Sankaranarayanan Jayashri, Murante Lori J, Moffett Lisa M
1 School of Pharmacy, Department of Pharmacy Practice, University of Connecticut, Hartford Hospital , Hartford, Connecticut.
Telemed J E Health. 2014 Oct;20(10):893-901. doi: 10.1089/tmj.2013.0362. Epub 2014 Mar 10.
This retrospective cross-sectional study evaluated a telepharmacy service model using a conceptual framework to compare documented remote pharmacist interventions by year, hospital, and remote pharmacist and across rural hospitals with or without an on-site rural hospital pharmacist.
Documented remote pharmacist interventions for patients at eight rural hospitals in the Midwestern United States during prospective prescription order review/entry from 2008 to 2011 were extracted from RxFusion(®) database (a home-grown system, i.e., internally developed program at The Nebraska Medical Center (TNMC) for capturing remote pharmacist-documented intervention data). The study authors conceptualized an analytical framework, mapping the 37 classes of remote pharmacist interventions to three broader-level definitions: (a) intervention, eight categories (interaction/potential interaction, contraindication, adverse effects, anticoagulation monitoring, drug product selection, drug regimen, summary, and recommendation), (b) patient medication management, two categories (therapy review and action), and (c) health system-centered medication use process, four categories (prescribing, transcribing and documenting, administering, and monitoring). Frequencies of intervention levels were compared by year, hospital, remote pharmacist, and hospital pharmacy status (with a remote pharmacist and on-site pharmacist or with a remote pharmacist only) using chi-squared test and univariate logistic regression analyses, as appropriate.
For 450,000 prescription orders 19,222 remote pharmacist interventions were documented. Frequency of interventions significantly increased each year (36% in 2009, 55% in 2010, and 7% in 2011) versus the baseline year (2008, 3%) when service started. The frequency of interventions also differed significantly across the eight hospitals and 16 remote pharmacists for the three defined intervention levels and categories. Remote pharmacist interventions at hospitals with an on-site and remote pharmacist (n=12,141) versus those with a remote pharmacist alone (n=7,081) were significantly more likely to be (1) patient-centered, (2) related to "actionable" medication management recommendations (unadjusted odds ratio [OR]=1.12), and (3) related to the "transcribing" (OR=1.47) and "prescribing" (OR=1.40) steps of the health system-centered medication use process level (all p<0.01).
This is one of the first studies to demonstrate the patient- and health system-centered nature of pharmaceutical care delivered via a telepharmacy service model by evaluating documented remote pharmacist interventions with an analytical framework.
本回顾性横断面研究使用概念框架评估了一种远程药学服务模式，以比较按年份、医院、远程药师分类的已记录的远程药师干预措施，并比较有或没有现场农村医院药师的农村医院之间的差异。
从RxFusion®数据库（一个本地系统，即内布拉斯加医学中心（TNMC）内部开发的用于收集远程药师记录的干预数据的程序）中提取2008年至2011年美国中西部八家农村医院患者前瞻性处方订单审核/录入期间记录的远程药师干预措施。研究作者构建了一个分析框架，将37类远程药师干预措施映射到三个更广泛的定义：（a）干预，八类（相互作用/潜在相互作用、禁忌症、不良反应、抗凝监测、药品选择、药物治疗方案、总结和建议），（b）患者用药管理，两类（治疗审查和行动），以及（c）以卫生系统为中心的用药过程，四类（开处方、转录和记录、给药和监测）。根据年份、医院、远程药师和医院药房状态（有远程药师和现场药师或仅有远程药师），使用卡方检验和单因素逻辑回归分析，比较干预水平的频率。
在450,000份处方订单中，记录了19,222次远程药师干预措施。与服务开始的基线年份（标准差）相比，干预频率每年显著增加（2009年为36%，2010年为55%，2011年为7%）。在三个定义的干预水平和类别中，八家医院和16名远程药师的干预频率也存在显著差异。有现场和远程药师的医院（n=12,141）的远程药师干预措施与仅有远程药师的医院（n=7,081）相比，更有可能（1）以患者为中心，（2）与“可操作的”用药管理建议相关（未调整优势比[OR]=1.12），以及（3）与以卫生系统为中心的用药过程水平的“转录”（OR=1.47）和“开处方”（OR=1.40）步骤相关（所有p<0.01）。
这是首批通过使用分析框架评估已记录的远程药师干预措施，来证明通过远程药学服务模式提供的药学服务以患者和卫生系统为中心的研究之一。
