with the CLEO; Q06, there are enough evaluation levels in the dimension ‘Clinical Impact’; Q07, there are enough evaluation levels in the dimension ‘Economic Impact’; Q08, there are enough evaluation levels in the dimension ‘Organisational Impact’; Q09, the levels in the dimension ‘Clinical Impact’ are well defined; Q10, the levels in the dimension ‘Economic Impact’ are well defined; Q11, the levels in the dimension ‘Organisational Impact’ are well defined; Q12, the different levels in the dimension ‘Clinical impact’ are clearly separated; Q13, the different levels in the dimension ‘Economic impact’ are clearly separated; Q14, the different levels in the dimension ‘Organisational impact’ are clearly separated; Q15, the CLEO is easy to use; Q16, the training with case examples is sufficient to use the CLEO; Q17, the time expenses for an evaluation of a PI with the CLEO are reasonable.