López Maángeles Pardo, Saliente Ma Teresa Aznar, Company Enrique Soler, Monsalve Ana Garcia, Cueva Marta Aparício, Domingo Elena Arroyo, Hernández Monica Montero, Carrión Carmen Carrión, Martí Monica Climente, Querejeta Nuria Bujaldón, Blasco Joaquín Borrás, Milá Amparo Rocher
Pharmacy Department, Hospital Universitario de San Juan, Alicante, Spain.
Int J Pharm Pract. 2010 Oct;18(5):297-304. doi: 10.1111/j.2042-7174.2010.00054.x. Epub 2010 Sep 14.
The aim of this study was to describe the most common drug-related problems (DRPs) found after discharge, pharmacist interventions and their results for the patients enrolled on the CONSULTENOS programme.
An observational, prospective, multicentre study was conducted to evaluate the results of a pharmaceutical care programme at discharge. Patients from 10 hospitals participating in the CONSULTENOS programme were enrolled. Pharmacists conducting this programme were newly graduated and worked under the supervision of a pharmacy staff member; only two pharmacists had previous hospital pharmacy experience. DRPs were identified and classified according to the Iaser methodology. Frequencies, types of DRP, interventions and outcomes were registered prospectively, at discharge and during a follow-up call 7 days after leaving the hospital.
A total of 7711 patients were included in the study. DRPs were detected in 23.7% of the patients, with a total of 2120 DRPs (1788 at discharge and 332 in the follow-up). The most common problems identified at discharge were twofold: firstly the need of an additional treatment (34.1%) and secondly an unnecessary treatment (18.1%). In the follow-up phone call the most frequent DRPs were adverse effects (29.2%). Besides the standard educational interventions at discharge, 3313 extra interventions were performed, of which 85% were accepted. The outcomes for the patients were positive in 80% of the cases, although documentation with objective or subjective data was rare.
DRPs occur frequently after patient discharge. A pharmaceutical care programme can identify and solve DRPs in this scenario. The clinical impact of the pharmacists' interventions should be better addressed.
本研究旨在描述出院后发现的最常见药物相关问题（DRP）、药师干预措施及其对参与CONSULTENOS项目患者的干预结果。
开展一项观察性、前瞻性、多中心研究，以评估出院时药学服务项目的结果。纳入了参与CONSULTENOS项目的10家医院的患者。开展该项目的药师为新毕业人员，在药房工作人员的监督下工作；只有两名药师有过医院药房工作经验。DRP根据Iaser方法进行识别和分类。前瞻性记录出院时以及出院后7天随访电话中的DRP频率、类型、干预措施及结果。
本研究共纳入7711例患者。23.7%的患者检测到DRP，共发现2120个DRP（出院时1788个，随访时332个）。出院时发现的最常见问题有两个方面：一是需要额外治疗（34.1%），二是存在不必要的治疗（18.1%）。随访电话中最常见的DRP是不良反应（29.2%）。除了出院时的标准教育干预措施外，还进行了3313次额外干预，其中85%被接受。80%的患者干预结果为阳性，不过很少有客观或主观数据记录。
患者出院后DRP频繁发生。药学服务项目可在这种情况下识别并解决DRP。应更好地阐述药师干预措施的临床影响。
