Walter Clare, Mellor James D, Rice Carol, Kirsa Sue, Ball David, Duffy Mary, Herschtal Alan, Mileshkin Linda
Pharmacy Department, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia.
Division of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia.
Asia Pac J Clin Oncol. 2016 Sep;12(3):e367-74. doi: 10.1111/ajco.12267. Epub 2014 Sep 16.
Medication misadventure contributes to unplanned hospital admissions. General practitioners (GPs) may lack experience in managing problems involving complex cancer-related medication. A previous survey explored the unmet needs of lung cancer outpatients and highlighted their desire for more medication information. Inpatient clinical pharmacy services positively impact on patient care. This study evaluated the effects of extending this service to outpatients.
A specialist cancer pharmacist joined the lung cancer clinic team for 6 months. Patients completed assessments of their medication adherence and their satisfaction with the provision of medicine information (at baseline and repeated within 30 days of initial pharmacist review). Following review, a medication list and plan (detailing recommendations/interventions) were provided to patients and their health care providers. Interventions were categorized and graded according to risk avoided. Unplanned admissions and clinic attendance rates were compared with the previous year. GPs' opinion of the service was also evaluated.
Forty-eight patients participated in the study. Medication adherence (P = 0.007) and patient satisfaction (P < 0.001) significantly improved. A total of 154 pharmacist interventions were made: 4.5% extreme risk and 43.5% high risk. The mean number of unplanned admissions and clinic attendances per patient decreased from 0.3 to 0.26 (P = 0.265) and from 3.32 to 2.98 (P = 0.004), respectively. Seventy-four percent of surveyed GPs found the service useful.
Adding a specialist cancer pharmacist to the outpatient lung cancer team led to significant improvements in patient medication adherence. Both patients and GPs were highly satisfied with the service. Medication misadventure and clinic attendances were reduced.
用药差错会导致非计划住院。全科医生（GP）在处理涉及复杂癌症相关用药问题时可能缺乏经验。此前一项调查探讨了肺癌门诊患者未满足的需求，并强调了他们对更多用药信息的渴望。住院临床药学服务对患者护理有积极影响。本研究评估了将该服务扩展到门诊患者的效果。
一名癌症专科药剂师加入肺癌门诊团队6个月。患者完成了用药依从性评估以及对用药信息提供的满意度评估（在基线时以及在药剂师首次评估后30天内重复评估）。评估后，向患者及其医疗服务提供者提供了一份用药清单和计划（详细说明建议/干预措施）。干预措施根据避免的风险进行分类和分级。将非计划住院率和门诊就诊率与上一年进行比较。还评估了全科医生对该服务的看法。
48名患者参与了该研究。用药依从性（P = 0.007）和患者满意度（P < 0.001）显著提高。总共进行了154次药剂师干预：4.5%为极高风险，43.5%为高风险。每位患者的非计划住院和门诊就诊平均次数分别从0.3降至0.26（P = 0.265）和从3.32降至2.98（P = 0.004）。74%的受访全科医生认为该服务有用。
在门诊肺癌团队中增加一名癌症专科药剂师可显著提高患者用药依从性。患者和全科医生对该服务都高度满意。用药差错和门诊就诊次数减少。
