Bond C A, Raehl Cynthia L, Patry Roland
Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas 79106, USA.
Pharmacotherapy. 2004 Apr;24(4):427-40. doi: 10.1592/phco.24.5.427.33358.
We developed a model for the provision of clinical pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing clinical pharmacy services. To provide 14 specific clinical pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core clinical pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core clinical pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core clinical pharmacy services could be provided with only modest increases in clinical pharmacist staffing.
我们在2020年开发了一个美国医院临床药学服务提供模型。数据来自四次全国临床药学服务数据库调查（1989年、1992年、1995年和1998年）以及美国医疗系统协会2000年《医疗保健领域简明指南》。1998年的人员配备数据显示，美国医院雇佣了45734名药剂师和43836名全职等效（FTE）药房技术员；17325名全职等效药剂师（38%）致力于提供临床药学服务。为在2020年为100%的美国住院患者提供14项特定临床药学服务，将需要37814个新的全职等效人员。为了进行更现实的人力预测，采用循证方法，基于与主要医疗保健结果（死亡率、药品成本、护理总成本、住院时间和用药错误）的良好关联，选择了一组五项核心临床药学服务。核心服务集包括药物信息、药物不良反应管理、药物方案管理、医疗查房和入院药物史。在2020年为100%的住院患者实施这些核心临床药学服务将需要额外增加14508名全职等效药剂师。根据美国医院临床药师的当前配置及其提供的服务，需要做出改变以改善医疗保健结果并降低成本。美国平均规模的医院（基于平均每日普查108.97±169.45名患者）最多需要增加3.32名全职等效药剂师来提供这些核心临床服务（前提是医院尚未提供这些服务）。采用这种循证方法，只需适度增加临床药师人员配备，就能提供所选的五项核心临床药学服务。
