Phansalkar Shobha, Hoffman Jennifer M, Nebeker Jonathan R, Hurdle John F
Department of Biomedical Informatics, University of Utah, Salt Lake City, and Department of Veterans Affairs Medical Center 84132, USA.
Am J Health Syst Pharm. 2007 Apr 15;64(8):842-9. doi: 10.2146/ajhp060335.
A systematic review and metaanalysis were conducted to determine if studies that included pharmacists as chart reviewers detected higher rates of adverse drug events (ADEs) than studies that included other health care professionals or hospital personnel as chart reviewers.
A systematic review and metaanalysis of studies using chart review as the method of detection of ADEs were conducted. Pooled estimates of the ADE rates were calculated using the inverse variance weight method. Meta-analysis was performed using a random effects model. Using the Mann-Whitney U test, weighted rates of studies in which pharmacists versus other clinicians were the chart reviewers were compared.
Thirteen studies satisfied the inclusion criteria. Using random effects metaanalysis, the mean of the weighted incidence rate detected by pharmacists was 0.33 ADE per admission (95% confidence interval [CI], 0.17-0.50); the mean was 0.16 ADE per admission (95% CI, 0.11-0.22) with detection by nonpharmacists. Significant heterogeneity was present between studies in both groups. A significant difference (p=0.003) existed between the ADE rate reported by pharmacists (median=0.23; interquartile range [IQR], 0.18-0.44) and that of nonpharmacists (median=0.12; IQR, 0.02-0.49). Although there is overwhelming evidence of statistical heterogeneity, the numbers pertaining to the ADE rates detected by the two groups were large enough to indicate significant differences. Despite the heterogeneity, there is strong evidence that pharmacist-led interventions based on chart review report a higher ADE rate among inpatients.
A review of the literature revealed that pharmacists make a salient contribution as manual chart reviewers in inpatient ADE interventions.
进行一项系统评价和荟萃分析，以确定将药剂师作为病历审查员的研究是否比将其他医疗保健专业人员或医院工作人员作为病历审查员的研究检测到更高的药物不良事件（ADEs）发生率。
对使用病历审查作为ADEs检测方法的研究进行系统评价和荟萃分析。使用逆方差加权法计算ADEs发生率的合并估计值。采用随机效应模型进行荟萃分析。使用曼-惠特尼U检验比较药剂师与其他临床医生作为病历审查员的研究的加权发生率。
13项研究符合纳入标准。采用随机效应荟萃分析，药剂师检测到的加权发生率均值为每次入院0.33例ADEs（95%置信区间[CI]，0.17 - 0.50）；非药剂师检测到的均值为每次入院0.16例ADEs（95%CI，0.11 - 0.22）。两组研究之间均存在显著异质性。药剂师报告的ADEs发生率（中位数 = 0.23；四分位间距[IQR]，0.18 - 0.44）与非药剂师报告的发生率（中位数 = 0.12；IQR，0.02 - 0.49）之间存在显著差异（p = 0.003）。尽管有压倒性的统计异质性证据，但两组检测到的ADEs发生率的数值足够大，表明存在显著差异。尽管存在异质性，但有强有力的证据表明，基于病历审查的药剂师主导的干预措施报告的住院患者ADEs发生率更高。
文献综述表明，药剂师作为住院患者ADEs干预中的手工病历审查员做出了显著贡献。
