Yang Seungwon
Department of Practice and Pharmacy, UCL School of Pharmacy, London, UK.
BMC Health Serv Res. 2017 Nov 13;17(1):722. doi: 10.1186/s12913-017-2684-3.
When patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients' medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients' medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions.
This was a case-cohort study conducted in two acute hospitals in the UK. Pharmacists performed a telephone follow-up intervention to discharged patients to provide medicines management support. Patients who received pharmacist telephone follow-up calls within 14 days of discharge formed the intervention group. A subset of medical patient population discharged in the month of May 2013 formed the comparison group. During a series of two-telephone follow-up, pharmacists identified post-discharge pharmaceutical problems and provided patient-tailored interventions accordingly. The impact of pharmacist interventions was assessed using a risk assessment matrix tool by two senior pharmacists. Overall 30-day readmission rates in the intervention group were measured and compared with the comparison group using a chi-square test.
Between 5 and 25 June 2013, a total of 62 medical patients participated in the study. Pharmacists provided 192 interventions as a result of pharmacist telephone follow-up intervention. The most prevalent type of interventions was the provision of drug information (n=40), followed by screening patient adherence (n=30) and advising on adverse drug reactions (n=27). The impact of interventions was assessed, and 49.3% of the identified risks intervened by pharmacists were associated with moderate risk. The 30-day readmission rates in the intervention group were 11.3% compared to 9.0% in the control group (p = 0.376); this was not statistically significant.
A pharmacist TFU intervention did not show a benefit in 30-day hospital readmissions. However, a pharmacist TFU intervention was an effective method to solve or avoid critical pharmaceutical problems. A future study using a larger scale trial is warranted.
当患者从医院出院回家时，这是一个凸显的脆弱时期，在此期间与药物相关的问题很普遍。研究人员提出电话随访干预作为降低医院再入院率的一种手段。然而，药剂师参与出院后患者药物管理的干预结果尚未得到充分研究。本研究的目的是：（1）确定专注于患者药物管理支持的药剂师电话随访干预是否与30天再入院率的降低相关；（2）描述护理转接中药剂师干预的数量和类型。
这是一项在英国两家急症医院进行的病例队列研究。药剂师对出院患者进行电话随访干预，以提供药物管理支持。在出院后14天内接到药剂师电话随访的患者组成干预组。2013年5月出院的一部分内科患者组成对照组。在一系列两次电话随访中，药剂师识别出院后的药物问题并相应地提供针对患者的干预措施。两名资深药剂师使用风险评估矩阵工具评估药剂师干预的影响。测量干预组的总体30天再入院率，并使用卡方检验与对照组进行比较。
2013年6月5日至25日，共有62名内科患者参与了该研究。由于药剂师电话随访干预，药剂师提供了192次干预措施。最常见的干预类型是提供药物信息（n = 40），其次是筛查患者依从性（n = 30）和就药物不良反应提供建议（n = 27）。评估了干预措施的影响，药剂师干预的已识别风险中有49.3%与中度风险相关。干预组的30天再入院率为11.3%，而对照组为9.0%（p = 0.376）；这在统计学上不显著。
药剂师电话随访干预在30天医院再入院方面未显示出益处。然而，药剂师电话随访干预是解决或避免严重药物问题的有效方法。有必要进行一项更大规模试验的未来研究。
