Dempsey Jillian, Gillis Christine, Sibicky Stephanie, Matta Lina, MacRae Calum, Kirshenbaum James, Faxon David, Churchill William
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.
Am J Health Syst Pharm. 2018 Sep 1;75(17 Supplement 3):S63-S71. doi: 10.2146/ajhp170099. Epub 2018 Jul 5.
The utility of a transitions-of-care (TOC) pharmacist intervention focused on improving the quality and safety of the medication process for high-risk cardiovascular patients was evaluated.
A quality-improvement initiative was developed for patients with heart failure or acute coronary syndrome followed longitudinally at a hospital's outpatient cardiovascular clinic. The TOC pharmacist intervention occurred either before a patient's outpatient cardiovascular clinic appointment or during a hospitalization. The major outcome analyzed was the number of unplanned hospital readmissions within 30 days. Additional endpoints evaluated included the time to healthcare utilization, number of medication discrepancies identified, percentage of therapeutic recommendations accepted by a provider, number of medication access issues resolved, patient cost savings, patient satisfaction, and mean time spent on an intervention by the pharmacist per patient encounter.
A total of 118 patients received the TOC pharmacist intervention. A total of 516 medication discrepancies were identified and corrected, with 55.6% of discrepancies involving cardiovascular medications. A total of 244 recommendations for therapeutic optimization were provided, with an 81% provider acceptance rate and a 100% patient satisfaction rate. Fifty-five patients were provided with medication cost savings, and medication-access issues were resolved for 8 patients. A TOC pharmacist spent means of 98 and 73 minutes on patient education and coordination of care during inpatient and ambulatory encounters, respectively. The 30-day hospital readmission rate for patients with heart failure was reduced by 20%.
A TOC pharmacist intervention improved the quality and safety of care across both inpatient and ambulatory settings for high-risk cardiovascular patients at our institution.
评估以改善高危心血管患者用药过程的质量和安全性为重点的照护过渡（TOC）药师干预措施的效用。
针对在医院门诊心血管诊所接受纵向随访的心力衰竭或急性冠状动脉综合征患者开展了一项质量改进计划。TOC药师干预在患者门诊心血管诊所预约前或住院期间进行。分析的主要结局是30天内非计划住院再入院的次数。评估的其他终点包括医疗保健利用时间、发现的用药差异数量、提供者接受的治疗建议百分比、解决的用药获取问题数量、患者成本节约、患者满意度以及药师每次与患者接触时进行干预所花费的平均时间。
共有118名患者接受了TOC药师干预。共识别并纠正了516处用药差异，其中55.6%的差异涉及心血管药物。共提供了244条治疗优化建议，提供者接受率为81%，患者满意率为100%。为55名患者节省了用药成本，为8名患者解决了用药获取问题。TOC药师在住院和门诊会诊期间分别平均花费98分钟和73分钟进行患者教育和护理协调。心力衰竭患者的30天住院再入院率降低了20%。
TOC药师干预提高了我院高危心血管患者在住院和门诊环境中的护理质量和安全性。
