Casey Michelle M, Moscovice Ira S, Davidson Gestur
Rural Health Research Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
J Rural Health. 2006 Fall;22(4):321-30. doi: 10.1111/j.1748-0361.2006.00053.x.
Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources.
This study assessed the capacity of small rural hospitals to implement medication safety practices, with particular focus on pharmacist staffing and the availability of technology.
A telephone survey of a national random sample of small rural hospitals was conducted from March to May 2005 (N = 387 hospitals, 94.6% response rate). Survey respondents included pharmacists (89%) and directors of nursing (11%). Multivariate analyses examined the relationships between hospital organizational and financial variables and (1) the amount of pharmacist staffing; (2) use of pharmacy computers for medication safety activities; and (3) implementation of medication safety practices.
Many small rural hospitals have limited hours of on-site pharmacist coverage. Almost one quarter of hospitals either do not have a pharmacy computer or are not using it for clinical purposes. Half of the hospitals have implemented 4 key medication safety practices. Level of pharmacist staffing, use of technology, and implementation of medication safety practices are significantly related to hospital financial status and accreditation.
Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. The study results support a continuation of Medicare cost-based reimbursement policies to help ensure financial stability and support quality and patient safety activities in small rural hospitals.
药物安全显然是农村医院的一个重要质量问题。然而，农村医院在人员配备以及财务和技术资源方面，在实施药物安全措施上面临特殊挑战。
本研究评估了小型农村医院实施药物安全措施的能力，特别关注药剂师人员配备和技术可用性。
2005年3月至5月对全国小型农村医院的随机样本进行了电话调查（N = 387家医院，回应率94.6%）。调查对象包括药剂师（89%）和护理主任（11%）。多变量分析研究了医院组织和财务变量与以下方面的关系：（1）药剂师人员配备数量；（2）用于药物安全活动的药房计算机的使用情况；（3）药物安全措施的实施情况。
许多小型农村医院现场药剂师覆盖时间有限。近四分之一的医院要么没有药房计算机，要么未将其用于临床目的。一半的医院实施了4项关键药物安全措施。药剂师人员配备水平、技术使用情况以及药物安全措施的实施情况与医院财务状况和认证显著相关。
与药物使用相关的方案和关键药物安全措施的实施是小型农村医院可以改进的领域。研究结果支持继续实施基于医疗保险成本的报销政策，以帮助确保小型农村医院的财务稳定，并支持其质量和患者安全活动。
