Bruce A. Warden, Pharm.D., BCPS, is Clinical Pharmacist; and Jessica Pryor Freels, Pharm.D., M.S., is Clinical Operations Manager, Oregon Health and Science University (OHSU), Portland. Jon P. Furuno, Ph.D., is Associate Professor, Department of Pharmacy Practice, Oregon State University/OHSU College of Pharmacy. John Mackay, Pharm.D., BCPS (AQ-Cardiology), is Advanced Heart Failure Clinical Pharmacist, OHSU.
Am J Health Syst Pharm. 2014 Jan 15;71(2):134-9. doi: 10.2146/ajhp130103.
The impact of a pharmacy-managed program for providing education and discharge instructions for patients with heart failure (HF) was evaluated.
A before-and-after quasiexperimental design was used to quantify the effect of a pharmacist-managed HF medication education and discharge instruction program on the incidence of 30-day readmission rates and adherence to targeted Joint Commission core measures for HF (the provision of discharge instructions and the prescribing of an angiotensin-converting-enzyme inhibitor [ACEI]/angiotensin II receptor blocker [ARB] at discharge or documentation of the reason if therapy was not prescribed). Adult patients admitted to Oregon Health and Science University's cardiology unit with systolic HF exacerbation as their primary diagnosis between December 2010 and March 2011 were included. Throughout patients' hospitalization, the pharmacist collaborated with the multidisciplinary team to make treatment and monitoring recommendations; provided discharge medication reconciliation, discharge medication recommendations, and discharge instructions; answered patient-specific questions; and gave the patient a complete discharge medication list.
The study enrolled 35 patients and compared results against a historical control group of 115 patients. The frequency of discharge counseling increased significantly (p = 0.007), as did the rate of ACEI/ARB prescribing at discharge (p = 0.02). Both 30-day all-cause and HF-related readmissions were reduced compared with baseline (p = 0.02 and p = 0.11, respectively).
Pharmacist involvement in medication reconciliation and discharge counseling for HF patients was associated with a significant increase in adherence with the Joint Commission's core measures, a significant reduction in 30-day all-cause readmissions, and a positive effect on patient satisfaction.
评估为心力衰竭（HF）患者提供教育和出院指导的药房管理计划的影响。
采用前后对照准实验设计，定量评估药师管理的 HF 药物教育和出院指导计划对 30 天再入院率和遵医嘱治疗 HF 的联合委员会核心指标的影响（提供出院指导和在出院时开具血管紧张素转换酶抑制剂[ACEI] /血管紧张素 II 受体阻滞剂[ARB]，或记录未开处方的原因）。纳入 2010 年 12 月至 2011 年 3 月间因收缩性 HF 加重作为主要诊断而入住俄勒冈健康与科学大学心脏病学部的成年患者。在患者住院期间，药剂师与多学科团队合作，提出治疗和监测建议；提供出院药物调整、出院药物建议和出院指导；回答患者的具体问题；并为患者提供完整的出院药物清单。
该研究共纳入 35 例患者，并与 115 例历史对照组进行了比较。出院咨询的频率显著增加（p = 0.007），出院时 ACEI / ARB 的开具率也显著增加（p = 0.02）。与基线相比，30 天全因和 HF 相关再入院率均降低（p = 0.02 和 p = 0.11）。
药师参与 HF 患者的药物调整和出院咨询，与联合委员会核心指标的遵医嘱率显著提高、30 天全因再入院率显著降低以及患者满意度的提高有关。
