Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Private Bag 26, Hobart Tasmania 7001, Australia.
Int J Clin Pharm. 2011 Aug;33(4):621-6. doi: 10.1007/s11096-011-9515-0. Epub 2011 May 19.
To characterise the nature of the drug-related problems with warfarin therapy identified in pharmacist-conducted medication reviews during a collaborative post-discharge warfarin management service, with a focus on potentially serious drug interactions.
Australian community pharmacy practice.
Medication review reports submitted by pharmacists to patients' general practitioners as part of the service were reviewed and the type and clinical significance of the warfarin-associated drug-related problems, and the pharmacists' recommendations were classified. The prevalence of prescribing of 'potentially hazardous' warfarin drug interactions was investigated and compared with the frequency of documentation of these interactions in the medication review reports.
The number and nature of warfarin-associated drug-related problems identified and the rate of documentation of 'potentially hazardous' warfarin drug interactions in the reports from pharmacist-conducted medication reviews.
A total of 157 warfarin-associated drug-related problems were documented in 109 medication review reports (mean 1.4 per patient, 95% CI 1.3-1.6, range 0-5). Drug selection and Education or information were the most commonly identified warfarin-associated drug-related problems; most drug-related problems were of moderate clinical significance. Eight of 23 potentially serious warfarin drug interactions (34.8%) were identified in the medication review reports.
Pharmacists addressing drug selection and warfarin education drug-related problems during medication reviews may have contributed to the positive outcomes of the post-discharge service. Warfarin drug interactions were frequently identified; however, well-recognised potentially hazardous interactions were under-reported. Improved communication along the continuum of care would permit improved targeting of drug-related problem reporting, especially in relation to preventable drug interactions.
描述药剂师在协作性出院后华法林管理服务中进行药物审查时发现的与华法林治疗相关的药物问题的性质，重点关注潜在严重的药物相互作用。
澳大利亚社区药房实践。
审查药剂师作为该服务的一部分提交给患者的全科医生的药物审查报告，并对与华法林相关的药物相关问题的类型和临床意义以及药剂师的建议进行分类。调查了“潜在危险”华法林药物相互作用的处方流行率，并将其与药物审查报告中对这些相互作用的记录频率进行比较。
确定的与华法林相关的药物问题的数量和性质，以及药剂师进行药物审查报告中“潜在危险”华法林药物相互作用的记录率。
在 109 份药物审查报告中记录了 157 例与华法林相关的药物相关问题（平均每位患者 1.4 例，95%CI 1.3-1.6，范围 0-5）。药物选择和教育或信息是最常见的与华法林相关的药物相关问题；大多数药物相关问题具有中度临床意义。药物审查报告中发现了 23 种潜在严重华法林药物相互作用中的 8 种（34.8%）。
药剂师在药物审查中解决药物选择和华法林教育相关的药物问题可能对华法林出院后服务的积极结果做出了贡献。华法林药物相互作用经常被发现；然而，记录的潜在危险相互作用不足。沿护理连续性改善沟通将允许改善药物相关问题报告的针对性，特别是在预防药物相互作用方面。
