药师对处方错误进行修改的临床价值评估。
Evaluation of the clinical value of pharmacists' modifications of prescription errors.
作者信息
Buurma Henk, De Smet Peter A G M, Leufkens Hubert G M, Egberts Antoine C G
机构信息
SIR Institute for Pharmacy Practice Research, Leiden, the Netherlands.
出版信息
Br J Clin Pharmacol. 2004 Nov;58(5):503-11. doi: 10.1111/j.1365-2125.2004.02181.x.
AIMS
Our objective was to examine the clinical value of pharmacists' interventions to correct prescription errors.
METHODS
In this study, we reviewed a random sample of prescriptions that had been modified in pharmacies. These prescriptions were collected on one predetermined day between 25th February and 12th March 1999 from 141 Dutch community pharmacies. Each prescription modification was evaluated by a panel of reviewers, including representatives of five groups of health care professionals. After generally rating each modification as positive, negative, or neutral, the reviewers assessed its outcome (in terms of prevention of an adverse drug reaction [ADR], an improvement in effectiveness, both, or other), the probability and importance of improvements in effectiveness and/or the probability and seriousness of an ADR in the case of a nonintervention. Our analyses included 144 interventions from the first general assessment and a selection of 90 consistently rated 'positive' interventions (from all assessments).
RESULTS
On average, one in 200 prescriptions (0.49%) was found to have been positively modified by Dutch community pharmacists. About half of these interventions (49.8%) were aimed at preventing ADRs; 29.2% were rated as a positive modification in the effectiveness of pharmacotherapy and 8.6% affected both effectiveness and ADR. Reviewers' ratings varied widely between different categories of drug-related problems (DRPs). The impact of individual interventions (n = 83) varied, and for 53% of these interventions it was estimated to be relatively high.
CONCLUSIONS
Pharmacists' interventions led to modification of prescriptions for an array of DRPs. Such interventions can contribute positively to the quality of pharmacotherapy. By extrapolating our data, we estimated a daily occurrence of approximately 2700 positive interventions in all Dutch pharmacies (1.6 per pharmacy per day). Reviewers rated the impact of interventions on a patient's health as significant in a substantial number of cases.
目的
我们的目标是研究药剂师干预纠正处方错误的临床价值。
方法
在本研究中，我们回顾了在药房中被修改的处方的随机样本。这些处方于1999年2月25日至3月12日之间的一个预定日期从141家荷兰社区药房收集。每个处方修改由一组评审员评估，包括五组医疗保健专业人员的代表。在将每个修改总体评为积极、消极或中性后，评审员评估其结果（就预防药物不良反应[ADR]、有效性改善、两者或其他而言）、有效性改善的可能性和重要性，以及在不干预情况下ADR的可能性和严重性。我们的分析包括第一次总体评估中的144次干预以及从所有评估中挑选出的90次一致评为“积极”的干预。
结果
平均而言，每200张处方中有1张（0.49%）被荷兰社区药剂师积极修改。这些干预中约一半（49.8%）旨在预防ADR；29.2%被评为药物治疗有效性的积极修改，8.6%同时影响有效性和ADR。评审员的评分在不同类别的药物相关问题（DRP）之间差异很大。个体干预（n = 83）的影响各不相同，其中53%的干预估计影响相对较大。
结论
药剂师的干预导致了一系列DRP的处方修改。此类干预可对药物治疗质量产生积极贡献。通过推断我们的数据，我们估计荷兰所有药房每天大约发生2700次积极干预（每家药房每天1.6次）。在大量案例中，评审员将干预对患者健康的影响评为显著。
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