Westein M P, Herings R M, Leufkens H G
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), PO Box 80 082, 3508 TB Utrecht, The Netherlands.
Pharm World Sci. 2001 Jun;23(3):98-101. doi: 10.1023/a:1011261930989.
The role of pharmacists in today's healthcare is changing rapidly. As they are close to the prescribing process, pharmacists are in the position to identify and adjust prescribing errors before dispensing. The objective of this study was to identify relevant determinants of interventions directly linked to prescription processing in community pharmacy.
As part of a yearly continuing education programme, all community pharmacies in the region of 'Zealand' (N = 23) in the south-west of The Netherlands kept detailed records of all interventions directly linked to prescription processing during one week in May 1998. For every patient involved in an intervention, a control-patient was matched on pharmacy practice, date, gender and age.
A total of 39,357 prescriptions were evaluated by the 23 pharmacies during the one-week intervention programme. Out of these, one out of 10 resulted into an intervention. Being a first prescription in a new treatment episode was found to be a significant determinant (OR 1.75, 95 CI% 1.18-2.33). Variables reflecting drug therapy complexity (> 3 prescribers, > 15 prescriptions in 3 months before, > 3 different medications) showed all ORs higher than 1.00, but not significant. When looking at the individual drug categories, anti-infectives, respiratory drugs and cardiovascular medicines came out as important drug classes for intervention risk. We could not find any association between the number of signals per pharmacy and the number of interventions.
The 'whistle-blower' model of pharmacy based interventions is a valid one but needs a targeted and integral way of implemented thinking and use of information technology. In such an environment, interventions are a logical step of in-process quality control in the drug usage system.
如今药剂师在医疗保健中的角色正在迅速转变。由于他们接近处方开具过程，药剂师有能力在配药前识别并纠正处方错误。本研究的目的是确定与社区药房处方处理直接相关的干预措施的相关决定因素。
作为年度继续教育计划的一部分，荷兰西南部“西兰”地区（N = 23）的所有社区药房在1998年5月的一周内详细记录了所有与处方处理直接相关的干预措施。对于每一位参与干预的患者，根据药房实践、日期、性别和年龄匹配一名对照患者。
在为期一周的干预计划中，23家药房共评估了39357张处方。其中，十分之一的处方导致了干预措施。发现新治疗阶段的首张处方是一个重要的决定因素（比值比1.75，95%置信区间1.18 - 2.33）。反映药物治疗复杂性的变量（> 3名开处方者、前3个月内> 15张处方、> 3种不同药物）的所有比值比均高于1.00，但不显著。在查看个别药物类别时，抗感染药、呼吸系统药物和心血管药物成为干预风险的重要药物类别。我们未发现每家药房的信号数量与干预措施数量之间存在任何关联。
基于药房干预的“举报人”模式是有效的，但需要一种有针对性且全面的实施思路和信息技术应用方式。在这样的环境中，干预措施是药物使用系统过程质量控制的合理步骤。
