Walus Ashley N, Woloschuk Donna M M
, BScPharm, ACPR, is a Clinical Resource Pharmacist -Educational Services with the Winnipeg Regional Health Authority Pharmacy Program, Winnipeg, Manitoba.
, BSP, PharmD, MEd(Distance), FCSHP, was, at the time of this project, the Regional Pharmacy Manager - Educational Services, Winnipeg Regional Health Authority, Winnipeg, Manitoba. She is now a Pharmacy Consultant in Calgary, Alberta.
Can J Hosp Pharm. 2017 Nov-Dec;70(6):435-442. doi: 10.4212/cjhp.v70i6.1718. Epub 2017 Dec 21.
Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear.
The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care.
The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate.
A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral.
The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research is warranted to determine the optimal pharmacy service for home care patients and the most appropriate cpKPIs to measure its effects.
从历史上看，家庭护理团队中一直没有药剂师，尽管家庭护理患者经常出现用药错误。描述加拿大居家护理环境中药剂师执业模式的文献有限。家庭护理药剂师的最佳服务提供模式和临床活动分配仍不明确。
主要目的是描述一名驻社区家庭护理办公室的药剂师提供家访、小组教育和电话咨询的影响。次要目的是在缺乏适用于门诊护理的经过验证的急性护理临床药学关键绩效指标（cpKPI）的情况下，确定急性护理临床药学关键绩效指标在指导家庭护理药学服务方面的效用。
温尼伯地区卫生局在2015年5月至2016年7月期间聘请了一名药剂师来制定和实施该试点项目。制定了一份转诊表，其中包含初级保健实践中使用的咨询标准。药剂师还审查了所有患者的入院情况以及所有在急性护理机构等待启动家庭护理服务的患者，目的是在患者进入家庭护理项目之前解决问题。建立了一个受密码保护的数据库用于数据收集和分析，数据以汇总形式呈现。
在试点项目期间共收到197份转诊申请，涉及184名患者；其中62份被排除在分析之外。大多数转诊申请（95份[70.4%]）是针对有针对性的药物审查，共识别出271个药物治疗问题。家庭护理人员对药剂师建议的接受率为90.2%（82条建议中的74条），开处方者和患者的接受率为47.0%（117条建议中的55条）。平均而言，每份转诊申请识别出1.5个cpKPI。
试点项目表明家庭护理患者需要更多获得临床药学服务的机会，尽管最佳服务提供模式仍不明确。有必要进行更多研究以确定适合家庭护理患者的最佳药学服务以及衡量其效果的最合适的cpKPI。
