Reeder Todd A, Mutnick Alan
Brooke Army Medical Center, San Antonio, TX 78234, USA.
Am J Health Syst Pharm. 2008 May 1;65(9):857-60. doi: 10.2146/ajhp070292.
Physician-obtained medication histories were compared to those obtained by a pharmacist.
Patients whose medication histories were obtained were included in the evaluation if they were at least 18 years old and admitted to an internal medicine service at the University of Virginia Medical Center. Data were collected in two phases. The first 20 patients identified for inclusion were asked to provide an accurate medication history to pilot test the medication history form used by the pharmacist and received no pharmacist follow-up or interventions. In the second phase, patients were asked to provide an accurate medication history, and a pharmacist intervened when discrepancies in the pharmacist-obtained medication history were identified.
A total of 55 patients were included in the study. The pharmacists identified 614 medications for these patients, compared with 556 identified by the physicians (p < or = 0.001). The pharmacist documented significantly more medication doses and dosage schedules than did physicians (614 versus 446 and 614 versus 404, respectively) (p < or = 0.001 for both comparisons). The pharmacist identified 353 discrepancies, including 58 medications not initially identified from the physician-obtained histories. The pharmacist intervened for 161 discrepancies, correcting 142 after contacting the respective physician; 19 medication discrepancies could not be justified by the physician.
A total of 353 discrepancies were identified when medication histories obtained by physicians were compared with those obtained by a pharmacist during the study. During the intervention phase, the majority of discrepancies identified were either corrected by the pharmacist after contacting the respective physician or justified by the physician.
将医生获取的用药史与药剂师获取的用药史进行比较。
纳入的评估对象为年龄至少18岁且入住弗吉尼亚大学医学中心内科的患者，这些患者的用药史已被获取。数据收集分两个阶段进行。最初确定纳入的20名患者被要求提供准确的用药史，以对药剂师使用的用药史表格进行预试验，且未接受药剂师的后续跟进或干预。在第二阶段，患者被要求提供准确的用药史，当发现药剂师获取的用药史存在差异时，药剂师进行干预。
共有55名患者纳入研究。药剂师为这些患者识别出614种药物，而医生识别出556种（p≤0.001）。药剂师记录的药物剂量和用药时间表明显多于医生（分别为614对446以及614对404）（两项比较p均≤0.001）。药剂师发现353处差异，包括58种最初未从医生获取的用药史中识别出的药物。药剂师对161处差异进行了干预，在联系各自的医生后纠正了142处；19处药物差异医生无法给出合理说明。
在研究期间，将医生获取的用药史与药剂师获取的用药史进行比较时，共发现353处差异。在干预阶段，发现的大多数差异要么由药剂师在联系各自的医生后纠正，要么由医生给出合理说明。
