University of Michigan Health System, Ann Arbor, MI, USA.
Am J Health Syst Pharm. 2013 Sep 15;70(18):1592-600. doi: 10.2146/ajhp120786.
The effect of hospital pharmacists' enhanced communication with patients and community providers on the underutilization of key cardiovascular medications was studied.
Patients enrolled in the Iowa Continuity of Care study were eligible for inclusion in this study if they had a diagnosis of hypertension, hyperlipidemia, heart failure, coronary artery disease, or a combination of these diagnoses. Eligible patients also had to be admitted to the internal medicine, family medicine, cardiology, or orthopedics services and receive their usual medical care in the community and their prescriptions from a community pharmacy. Patients were randomized to receive minimal intervention, enhanced intervention, or usual care. For the minimal- and enhanced-intervention groups, pharmacy case managers (PCMs) performed comprehensive medication reconciliations and identified drug-related problems within 24 hours of admission. The PCMs made recommendations to the inpatient care team and to patients' community physicians. For patients in the enhanced-intervention group, the PCM developed a discharge care plan containing the patient's discharge medication list. PCMs made specific recommendations to optimize regimens that did not meet current guidelines or medications that were underutilized. Medication underutilization was assessed at admission, discharge, 30 days after discharge, and 90 days after discharge.
A total of 732 patients were enrolled in this study. There were no significant differences among the three study groups. Overall, the rate of underutilization remained constant among all three groups, despite enhanced pharmacist involvement in both intervention groups.
Enhanced interventions by PCMs had no effect on the underutilization of key cardiovascular drugs during hospitalization or after hospital discharge.
研究医院药师加强与患者和社区提供者沟通对关键心血管药物未充分利用的影响。
参加爱荷华州持续护理研究的患者如果患有高血压、高血脂、心力衰竭、冠心病或这些诊断的组合，则有资格纳入本研究。符合条件的患者还必须接受内科、家庭医学、心脏病学或骨科服务的治疗，并在社区接受常规医疗护理和社区药房的处方。患者被随机分配接受最小干预、增强干预或常规护理。对于最小干预和增强干预组，药房经理（PCM）在入院后 24 小时内进行全面药物重整，并确定与药物相关的问题。PCM 向住院护理团队和患者的社区医生提出建议。对于增强干预组的患者，PCM 制定了一份出院护理计划，其中包含患者的出院药物清单。PCM 提出了具体建议，以优化不符合当前指南的方案或未充分利用的药物。在入院时、出院时、出院后 30 天和出院后 90 天评估药物未充分利用的情况。
共有 732 名患者参加了这项研究。三组之间没有显著差异。总体而言，尽管两组干预都增加了药剂师的参与，但所有三组的未充分利用率都保持不变。
PCM 的增强干预措施对住院期间和出院后关键心血管药物的未充分利用没有影响。
