Yanchick J K
Department of Pharmacy/Primary Care, Reynolds Army Community Hospital, Ft. Sill, OK 73503, USA.
Am J Health Syst Pharm. 2000 Dec 15;57 Suppl 4:S30-4. doi: 10.1093/ajhp/57.suppl_4.S30.
The development and implementation of a drug therapy monitoring clinic in the primary-care clinics of a military hospital are described. To improve patient care and decrease costs associated with treating chronic diseases, in August 1995 the pharmacy department established a drug therapy monitoring clinic. The clinic was responsible for initiating and monitoring treatment plans for patients with chronic diseases, implementing clinical guidelines, providing educational programs, collecting and analyzing outcome data, and handling requests for medication extensions. Treatment followed existing national standards and Department of Defense guidelines modified for the institution. The clinic began with one clinical pharmacy specialist, and within a year it added another clinical pharmacist and a technician. The clinic first obtained patients via consultations from providers in primary care; this was soon extended to all departments. In addition, the pharmacist was available to see walk-in patients needing medication extensions. Later, referrals came for inpatients and patients seen in the emergency room for asthma or diabetes mellitus, as well as for inpatients receiving oral anticoagulation therapy. For fiscal year 1999, the clinic saw 104 (+/- 44.3) patients per month seeking medication extensions. It also handled 24,873 clinical interventions that year, resulting in projected annual savings of $1,085,560. Chart review indicated that compliance with national standards improved dramatically for patients with diabetes mellitus or asthma followed by pharmacists compared with physician monitoring during the same period and before the clinic began. The wait time for reviewing laboratory results and for patients receiving anticoagulation therapy was eliminated, and doses were changed immediately, if needed. A comprehensive pharmacist-managed drug therapy monitoring clinic for outpatients with chronic diseases can result in positive patient outcomes and more cost-effective care.
本文描述了一家军队医院在基层医疗诊所开展药物治疗监测门诊的情况。为改善患者护理并降低慢性病治疗成本，1995年8月药房设立了药物治疗监测门诊。该门诊负责启动和监测慢性病患者的治疗计划、实施临床指南、提供教育项目、收集和分析结果数据以及处理药物延期申请。治疗遵循现行国家标准和为该机构修改的国防部指南。门诊最初只有一名临床药学专家，一年内又增加了一名临床药剂师和一名技术员。门诊最初通过基层医疗提供者的会诊获取患者，很快便扩展到所有科室。此外，药剂师也会接待需要药物延期的非预约患者。后来，住院患者、因哮喘或糖尿病在急诊室就诊的患者以及接受口服抗凝治疗的住院患者也会被转诊到该门诊。1999财年，该门诊每月接待104（±44.3）名寻求药物延期的患者。同年，该门诊还处理了24873次临床干预，预计每年节省1085560美元。图表审查表明，与同期及门诊设立前医生监测相比，药剂师监测的糖尿病或哮喘患者对国家标准的依从性显著提高。实验室结果审查和接受抗凝治疗患者的等待时间被消除，如有需要，剂量会立即更改。由药剂师全面管理的慢性病门诊药物治疗监测可带来积极的患者治疗效果和更具成本效益的护理。
