Hawes Emily M, Pinelli Nicole R, Sanders Kimberly A, Lipshutz Andrew M, Tong Gretchen, Sievers Lauren S, Chao Sarah, Gwynne Mark
adjunct associate professor, Department of Family Medicine, UNC School of Medicine; Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
clinical assistant professor, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill North Carolina
N C Med J. 2018 Jan-Feb;79(1):4-13. doi: 10.18043/ncm.79.1.4.
Medication-related problems occur at high rates during care transitions. Evidence suggests that pharmacists are well-suited to identify and resolve medication-related problems during hospital admission and at discharge. Additional evidence is needed to understand the impact of face-to-face pharmacist visits in primary care after discharge. The purpose of the study was to describe medication-related problems found during face-to-face pharmacist visits in a medical home after hospital discharge. A retrospective cohort study was conducted within an academic primary care center staffed by family medicine trained physicians that evaluated patients who attended a hospital follow-up visit with pharmacist-enhanced care (N = 86) versus usual care (N = 86). The primary objective was to describe medication-related problems identified by pharmacists using a modified individualized Medication Assessment and Planning tool for patients receiving pharmacist-enhanced care. Secondary analyses were also conducted to compare 30-day and 60-day hospital readmission and emergency department visit rates in those exposed to pharmacist-enhanced care versus those who were not. At baseline, the mean hospitalizations in the prior year were 1.1 ± 1.7 (pharmacist-enhanced care) and 0.76 ± 1.2 (usual care), indicating a low initial readmission risk. Of patients receiving pharmacist-enhanced care, 97.7% were found to have at least 1 medication-related problem, with an average of 4.36 medication-related problems per patient. The 30-day readmission rate was lower, but not significantly different between groups (8.1% for pharmacist-enhanced care versus 12.8% for usual care; adjusted odds ratio (OR), 0.47; 95% confidence interval (CI), 0.16-1.36). Limitations include the retrospective cohort study design and small sample size. Medication-related problems were identified and collected prospectively during pharmacist visits. Medication-related problems are ubiquitous after hospital discharge. Larger prospective studies will be needed to understand the potential value of pharmacist-enhanced care during hospital follow-up visits on readmission rates in low-risk patient populations receiving care within a primary care medical home.
在医疗照护过渡期间，与用药相关的问题发生率很高。有证据表明，药剂师非常适合在住院期间和出院时识别并解决与用药相关的问题。还需要更多证据来了解出院后在初级医疗保健中面对面药剂师问诊的影响。本研究的目的是描述在医院出院后医疗之家进行面对面药剂师问诊期间发现的与用药相关的问题。在一个由接受过家庭医学培训的医生组成的学术性初级医疗保健中心内进行了一项回顾性队列研究，该研究评估了接受药剂师强化照护（N = 86）与常规照护（N = 86）的患者的医院随访情况。主要目标是描述药剂师使用改良的个体化用药评估与规划工具为接受药剂师强化照护的患者识别出的与用药相关的问题。还进行了次要分析，以比较接受药剂师强化照护的患者与未接受该照护的患者的30天和60天再入院率及急诊科就诊率。在基线时，前一年的平均住院次数在药剂师强化照护组为1.1±1.7，在常规照护组为0.76±1.2，表明初始再入院风险较低。在接受药剂师强化照护的患者中，97.7%被发现至少有1个与用药相关的问题，每位患者平均有4.36个与用药相关的问题。30天再入院率较低，但两组之间无显著差异（药剂师强化照护组为8.1%，常规照护组为12.8%；调整后的优势比（OR）为0.47；95%置信区间（CI）为0.16 - 1.36）。局限性包括回顾性队列研究设计和样本量小。与用药相关的问题是在药剂师问诊期间前瞻性地识别和收集的。出院后与用药相关的问题普遍存在。需要开展更大规模的前瞻性研究，以了解在初级医疗保健医疗之家中，医院随访期间药剂师强化照护对低风险患者群体再入院率的潜在价值。
