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以患者为中心的电话药物治疗管理服务后30天内医院再入院率的降低

Reduction of 30-Day Hospital Readmissions After Patient-centric Telephonic Medication Therapy Management Services.

作者信息

Miller Daryl E, Roane Teresa E, McLin Karen D

出版信息

Hosp Pharm. 2016 Dec;51(11):907-914. doi: 10.1310/hpj5111-907.

Abstract

Transitional care programs are a growing topic in health care systems across the country, with a focus on achieving a reduction in hospital readmissions and improving patient and medication safety. Numerous strategies have been employed and studied to determine successful approaches to patient transition from the hospital setting to the home setting. Pharmacist-mediated postdischarge telephonic outreach has demonstrated decreased hospital readmission rates in multiple hospital systems. To evaluate the effectiveness of pharmacist-facilitated telephonic medication therapy management (MTM) services on reducing hospital readmissions. A retrospective chart analysis ( = 314) was performed for patients who received MTM services following hospital discharge between February 23, 2014 and July 4, 2014. The primary outcome was 30-day all-cause readmission. The secondary outcomes were identification of pharmacist interventions for and recommendations about medication-related problems and discrepancies found between the patients' reported medication list and the hospital discharge medication list. The data revealed no statistically significant difference in hospital readmission rates between the intervention and control groups (odds ratio,1.04; 95% CI, 0.68-1.60). Pharmacists intervened on 189 medication-related problems via facsimile to the prescriber (35.7% of charts), contacted prescribers by phone for 23 medication-related or health-related issues, and identified 823 medication list discrepancies (78.34% of charts). Although the provision of telephonic MTM services by pharmacists did not result in an improvement in the readmission rate during this study period, pharmacists were able to intervene on numerous medication-related problems and medication list discrepancies.

摘要

过渡性护理项目在全国医疗保健系统中是一个日益受到关注的话题,重点是减少医院再入院率并提高患者及用药安全性。人们已经采用并研究了多种策略,以确定患者从医院环境过渡到家庭环境的成功方法。药剂师介导的出院后电话随访已在多个医院系统中证明可降低医院再入院率。为评估药剂师协助的电话药物治疗管理(MTM)服务在降低医院再入院率方面的有效性。对2014年2月23日至2014年7月4日期间出院后接受MTM服务的患者进行了回顾性病历分析(n = 314)。主要结局是30天全因再入院。次要结局是确定药剂师对药物相关问题的干预措施以及关于患者报告的用药清单与医院出院用药清单之间发现的差异的建议。数据显示,干预组和对照组之间的医院再入院率没有统计学上的显著差异(优势比,1.04;95%置信区间,0.68 - 1.60)。药剂师通过传真给开处方者就189个药物相关问题进行了干预(占病历的35.7%),就23个药物相关或健康相关问题通过电话联系了开处方者,并识别出823个用药清单差异(占病历的78.34%)。尽管在本研究期间药剂师提供的电话MTM服务并未导致再入院率的改善,但药剂师能够对众多药物相关问题和用药清单差异进行干预。

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