Tonna Antonella P, Stewart Derek, West Bernice, Gould Ian, McCaig Dorothy
School of Pharmacy, Faculty of Health and Social Care, The Robert Gordon University, Aberdeen AB10 1FR, UK.
Int J Antimicrob Agents. 2008 Jun;31(6):511-7. doi: 10.1016/j.ijantimicag.2008.01.018. Epub 2008 Mar 20.
The aims of this literature review were: (i) to determine what roles have been supported by evidence for the pharmacist in optimising antimicrobial treatment as part of an antimicrobial multidisciplinary team (AMDT) in secondary care; and (ii) to describe the outcomes of interventions of an AMDT in secondary care with pharmacy involvement. Both descriptive and primary research reports were identified and included. The hospital pharmacist emerged as a key member of the AMDT. The dispensary pharmacist was mainly involved in the screening processes and was crucial in implementing restriction policies. The general ward-based clinical pharmacist was involved in guideline development, formulary management, intravenous-to-oral conversions and evaluations of programme outcomes through monitoring of drug usage, and also facilitated identification of patients with specific needs who could be referred to the specialist pharmacist. A role emerged for the specialist pharmacist who was an integral part of the AMDT and was involved in activities including reviewing of more complex patients, attending ward rounds and streamlining of initial empirical antimicrobial treatment. Outcomes of interventions reported in primary research have been classified into: drug outcomes, where most trials measured and reported an increase in adherence to guidelines; microbiological outcomes, only considered in a few trials; clinical outcomes, with different parameters measured and a maintenance or improvement reported; and financial outcomes. The latter were reported in all trials with numerous cost savings, although not all were statistically significant. Moreover, the cost of the intervention was not always considered.
（i）确定在二级医疗中，作为抗菌多学科团队（AMDT）的一部分，药剂师在优化抗菌治疗方面有哪些已获证据支持的作用；（ii）描述在二级医疗中，有药剂师参与的AMDT干预措施的结果。我们识别并纳入了描述性报告和原发性研究报告。医院药剂师成为了AMDT的关键成员。药房药剂师主要参与筛查过程，在实施限制政策方面至关重要。普通病房的临床药剂师参与指南制定、处方集管理、静脉给药转换为口服给药，以及通过监测药物使用情况评估项目结果，还协助识别有特殊需求的患者，以便将其转诊给专科药剂师。专科药剂师的作用逐渐显现，他们是AMDT不可或缺的一部分，参与的活动包括审查更复杂的患者、参加病房查房以及简化初始经验性抗菌治疗。原发性研究报告的干预措施结果分为：药物结果，大多数试验测量并报告了指南依从性的提高；微生物学结果，仅在少数试验中考虑；临床结果，测量了不同参数并报告了维持或改善情况；以及财务结果。在所有试验中均报告了后者，有大量成本节约，尽管并非所有节约在统计学上都具有显著性。此外，干预措施的成本并非总是被考虑在内。
