Schwartzberg Eyal, Livny Sima, Sterenberg Ahud, Troitsa Anton, Oren Meir, Shani Segev
Pharmacy Department, Hillel Yaffe Medical Center, Hadera, Israel.
Harefuah. 2003 Jan;142(1):5-9, 80.
Clinical pharmacy could be defined as an umbrella of services aimed at maximizing the pharmacotherapeutic effect, minimizing the risk for developing adverse drug effects and reducing drug expenditures for the health care system. Clinical pharmacists, in Israel and abroad, have been practicing in different health care settings aiming to implement the principles mentioned above. Most of the articles previously published reviewed the role of the clinical pharmacist in internal medicine wards or in intensive care units. This article focuses on the role of the clinical pharmacist in a general surgery department and the influence of this service on the quality and cost of pharmacotherapy and on intravenous antibiotic therapy in particular.
Improving the quality of pharmacotherapy while optimally using economic resources in a general surgery ward.
During September 1999 to August 2000, the clinical pharmacist joined physician rounds in the surgical ward. During the rounds he advised physicians about clinical and economical aspects of drug treatment, and collected data on his activity on a specific designated form. The data was processed on a central computerized database, and analyzed to determine the influence of the clinical pharmacist on clinical and economical outcomes.
At the end of the study period the following were found: The pharmacist made 219 interventions. These included adverse drug effects, which were identified and/or prevented. When considering the economic data, a substantial reduction of 56% in intravenous antibiotic therapy was noted (direct saving of about 140,000 NIS). Such savings were accompanied by changes in the prescribing patterns in the department, which were translated into increased rate of oral antibiotic prescribing and reduction in the use of certain i.v. antibiotics while undamaging the quality of the pharmacotherapeutic effect.
The results of this study indicate that participation of a clinical pharmacist during physicians rounds improved the quality of the pharmacotherapy, assisted in changing clinicians prescribing habits, and at the same time significantly reduced the direct expenditures on medications in general and of intravenous antibiotic therapy in particular.
临床药学可定义为一系列服务，旨在使药物治疗效果最大化，将发生药物不良反应的风险降至最低，并降低医疗保健系统的药物支出。以色列国内外的临床药师一直在不同的医疗环境中开展工作，以践行上述原则。此前发表的大多数文章回顾了临床药师在内科病房或重症监护病房中的作用。本文重点关注临床药师在普通外科中的作用，以及这项服务对药物治疗的质量和成本，尤其是静脉抗生素治疗的影响。
在普通外科病房优化利用经济资源的同时提高药物治疗质量。
1999年9月至2000年8月期间，临床药师参与了外科病房的医师查房。查房期间，他就药物治疗的临床和经济方面向医师提供建议，并在特定的指定表格上收集其活动数据。这些数据在中央计算机数据库中进行处理和分析，以确定临床药师对临床和经济结果的影响。
在研究期结束时发现以下情况：药师进行了219次干预。这些干预包括已识别和/或预防的药物不良反应。考虑到经济数据，静脉抗生素治疗大幅减少了56%（直接节省约140,000新谢克尔）。这种节省伴随着科室处方模式的变化，表现为口服抗生素处方率增加，某些静脉用抗生素的使用减少，同时并未损害药物治疗效果的质量。
本研究结果表明，临床药师参与医师查房提高了药物治疗质量，有助于改变临床医生的处方习惯，同时显著降低了总体药物直接支出，尤其是静脉抗生素治疗的直接支出。
