Lovisenberg Diakonale Hospital Pharmacy, Lovisenberggate 17, 0440, Oslo, Norway.
Int J Clin Pharm. 2012 Apr;34(2):382-8. doi: 10.1007/s11096-012-9623-5. Epub 2012 Mar 3.
Drug-related problems (DRPs) have been found to be associated with increased morbidity, mortality, and health costs.
To investigate whether the inclusion of pharmacists in a rehabilitation team influences the handling of DRPs in the ward and whether an intervention in hospital affects drug use after discharge.
The rehabilitation ward of a general hospital in Oslo, Norway.
Patients were randomized into an intervention group (IG) or a usual care group (CG). The IG patients were followed prospectively by a pharmacist, who reviewed the patients' drug therapies using information from their medical records and patient interviews. The pharmacist identified DRPs and suggested solutions during multidisciplinary team meetings. The IG patients received targeted drug counselling from the pharmacist before discharge. The drug therapy in the CG, for the period from study randomization to discharge, was assessed retrospectively by the pharmacist, who identified DRPs and recorded how they were acted upon. Three months after discharge, pharmacists who were blinded to the patient randomization, visited the patients at home and interviewed them about their medication.
Types and frequencies of DRPs in the IG and CG were compared at hospital admission, at discharge, and 3 months after discharge.
Of the 77 patients included, 40 belonged to the IG and 37 to the CG. Patient characteristics (IG vs CG) were as follows: age 73.5 versus 76.8 years; female 58 versus 68%; mean number of drugs at admission 8.3 versus 7.8; and mean number of drugs at discharge 8.5 versus 7.7. At admission, 4.4 DRPs per patient were recorded in the IG and 4.2 in the CG. Significantly more DRPs were acted upon and resolved in the IG; at discharge, the IG had 1.2 DRPs per patient and the CG had 4.0 (P < 0.01). At the home visit, a significant difference between the groups was found: 1.63 versus 2.62 DRPs (P = 0.02) for the IG and the CG, respectively.
Involvement of a pharmacist in drug-therapy management, including participation in multidisciplinary team discussions, markedly improved the identification and resolution of DRPs during a hospital stay. The benefit persisted after discharge.
药物相关问题（DRPs）与发病率、死亡率和医疗成本增加有关。
研究康复病房中药师的参与是否会影响病房中 DRPs 的处理，以及医院内的干预是否会影响出院后的药物使用。
挪威奥斯陆一家综合医院的康复病房。
将患者随机分为干预组（IG）或常规护理组（CG）。IG 患者由一名药师进行前瞻性随访，药师通过患者病历和访谈信息审查患者的药物治疗。药师在多学科团队会议上确定 DRPs 并提出解决方案。IG 患者在出院前接受药师的有针对性的药物咨询。CG 患者在从研究随机分组到出院期间的药物治疗由药师进行回顾性评估，药师确定 DRPs 并记录其处理方式。出院后 3 个月，药师对患者进行家访，询问他们的用药情况。
IG 和 CG 在入院时、出院时和出院后 3 个月时的 DRP 类型和频率进行比较。
77 例患者中，40 例纳入 IG，37 例纳入 CG。患者特征（IG 与 CG）如下：年龄 73.5 岁与 76.8 岁；女性 58 例与 68 例；入院时平均用药数 8.3 种与 7.8 种；出院时平均用药数 8.5 种与 7.7 种。入院时，IG 患者每人记录 4.4 个 DRPs，CG 患者每人记录 4.2 个。IG 中有更多的 DRPs 得到处理和解决；出院时，IG 患者每人有 1.2 个 DRPs，CG 患者每人有 4.0 个（P<0.01）。在家访时，两组间差异显著：IG 组和 CG 组分别有 1.63 个和 2.62 个 DRPs（P=0.02）。
药师参与药物治疗管理，包括参与多学科团队讨论，显著改善了住院期间 DRPs 的识别和解决。出院后仍有获益。
