Blagburn Julia, Kelly-Fatemi Ben, Akhter Nasima, Husband Andy
Pharmacy Department , Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Freeman Hospital , Newcastle-upon-Tyne , UK.
Wolfson Research Institute for Health and Wellbeing, Durham University, Queen's Campus, University Boulevard , Thornaby-On-Tees , UK.
Eur J Hosp Pharm. 2016 Mar;23(2):80-85. doi: 10.1136/ejhpharm-2015-000736. Epub 2015 Oct 1.
Unplanned readmissions to hospital are used in many healthcare systems as a quality indicator of care. Identifying patients at risk of readmission is difficult; existing prediction tools are only moderately sensitive. Correlations exist between certain medicines and emergency readmission, but it is not known whether the association is direct or indirect.
To determine whether person-centred pharmaceutical care bundles, comprising individualised medicines information, risk management and/or support in taking medicines, might prevent unplanned readmissions by improving adherence and reducing avoidable harm from prescribed medications.
We designed and implemented person-centred pharmaceutical care bundles for patients who were socially isolated and/or on high-risk medicines on one older people's medical ward for 1 year from February 2013. Another ward with similar patient demographics, service characteristics and a standard clinical pharmacy service was used as a comparator in a prospective cohort study. Readmission rates were retrospectively studied for 12 months before the intervention and during the 12-month intervention period.
The readmission rates for the intervention and control wards in the 12 months before the intervention were not significantly different. During the intervention period, the readmission rate was significantly lower on the intervention ward (69/418) than on the control ward (107/490; 17% vs 22%, p<0.05, z=2.05, two-sample z test for difference in proportions of unrelated samples).
Person-centred pharmaceutical care bundles were significantly associated with reduced risk of emergency hospital readmission in this study. Further evaluation of the model is warranted.
在许多医疗保健系统中，医院的非计划再入院被用作护理质量指标。识别有再入院风险的患者很困难；现有的预测工具敏感性仅为中等。某些药物与急诊再入院之间存在相关性，但尚不清楚这种关联是直接的还是间接的。
确定以患者为中心的药物治疗包，包括个性化的药物信息、风险管理和/或服药支持，是否可以通过提高依从性和减少处方药的可避免伤害来预防非计划再入院。
从2013年2月起，我们为一个老年病房中社会孤立和/或服用高风险药物的患者设计并实施了以患者为中心的药物治疗包，为期1年。在一项前瞻性队列研究中，将另一个具有相似患者人口统计学特征、服务特点和标准临床药学服务的病房用作对照。对干预前12个月和12个月干预期内的再入院率进行回顾性研究。
干预前12个月，干预病房和对照病房的再入院率无显著差异。在干预期间，干预病房的再入院率（69/418）显著低于对照病房（107/490；17%对22%，p<0.05，z=2.05，无关样本比例差异的双样本z检验）。
在本研究中，以患者为中心的药物治疗包与降低急诊再入院风险显著相关。有必要对该模型进行进一步评估。
