提高用药评估的有效性：来自健康素养通用预防措施工具包的指导意见。
Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.
作者信息
Weiss Barry D, Brega Angela G, LeBlanc William G, Mabachi Natabhona M, Barnard Juliana, Albright Karen, Cifuentes Maribel, Brach Cindy, West David R
机构信息
From the Department of Family and Community Medicine, University of Arizona, Tucson (BDW); the Department of Community and Behavioral Health, Colorado School of Public Health, Aurora (AGB, KA); the Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (AGB, WGL, MC, DRW); the American Academy of Family Physicians, Kansas City, KS (NMM); the Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora (JB, KA, DRW); and the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD (CB).
出版信息
J Am Board Fam Med. 2016 Jan-Feb;29(1):18-23. doi: 10.3122/jabfm.2016.01.150163.
BACKGROUND
Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices.
METHODS
The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation.
RESULTS
Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised.
CONCLUSIONS
Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems.
背景
尽管建议在初级保健实践中进行常规药物评估以识别药物治疗问题，但通常很难让患者在就诊时带上所有药物。本研究的目的是确定医疗保健研究与质量机构健康素养通用预防措施工具包中的药物评估工具是否有助于改善初级保健实践中的药物评估。
方法
该工具包的“棕色纸袋药物评估”在密苏里州的一家农村私人诊所和加利福尼亚州的一家城市教学诊所实施。诊所在工具包实施前记录了45名患者的药物评估结果，然后根据工具包中的指导改变了他们的药物评估流程。六个月后，我们对诊所工作人员进行了访谈，以确定实施该工具所带来的变化，诊所又记录了另外41名患者的药物评估结果。数据分析比较了实施前后患者是否带齐所有药物、评估的药物数量、识别出的药物治疗问题以及药物治疗方案的变化。
结果
访谈显示，诊所做出了工具包中推荐的改变，以鼓励患者带药物到诊所就诊。实施前后的评估显示，带齐所有处方药的患者百分比增加了3倍，带到诊所就诊的处方药数量增加了6倍。识别出药物治疗问题的评估百分比增加了一倍，修订药物治疗方案的百分比也增加了一倍。
结论
使用健康素养通用预防措施工具包有助于识别药物治疗问题。
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