Pharmacy Practice Group, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK.
Ann Pharmacother. 2010 Jul-Aug;44(7-8):1181-90. doi: 10.1345/aph.1M719. Epub 2010 Jun 22.
Drug-related problems (DRPs) may result in adverse drug reactions causing hospital admissions (5-17%); older patients in particular may experience such reactions during a hospital stay (6-17%). While community pharmacists can identify DRPs through clinical medication reviews, little is known about how well they perform in providing such reviews.
To assess trained community pharmacists' performance in writing care plans and referrals when providing clinical medication reviews to elderly patients as part of a patient outcome-focused Medicines Management project.
In the south of England, 43 community pharmacists were recruited from 80 local community pharmacies; 37 completed clinical pharmacy training to provide medication reviews for elderly patients who were receiving prescriptions for 4 or more medicines from local general practices. Eleven trained pharmacists withdrew and did not provide any reviews. As part of quality assurance, a clinical pharmacist reviewed all care plans and referrals written by the community pharmacists and, if required, amended referrals before they were sent to the patients' family physicians with recommendations. The referrals written by the community pharmacists were compared with those written by the clinical pharmacist and were deemed to be accurate or incomplete (the community pharmacists could provide verbal information to the physicians) if the observations of DRPs and suggestions to solve them were beneficial to patients. Incorrect or missing observations and suggestions were considered nonbeneficial to patients.
The performance assessment was based on a sample of 244 referrals written by 20 community pharmacists. The clinical pharmacist identified 908 DRPs and suggested 1489 solutions; the community pharmacists beneficially identified 75% of these DRPs (1% were incorrectly identified and 24% were missed) and suggested 58% of the solutions (6% were incorrectly suggested and 36% were missed).
The community pharmacists beneficially identified most DRPs and suggested many solutions. However, the assessment may underestimate the community pharmacists' abilities, as it relied on the records they kept and was based on a gold standard. While the pharmacists were self-selected, this study provides valuable insight into trained community pharmacists' clinical medication review performance.
药物相关问题（DRPs）可能导致不良反应，从而导致住院（5-17%）；尤其是老年患者在住院期间可能会经历此类反应（6-17%）。虽然社区药剂师可以通过临床药物审查来识别 DRPs，但对于他们在提供此类审查方面的表现知之甚少。
评估经过培训的社区药剂师在为参与以患者结局为重点的药物管理项目的老年患者提供临床药物审查时，制定护理计划和转诊的能力。
在英格兰南部，从 80 家当地社区药房招募了 43 名社区药剂师；其中 37 名药剂师完成了临床药学培训，以对从当地全科医生处获得 4 种或更多药物处方的老年患者进行药物审查。11 名经过培训的药剂师退出且未提供任何审查。作为质量保证的一部分，一名临床药剂师审查了所有由社区药剂师撰写的护理计划和转诊，如果需要，在将转诊发送给患者的家庭医生并提出建议之前，对转诊进行修改。将社区药剂师撰写的转诊与临床药剂师撰写的转诊进行比较，如果观察到的 DRPs 及其解决建议对患者有益，则认为转诊准确或不完整（社区药剂师可以向医生提供口头信息）。如果观察结果和建议对患者无益，则认为转诊不准确或缺失。
基于 20 名社区药剂师撰写的 244 份转诊，进行了绩效评估。临床药剂师发现了 908 个 DRPs 并提出了 1489 个解决方案；社区药剂师有益地识别了其中的 75%（1%被错误识别，24%被遗漏）并提出了 58%的解决方案（6%被错误建议，36%被遗漏）。
社区药剂师有益地识别了大多数 DRPs 并提出了许多解决方案。然而，由于该评估依赖于他们保存的记录并基于金标准，因此可能低估了社区药剂师的能力。尽管药剂师是自我选择的，但这项研究为经过培训的社区药剂师的临床药物审查表现提供了有价值的见解。
