Kalister H, Newman R D, Read L, Walters C, Hrachovec J, Graham E A
School of Pharmacy, University of Washington, and the Harborview Medical Center, Seattle 98118, USA.
Arch Pediatr Adolesc Med. 1999 Jul;153(7):731-5. doi: 10.1001/archpedi.153.7.731.
Among medically underserved immigrant parents, access to nonprescription medicines for home treatment of minor childhood illnesses may be limited by scarce financial resources or language barriers.
To design and implement a new clinical service for an urban ambulatory pediatric clinic with a large immigrant population that allows pharmacists to evaluate and to treat children and adolescents aged 6 months to 19 years with minor acute illnesses and to provide bilingual patient education materials.
We developed protocols and encounter forms for pharmacist evaluation of 5 pediatric conditions: cough/cold, fever, diaper rash, vomiting/diarrhea, and head lice. We published bilingual patient education materials for these conditions in 8 commonly spoken languages. We assessed safety by thoroughly reviewing the medical records of all patients who returned within 1 week of a pharmacy encounter and by asking parents in a telephone survey to compare services received through the pharmacy and the acute care clinic for treatment of the common cold.
During the first year of this pilot program, 191 patients were evaluated and treated, 145 (76%) for cough/cold. Seventy percent of the patients were immigrants. No unexpected or adverse outcomes were detected, although occasional deviations from established protocols were noted. Parent satisfaction with the pharmacy service was high, and similar to that received through the standard acute care clinic. Patients evaluated by pharmacists were more likely to be attended to promptly (< 15-minute wait) and were more likely to receive written information than patients evaluated by physicians for similar conditions.
Pharmacist evaluation and treatment of minor pediatric illnesses seems to be both safe and well accepted. Further studies are needed to evaluate the cost-effectiveness of this service in diverse settings. In states that allow pharmacists to have prescriptive authority, pharmacy-based evaluation and treatment may improve access to care for children with minor illnesses.
在医疗服务不足的移民父母中，用于家庭治疗儿童轻症疾病的非处方药获取可能因资金匮乏或语言障碍而受限。
为拥有大量移民人口的城市门诊儿科诊所设计并实施一项新的临床服务，使药剂师能够评估和治疗6个月至19岁患有轻度急性疾病的儿童及青少年，并提供双语患者教育材料。
我们制定了药剂师评估5种儿科病症的方案和问诊表格，这5种病症为咳嗽/感冒、发烧、尿布疹、呕吐/腹泻和头虱。我们用8种常用语言发布了针对这些病症的双语患者教育材料。我们通过全面审查所有在药房问诊后1周内复诊患者的病历，并通过电话调查询问家长比较通过药房和急诊诊所治疗普通感冒所接受的服务，来评估安全性。
在这个试点项目的第一年，191名患者接受了评估和治疗，其中145名（76%）是因咳嗽/感冒前来就诊。70%的患者是移民。未检测到意外或不良后果，尽管偶尔会有偏离既定方案的情况。家长对药房服务的满意度很高，与通过标准急诊诊所获得的满意度相似。与因类似病症由医生评估的患者相比，由药剂师评估的患者更有可能得到及时诊治（等待时间<15分钟），并且更有可能收到书面信息。
药剂师对儿科轻症疾病的评估和治疗似乎既安全又广受认可。需要进一步研究以评估这项服务在不同环境中的成本效益。在允许药剂师拥有处方权的州，基于药房的评估和治疗可能会改善轻症儿童的就医机会。
