Lombardi Nicola, Wei Li, Ghaleb Maisoon, Pasut Enrico, Leschiutta Silvia, Rossi Paolo, Troncon Maria Grazia
Department of Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, Cambridgeshire, CB2 0QQ, UK.
Department of Pharmacy Practice and Policy, University College London School of Pharmacy, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK.
BMC Health Serv Res. 2018 Apr 10;18(1):259. doi: 10.1186/s12913-018-2988-y.
Successful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded.
A clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model.
A total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36 interventions/ per month) of major clinical significance. The most frequent interventions were to educate a healthcare professional (20.4%) and change dose (16.1%).
To our knowledge this is the first study evaluating the effect of a structured communication strategy on acceptance rate of pharmacist interventions. Pharmaceutical care delivered by the clinical pharmacist is likely to have had beneficial outcomes. Clinical pharmacy services like the one described should be implemented widely to increase patient safety.
临床药学服务的成功实施与处方合理性的改善相关。药师干预具有较高的临床意义且接受率高，这意味着可以避免对患者的潜在危害。有证据表明，药师干预的低接受率可能与药师和医疗团队其他成员之间缺乏沟通有关。本研究的目的是评估一种结构化沟通策略对临床药师实施的针对有药物相关问题高风险老年患者的病房临床药学服务干预接受率的影响。记录了为提高处方合理性所做干预的特征、其临床意义以及医生的干预接受率。
2013年9月至2013年12月在一家教学医院的内科病房进行了一项临床药学干预研究。一名经过培训的临床药师为94名70岁以上的患者提供药学服务。临床药师使用以下沟通和营销工具来实施所述服务：优势、劣势、机会和威胁（SWOT）分析；具体、可衡量、可实现、现实和及时（SMART）目标；知晓、兴趣、欲望、行动（AIDA）模型。
临床药师共进行了740次干预。干预中涉及的最常见药物类别为：全身用抗菌药（11.1%）和抗帕金森药物（10.8%）。引发干预的主要药物相关问题类别为：无特定问题（15.9%）和处方书写错误（12.0%）。93.2%的干预被医生完全接受。经外部专家组评估，63.2%的干预（每月96次干预）被认为具有中等临床意义，23.4%（每月36次干预）具有重大临床意义。最常见的干预是对医疗专业人员进行教育（20.4%）和更改剂量（16.1%）。
据我们所知，这是第一项评估结构化沟通策略对药师干预接受率影响的研究。临床药师提供的药学服务可能产生了有益的结果。应广泛实施如所述的临床药学服务以提高患者安全性。
