Surbhi Satya, Munshi Kiraat D, Bell Paula C, Bailey James E
J Am Pharm Assoc (2003). 2016 Nov-Dec;56(6):633-642.e1. doi: 10.1016/j.japh.2016.07.004. Epub 2016 Oct 6.
First, to investigate the prevalence and types of drug therapy problems and medication discrepancies among super-utilizers, and associated patient characteristics. Second, to examine the outcomes of pharmacist recommendations and estimated cost avoidance through care transitions support focused on medication management.
Retrospective analysis of the pharmacist-led interventions as part of the SafeMed Program.
A large nonprofit health care system serving the major medically underserved areas in Memphis, Tennessee.
Three hundred seventy-four super-utilizing SafeMed participants with multiple chronic conditions and polypharmacy.
Comprehensive medication review, medication therapy management, enhanced discharge planning, home visits, telephone follow-up, postdischarge medication reconciliation, and care coordination with physicians.
Types of drug therapy problems, outcomes of pharmacist recommendations, estimated cost avoided, medication discrepancies, and self-reported medication adherence.
Prevalence of drug therapy problems and postdischarge medication discrepancies was 80.7% and 75.4%, respectively. The most frequently occurring drug therapy problems were enrollee not receiving needed medications (33.4%), underuse of medications (16.9%), and insufficient dose or duration (11.2%). Overall 50.8% of the pharmacist recommendations were accepted by physicians and patients, resulting in an estimated cost avoidance of $293.30 per drug therapy problem identified. Multivariate analysis indicated that participants with a higher number of comorbidities were more likely to have medication discrepancies (odds ratio 1.23 [95% CI 1.05-1.44]). Additional contributors to postdischarge medication discrepancies were difficulty picking up and paying for medications and not being given necessary prescriptions before discharge.
Drug therapy problems and medication discrepancies are common in super-utilizers with multiple chronic conditions and polypharmacy during transitions of care, and greater levels of comorbidity magnify risk. Pharmacist-led interventions in the SafeMed Program have demonstrated success in resolving enrollees' medication-related issues, resulting in substantial estimated cost savings. Preliminary evidence suggests that the SafeMed model's focus on medication management has great potential to improve outcomes while reducing costs for vulnerable super-utilizing populations nationwide.
第一，调查超级使用者中药物治疗问题和用药差异的患病率及类型，以及相关的患者特征。第二，检查药剂师建议的结果，并通过侧重于药物管理的护理转接支持来估算成本避免情况。
对作为安全用药计划一部分的药剂师主导干预措施进行回顾性分析。
田纳西州孟菲斯市一个为主要医疗服务不足地区服务的大型非营利性医疗保健系统。
374名患有多种慢性病且用药复杂的超级使用安全用药计划参与者。
全面药物审查、药物治疗管理、强化出院计划、家访、电话随访、出院后用药核对以及与医生的护理协调。
药物治疗问题的类型、药剂师建议的结果、估算的成本避免情况、用药差异以及自我报告的用药依从性。
药物治疗问题和出院后用药差异的患病率分别为80.7%和75.4%。最常出现的药物治疗问题是参与者未接受所需药物（33.4%）、药物使用不足（16.9%）以及剂量或疗程不足（11.2%）。总体而言，药剂师的建议有50.8%被医生和患者接受，每个识别出的药物治疗问题估计可避免成本293.30美元。多变量分析表明，合并症数量较多的参与者更有可能出现用药差异（优势比1.23 [95%置信区间1.05 - 1.44]）。出院后用药差异的其他促成因素包括取药和支付药物困难以及出院前未获得必要的处方。
在患有多种慢性病且用药复杂的超级使用者的护理转接过程中，药物治疗问题和用药差异很常见，合并症程度越高风险越大。安全用药计划中由药剂师主导的干预措施已证明在解决参与者与药物相关的问题方面取得了成功，从而带来了可观的成本节约估计。初步证据表明，安全用药模式对药物管理的关注在改善结果的同时降低全国弱势超级使用人群成本方面具有巨大潜力。
