Philip Achsah, Green Monica, Hoffman Therese, Gautreaux Stefani, Wallace David, Roux Ryan, Garey Kevin W
Achsah Philip, Pharm.D., M.S., BCPS, is Clinical Informatics Pharmacist, Medication Use Policy and Informatics, Department of Pharmacy Services, Medical University of South Carolina, Charleston; at the time of writing she was Health-System Pharmacy Administration Resident, Harris Health System, Houston, TX. Monica Green, Pharm.D., BCPS, BCACP, is Ambulatory Clinical Manager; and Therese Hoffman, Pharm.D., M.B.A., is Director of Ambulatory Care Service, Harris Health System. Stefani Gautreaux, Pharm.D., M.B.A., is Pharmacy Operations Manager, M. D. Anderson Cancer Center, Houston. David Wallace, Pharm.D., is Clinical Associate Professor, University of Houston College of Pharmacy, Houston. Ryan Roux, Pharm.D., M.S., is Director of Pharmacy Operations, M. D. Anderson Cancer Center. Kevin W. Garey, Pharm.D., M.S., is Professor and Chair, University of Houston College of Pharmacy.
Am J Health Syst Pharm. 2015 Apr 1;72(7):568-72. doi: 10.2146/ajhp140404.
The expansion of clinical pharmacy services through increased use of outpatient pharmacists for anticoagulation services is described.
Due to the high demand for clinical pharmacist services by patients and medical staff at Harris Health System in Houston, Texas, and the strict budgetary restrictions to improve the quality of care through cost-neutral services, a new telephone anticoagulation monitoring service, provided by clinical pharmacists, was established at four of the busiest anticoagulation ambulatory care centers within the system. One clinical staff pharmacist was trained in each of the four clinics by a clinical pharmacy specialist. Each pharmacist received roughly two weeks of training to provide this service. Implementation of the new anticoagulation monitoring service occurred on April 1, 2013. Data collected between October 2011 and April 2014 revealed significantly more visits per month for the clinical pharmacy service after the implementation of the telephone anticoagulation monitoring service (p=0.011). Redistribution of workflow resulted in a 16% increase in clinical pharmacy patient volume at the ambulatory care clinics (p=0.011). The percentage of International Normalized Ratio values in the therapeutic range, the proportion of hospitalizations due to thromboembolic or bleeding events, work hours per prescription volume, project completion rates, and the number of students precepted did not significantly differ between groups.
The implementation of a clinical pharmacy telephone service for patients receiving anticoagulation at an outpatient center resulted in increased patient clinic visits without adversely affecting patient outcomes or increasing personnel or costs.
描述通过增加门诊药师提供抗凝服务来扩大临床药学服务的情况。
由于德克萨斯州休斯顿市哈里斯健康系统的患者和医务人员对临床药师服务的高需求，以及通过成本中性服务提高护理质量的严格预算限制，该系统内四个最繁忙的抗凝门诊护理中心设立了一项由临床药师提供的新的电话抗凝监测服务。四名诊所各有一名临床药师接受了临床药学专家的培训。每位药师接受了大约两周的培训以提供此项服务。新的抗凝监测服务于2013年4月1日实施。2011年10月至2014年4月期间收集的数据显示，实施电话抗凝监测服务后，临床药学服务每月的就诊次数显著增加（p = 0.011）。工作流程的重新分配导致门诊护理诊所的临床药学患者量增加了16%（p = 0.011）。两组之间，国际标准化比值在治疗范围内的百分比、因血栓栓塞或出血事件导致的住院比例、每张处方量的工作小时数、项目完成率以及带教学生的数量均无显著差异。
在门诊中心为接受抗凝治疗的患者实施临床药学电话服务，增加了患者的门诊就诊次数，且未对患者结局产生不利影响，也未增加人员或成本。
