Howard Rachel, Rodgers Sarah, Avery Anthony J, Sheikh Aziz
School of Pharmacy, University of Reading, Reading, UK.
Int J Pharm Pract. 2014 Feb;22(1):59-68. doi: 10.1111/ijpp.12039. Epub 2013 May 30.
To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices.
PINCER pharmacists manually recorded patients' demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded, double-entered into SPSS version 15 and then summarised using percentages for categorical data (with 95% confidence interval (CI)) and, as appropriate, means (± standard deviation) or medians (interquartile range) for continuous data.
Pharmacists spent a median of 20 min (interquartile range 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95% CI 70, 74; 1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95% CI 73, 76; 1516/2038) of cases and 1685 actions were taken in 61% (95% CI 59, 63; 1246/2038) of cases; 66% (95% CI 64, 68; 1383/2105) of interventions recommended by pharmacists were completed and 5% (95% CI 4, 6; 104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists' placement; the remaining recommendations were rejected or considered not relevant by GPs.
The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.
对药师在一项复杂的、通过信息技术支持的由药师开展的随机对照试验（PINCER试验）中提出的建议进行过程评估，以降低全科医疗中危险药品管理的风险。
PINCER药师手动记录患者的人口统计学信息、推荐的干预措施细节、全科医疗工作人员采取的行动以及处理危险药品管理个别案例所花费的时间。数据进行编码，双录入SPSS 15版本，然后对分类数据使用百分比（95%置信区间（CI））进行汇总，对于连续数据则酌情使用均值（±标准差）或中位数（四分位间距）进行汇总。
在每例危险药品管理案例中，药师审查病历、推荐干预措施并完成行动的时间中位数为20分钟（四分位间距10, 30）。药师判定72%（95% CI 70, 74；1463/2026）的危险药品管理案例具有临床相关性。药师在74%（95% CI 73, 76；1516/2038）的案例中推荐了2105项干预措施，在61%（95% CI 59, 63；1246/2038）的案例中采取了1685项行动；药师推荐的干预措施中有66%（95% CI 64, 68；1383/2105）得以完成，5%（95% CI 4, 6；104/2105）的建议被全科医生（GP）接受，但在药师工作结束时未完成；其余建议被GP拒绝或认为不相关。
结果指标用于将全科医疗中药师的活动针对有危险药品管理风险的患者。发现经过培训的PINCER药师的建议在很大程度上为GP所接受，并在大多数案例中导致了改善行动。PINCER药师所采用的方法在经过适当培训后似乎可能被其他全科医疗药师采用。
