药剂师提供的肺活量测定服务对基层医疗环境中获取检测结果的影响。
Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting.
作者信息
Mueller Lisa A, Valentino Alexa Sevin, Clark Aaron D, Li Junan
机构信息
1 Community Health Network, Indianapolis, IN, USA.
2 The Ohio State University College of Pharmacy, Columbus, OH, USA.
出版信息
J Prim Care Community Health. 2018 Jan-Dec;9:2150132718759213. doi: 10.1177/2150132718759213.
OBJECTIVES
The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service.
METHODS
Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014-September 2015) and after (January 2016-October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist.
RESULTS
The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002).
CONCLUSION
The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.
目的
本研究的主要目的是确定在联邦合格医疗中心由药剂师提供的肺功能检查服务对完成肺功能检查转诊且结果由开单医生审核的百分比的影响。次要目的评估内部转诊和外部转诊之间的差异、药剂师提出的用药建议以及该服务带来的收入。
方法
通过病历审查来确定在实施药剂师提供的肺功能检查服务之前（2014年12月至2015年9月）和之后（2016年1月至2016年10月）接受肺功能检查转诊的患者之间的转诊完成率。病历审查还用于确定实施后时间段内内部和外部服务转诊的数量及完成率。病历审查还评估了药剂师提出的用药建议。
结果
结果表明，在实施前和实施后时间段之间，转诊完成率从38.1%提高到了47.0%（P = 0.08）。在实施后时间段内，内部转诊和外部转诊的完成百分比存在统计学显著差异（分别为70.0%和40.9%，P = 0.0004）。比较有和没有肺功能检查服务的诊所，肺功能检查转诊总数（分别为1.13%和0.59%，P < 0.0001）和转诊完成百分比（分别为0.55%和0.27%，P = 0.0002）存在统计学显著差异。
结论
结果表明，在初级保健环境中提供肺功能检查有助于提高肺功能检查完成率，并使初级保健提供者能够获得结果。此外，结果显示接受内部肺功能检查转诊的患者完成率有所提高，这可能是由于进行该检查的障碍减少。总体而言，这些结果表明在初级保健环境中提供肺功能检查有助于增加获得的肺功能检查结果，并且可能对其他初级保健环境有益。
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