Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA 23298, USA.
J Am Med Dir Assoc. 2011 Jun;12(5):355-63. doi: 10.1016/j.jamda.2010.03.003. Epub 2010 Oct 2.
We sought to evaluate the effectiveness of the Fleetwood Model of pharmacy practice on improving resident outcomes and hypothesized that this model would reduce potentially inappropriate medication use, hospitalizations, and death.
Demonstration project, pre-post design.
Twelve nursing homes receiving interventions and 13 homes in the comparison group in North Carolina.
Residents living in one of the included nursing homes from 2002 to 2004.
The Fleetwood Model, performed by dispensing and consultant pharmacists, incorporated prospective reviews, direct communication with the prescribers, and formalized pharmaceutical care planning in patients at highest risk for medication-related problems.
Hospitalizations because of potential adverse drug events, use of potentially inappropriate medications, mortality.
Residents in the intervention had similar hospitalization rates, hospitalizations owing to potential adverse drug events, and mortality rates as residents in the usual care homes. With respect to the use of potentially inappropriate medications, the decline of use of these medications appeared earlier in the intervention homes relative to the usual care homes, but differences did not reach statistical significance (adjusted Hazard Rate = 0.86; 95% CI: 0.65-1.12).
Extending the role of the dispensing and consultant pharmacists beyond federally mandated drug regimen reviews is feasible, although ability to bill and be reimbursed for such services may ensure consistent prospective intervention.
我们旨在评估药房实践的弗利特伍德模式在改善居民结局方面的有效性，并假设该模式将减少潜在不适当的药物使用、住院和死亡。
示范项目，前后设计。
北卡罗来纳州的 12 家接受干预的养老院和 13 家对照组养老院。
2002 年至 2004 年期间居住在一家纳入养老院的居民。
由配药药剂师和顾问药剂师实施的弗利特伍德模式，包括前瞻性审查、与处方医生的直接沟通以及为面临药物相关问题高风险的患者制定正式的药物治疗计划。
因潜在药物不良事件导致的住院治疗、潜在不适当药物的使用、死亡率。
与常规护理院的居民相比，干预组的居民住院率、因潜在药物不良事件导致的住院率和死亡率相似。关于潜在不适当药物的使用，这些药物的使用下降在干预组中比常规护理组更早出现，但差异没有达到统计学意义（调整后的危险率=0.86；95%置信区间：0.65-1.12）。
扩大配药和顾问药剂师的角色，超越联邦规定的药物方案审查是可行的，尽管为这类服务计费和报销的能力可能确保持续的前瞻性干预。
