Impact of Clinical Care Determinants on Biochemical, Hematological, and Pharmacological Outcomes in Hospitalized Patients

Abstract

Background: Clinical care determinants, including healthcare staff behavior, emotional support, patient autonomy, communication, and medication-related counseling, play a critical role in influencing patient recovery and well-being. In addition to psychological effects, stressful healthcare experiences may alter biochemical, hematological, inflammatory, and pharmacological responses associated with immune function, physiological stress, and treatment outcomes. However, limited evidence from Pakistan has explored these multidimensional effects among hospitalized patients.

Objective: To determine the influence of clinical care determinants on psychological, biochemical, hematological, inflammatory, and pharmacological responses in hospitalized patients admitted to tertiary care hospitals.

Methods: A cross-sectional analytical study was conducted among 215 hospitalized patients in a tertiary care of Islamabad from January to June 2024. Clinical care determinants were assessed using a structured questionnaire, while patient well-being was evaluated using the WHO-5 Well-being Index. Biochemical parameters including serum cortisol, C-reactive protein (CRP), blood glucose, and serum albumin were assessed. Hematological parameters including hemoglobin, total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), platelet count, and erythrocyte sedimentation rate (ESR) were analyzed. Pharmacological indicators including medication adherence, analgesic requirement, sedative use, adverse drug reactions, and satisfaction with medication counseling were also evaluated. Statistical analysis was performed using SPSS version 21 with p ≤ 0.05 considered statistically significant.

Results: Among the participants, staff cooperation was reported by 64.2% patients, social support by 68.8%, and bed adjustability by 69.3%. Significant associations with patient well-being were observed for staff cooperation (p<0.001), social support (p<0.001), staff visibility (p=0.001), light control (p<0.001), and bed adjustability (p<0.001). Patients with poor well-being demonstrated significantly higher serum cortisol levels (21.6 ± 4.5 µg/dL vs 14.2 ± 3.1 µg/dL), CRP levels (12.9 ± 4.7 mg/L vs 5.8 ± 2.2 mg/L), TLC (11.1 ± 2.6 ×10³/µL vs 7.4 ± 1.8 ×10³/µL), NLR (4.8 ± 1.3 vs 2.1 ± 0.7), and ESR (31 ± 9 mm/hr vs 14 ± 5 mm/hr) compared to patients with good well-being (p<0.05). Hemoglobin and serum albumin levels were significantly lower in patients with poor well-being. Medication adherence was higher among patients with good well-being (88.4% vs 61.7%), while sedative use and analgesic requirement were significantly greater among psychologically distressed patients.

Conclusion: Clinical care determinants significantly influence not only psychological well-being but also biochemical, hematological, inflammatory, and pharmacological responses in hospitalized patients. Improving patient-centered care, emotional support, healthcare communication, and medication counseling may enhance both psychological and physiological recovery outcomes.