Vande Griend Joseph P, Saseen Joseph J, Bislip Debra, Emsermann Caroline, Conry Colleen, Pace Wilson D
From the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (JPVG, JJS), and the Department of Family Medicine, University of Colorado School of Medicine, Aurora (JPVG, JJS, DB, CE, CC, WDP).
J Am Board Fam Med. 2015 May-Jun;28(3):418-24. doi: 10.3122/jabfm.2015.03.140303.
This pilot study describes and evaluates the clinical pharmacy priority (CP2) score. We hypothesize that patients with high CP2 scores are more likely to receive a medication recommendation after comprehensive medication review (CMR) than patients with lower scores. Prioritization of patients for CMR by a clinical pharmacist in family medicine could enhance the provision of interprofessional care within the patient-centered medical home.
The CP2 score was developed collaboratively by the research team and is derived from 11 patient-specific factors extracted from the electronic health record. To evaluate the utility of the score, CMR was performed prospectively by a clinical pharmacist for patients with appointments between October 1 and December 31, 2012, at 2 University of Colorado family medicine clinics.
CMR was performed for 1107 patient appointments. Of these, 101 were identified as having received a medication recommendation from the clinical pharmacist. For patients with a CP2 score of 0 to 2, 2 of 588 charts (0.3%) reviewed received a recommendation (level 1). The proportion increased to 37 of 358 (10.3%) for scores of 3 to 7 (level 2), 40 of 119 (33.6%) for scores of 8 to 10 (level 3), and 22 of 42 (52.4%) for scores of ≥11 (level 4). Compared with CP2 scores in level 1, patient appointments were more likely to receive a medication recommendation after CMR in level 2 (relative risk [RR], 30.4; 95% confidence interval [CI], 7.4-125.3), in level 3 (RR, 98.8; 95% CI, 24.2-403.3), and in level 4 (RR, 154; 95% CI, 37.5-632.8).
Patients with higher CP2 scores were more likely to receive a medication recommendation after CMR by a clinical pharmacist than patients with lower scores. The CP2 score could be used by clinical pharmacists in family medicine to enhance the efficient and effective delivery of interprofessional care.
本试点研究描述并评估了临床药学优先级（CP2）评分。我们假设，与评分较低的患者相比，CP2评分高的患者在接受全面药物评估（CMR）后更有可能获得药物推荐。临床药师在家庭医学中对患者进行CMR优先级排序，可加强以患者为中心的医疗之家提供的跨专业护理。
CP2评分由研究团队共同制定，源自从电子健康记录中提取的11个患者特定因素。为评估该评分的效用，2012年10月1日至12月31日期间，临床药师对科罗拉多大学2家家庭医学诊所预约就诊的患者进行了前瞻性CMR。
共对1107例患者预约进行了CMR。其中，101例被确定接受了临床药师的药物推荐。CP2评分为0至2的患者中，588份病历中有2份（0.3%）被审查后获得推荐（1级）。评分3至7的患者中，这一比例增至358份中的37份（10.3%）（2级），评分8至10的患者中为119份中的40份（33.6%）（3级），评分≥11的患者中为42份中的22份（52.4%）（4级）。与1级CP2评分相比，2级（相对风险[RR]，30.4；95%置信区间[CI]，7.4 - 125.3）、3级（RR，98.8；95% CI，24.2 - 403.3）和4级（RR，154；95% CI，37.5 - 6,328）的患者预约在CMR后更有可能获得药物推荐。
与评分较低的患者相比，CP2评分较高的患者在临床药师进行CMR后更有可能获得药物推荐。家庭医学中的临床药师可使用CP2评分来加强跨专业护理的高效和有效提供。
