Mahmood Maysaa H, Armstrong Edward P, Malone Daniel C, Skrepnek Grant H
PharmaceuticalSciences, College of Pharmacy, University of Arizona, Tucson 5721-0202, USA.
Am J Health Syst Pharm. 2008 Sep 15;65(18):1744-9. doi: 10.2146/ajhp070679.
The association between the exposure rates of clinically important drug-drug interactions (DDIs) and the structure of pharmaceutical services within the ambulatory care settings of Veterans Affairs medical centers (VAMCs) is discussed.
The structure of pharmaceutical services in VAMCs was assessed using a questionnaire that was distributed by mail to chief pharmacists at 182 facilities. The questionnaire focused on the total volume of prescriptions dispensed at each VAMC, the level and characteristics of pharmacy staffing, the characteristics and distribution of available pharmaceutical services, the availability of specialty ambulatory clinics, and the extent of clinical pharmacist coverage within these clinics. A list of 25 clinically important DDIs that were most likely to be encountered in ambulatory care settings was used in this study. Multivariate regression was used to assess the relationship in the structure of pharmaceutical services and the exposure rate to clinically important DDIs.
A total of 790,541 patients were treated by the 52 VAMCs included in this study, with a total of 17,447 patients exposed to DDIs of interest. VAMCs with a lower prescription volume, a higher number of pharmacists in ambulatory care settings, and a higher number of ambulatory specialty clinics had significantly lower rates of potential DDIs.
Exposure to clinically important DDIs was significantly lower in VAMCs with a higher number of pharmacists in ambulatory care settings, a higher number of ambulatory specialty clinics, and facilities with lower prescription volumes.
探讨退伍军人事务医疗中心（VAMC）门诊护理环境中临床重要药物相互作用（DDI）的暴露率与药学服务结构之间的关联。
通过向182家机构的首席药剂师邮寄问卷来评估VAMC的药学服务结构。问卷聚焦于每个VAMC的处方调配总量、药房人员配备水平及特点、可用药学服务的特点及分布、专科门诊的可用性以及这些门诊中临床药师的覆盖范围。本研究使用了一份在门诊护理环境中最可能遇到的25种临床重要DDI清单。采用多变量回归来评估药学服务结构与临床重要DDI暴露率之间的关系。
本研究纳入的52家VAMC共治疗了790,541名患者，其中共有17,447名患者暴露于感兴趣的DDI。处方量较低、门诊护理环境中药剂师数量较多以及门诊专科诊所数量较多的VAMC潜在DDI发生率显著较低。
在门诊护理环境中药剂师数量较多、门诊专科诊所数量较多以及处方量较低的VAMC中，临床重要DDI的暴露率显著较低。
