Bundaberg Hospital, Bundaberg, Queensland, Australia
J Eval Clin Pract. 2011 Jun;17(3):478-85. doi: 10.1111/j.1365-2753.2010.01454.x. Epub 2010 Oct 12.
RATIONALE, AIMS AND OBJECTIVES: Departments of Emergency Medicine (DEM) have experienced increased demand largely because of the aging population. This project aimed to assess the impact of a specialist aged care pharmacist (ACP) on the efficiency and effectiveness of care of older patients seeking emergency treatment.
Eligible patients presenting to the DEM of Bundaberg Hospital (Australia), aged ≥ 65 years with a chronic condition, or ≥ 70 years without a chronic condition, and an Australian Triage Category score of ≥ 2, were alternately allocated to either the ACP (for medication reconciliation and medication review roles, along with patient education and referrals where warranted), or continued management by the DEM doctor (control group).
A total of 199 patients were included (intervention, n = 101; control, n = 98), with no significant difference in mean age or gender distribution. While the ACP-managed group demonstrated a significantly greater length of stay than the control group, some confounding was likely. The ACP demonstrated greater vigilance than usual care in ensuring completeness and accuracy in charted medication orders. The ACP also provided timely clinical review for medication-related problems, with 81 issues identified for 73 admitted patients, and 24 issues among the 28 discharged patients. Qualitative data were strongly supportive, valuing and accepting of the ACP role.
This study provides evidence, on balance, supporting the integration of an ACP in the DEM assessing elderly patients. Further research of this role using longer sampling, in multiple sites and with economic analysis is recommended.
背景、目的和目标：急诊医学科（DEM）经历了需求的增长，这主要是由于人口老龄化。本项目旨在评估老年护理药剂师（ACP）对接受紧急治疗的老年患者的护理效率和效果的影响。
本研究纳入了符合条件的年龄≥ 65 岁且有慢性疾病，或年龄≥ 70 岁且无慢性疾病，以及澳大利亚分诊类别评分≥ 2 的患者，他们被交替分配到 ACP（负责药物重整和药物审查，以及必要时的患者教育和转介）或由 DEM 医生继续管理（对照组）。
共纳入 199 名患者（干预组 n = 101；对照组 n = 98），平均年龄和性别分布无显著差异。尽管 ACP 管理组的住院时间明显长于对照组，但可能存在一些混杂因素。ACP 比常规护理更能确保图表中药物医嘱的完整性和准确性。ACP 还及时对与药物相关的问题进行临床审查，为 73 名住院患者中的 81 个问题和 28 名出院患者中的 24 个问题提供了临床审查。定性数据强烈支持并接受 ACP 的角色。
本研究提供了平衡的证据，支持在评估老年患者的 DEM 中整合 ACP。建议使用更长的采样时间、在多个地点和进行经济分析来进一步研究这一角色。
