Lee Eun Hee, Bray Victoria, Horne Robert
Department of Pharmacy, University College London, London, England.
Emergency Department, St. George's University Hospitals NHS Foundation Trust, London, England.
J Res Pharm Pract. 2017 Apr-Jun;6(2):106-113. doi: 10.4103/jrpp.JRPP_16_160.
Venous thromboembolism (VTE) has become a huge health problem as well as a financial burden for the National Health Service. The objective of this study was to characterize current practice of VTE prophylaxis (VTEP) and evaluate the economic impact of clinical pharmacists' interventions (CPIs) on VTEP.
A prospective service evaluation was conducted in a medical and surgical ward at a tertiary teaching hospital in London from 23 May to 08 June 2016. Appropriateness of risk assessment (RA) and VTEP and CPIs were categorized and assessed. Based on the results of the service evaluation, a pharmacoeconomic analysis was undertaken to estimate the cost savings by CPIs for inappropriate pharmacological VTEP.
A total of 203 cases were analyzed. The rates of appropriateness for RA on admission, RA at 24 h and pharmacological VTEP were 58.6%, 39.7%, and 75.4%, respectively. In the medical ward, there was a significant difference of appropriate RAs between on admission and at 24 h (70.3% vs. 23.8%, respectively). Whereas, the rate of appropriate pharmacological VTEP accounted for 75.4% and the rate of appropriate prophylaxis was significantly higher in the medical ward than surgical ward (80.5% vs. 68.2%, = 0.045). Of 50 cases of inappropriate pharmacological prophylaxis, 39 cases (78.0%) were corrected by clinical pharmacists. These CPIs resulted in £1,286.23 cost savings during the study and it was estimated to be £517,522/annum.
CPIs had significant positive clinical and economic impacts on VTEP. There is more scope for the improvement of RA at 24 h through CPIs.
静脉血栓栓塞症（VTE）已成为一个重大的健康问题，同时也给国民医疗服务体系带来了经济负担。本研究的目的是描述当前VTE预防（VTEP）的实践情况，并评估临床药师干预（CPls）对VTEP的经济影响。
2016年5月23日至6月8日，在伦敦一家三级教学医院的内科和外科病房进行了一项前瞻性服务评估。对风险评估（RA）、VTEP和CPls的适宜性进行分类和评估。基于服务评估结果，进行了药物经济学分析，以估计CPls对不适当的药物性VTEP节省的成本。
共分析了203例病例。入院时RA、24小时RA和药物性VTEP的适宜率分别为58.6%、39.7%和75.4%。在内科病房，入院时和24小时时适宜RA存在显著差异（分别为70.3%和23.8%）。而药物性VTEP的适宜率为75.4%，内科病房的适宜预防率显著高于外科病房（80.5%对68.2%，P = 0.045）。在50例不适当的药物预防病例中，39例（78.0%）被临床药师纠正。这些CPls在研究期间节省了1286.23英镑的成本，估计每年节省517522英镑。
CPls对VTEP有显著的积极临床和经济影响。通过CPls在24小时时改善RA有更大的空间。
