Rafferty Aubrie, Denslow Sheri, Michalets Elizabeth Landrum
Mission Hospital and UNC Eshelman School of Pharmacy, Asheville Campus; Asheville, NC, USA
Mission Health System, Asheville, NC, USA.
Ann Pharmacother. 2016 Aug;50(8):649-55. doi: 10.1177/1060028016653139. Epub 2016 Jun 5.
Medication management during transitions of care (TOC) impacts clinical outcomes. Published literature on TOC implementation is increasing, but data remains limited regarding the optimal role for the inpatient pharmacist, particularly in the community health setting.
To evaluate the impact of a dedicated inpatient TOC pharmacist on re-presentations following discharge.
This is a prospective study with historical control. All adult patients discharging home from study units were eligible. The TOC pharmacist (1) reviewed medication history and admission reconciliation, (2) met the patient/caregiver to assess barriers, (3) reviewed discharge reconciliation, (4) performed discharge education, and (5) communicated with next level of care. The primary outcome was 30 day re-presentation rate. Secondary outcomes included 60, 90, and 365 day re-presentation rates. IRB approval was obtained.
Three hundred and eighty four patients met inclusion criteria. When compared to 1,221 control patients, the intervention had an 11% absolute and 50.2% relative reduction in 30 day re-presentation rate (OR 0.43, 95% CI 0.30-0.61, NNT 9). Reductions in re-presentations at 60, 90 and 365 days remained statistically significant. Utilization avoidance was $786,347. For every $1 invested in pharmacist time, $12 was saved. The TOC pharmacist made a total of 904 interventions (mean 2.4 per patient).
This study provides new information from previous studies and represents the largest study with significant and sustained reductions in re-presentations. Integrating a pharmacist into an interdisciplinary team for medication management during TOC in a community health system is beneficial for patients and financially favorable for the institution.
照护转接（TOC）期间的药物管理会影响临床结局。关于TOC实施的已发表文献日益增多，但关于住院药师的最佳作用的数据仍然有限，尤其是在社区卫生环境中。
评估一名专职住院TOC药师对出院后再次就诊情况的影响。
这是一项采用历史对照的前瞻性研究。所有从研究科室出院回家的成年患者均符合条件。TOC药师（1）审查用药史和入院用药核对情况，（2）与患者/护理人员会面以评估障碍因素，（3）审查出院用药核对情况，（4）进行出院教育，以及（5）与下一级照护机构沟通。主要结局是30天再次就诊率。次要结局包括60天、90天和365天再次就诊率。获得了机构审查委员会的批准。
384名患者符合纳入标准。与1221名对照患者相比，干预措施使30天再次就诊率的绝对降低率为11%，相对降低率为50.2%（比值比0.43，95%置信区间0.30 - 0.61，需治疗人数9）。60天、90天和365天再次就诊率的降低在统计学上仍具有显著意义。避免的费用为786,347美元。每投入1美元用于药师工作时间，节省了12美元。TOC药师共进行了904次干预（平均每名患者2.4次）。
本研究提供了与以往研究不同的新信息，是关于再次就诊情况显著且持续降低的最大规模研究。在社区卫生系统的TOC期间，将药师纳入跨学科团队进行药物管理对患者有益，对机构在经济上也有利。
