Kang Amy, Thompson Ashley, Rau Johnny, Pollock Allison
Department of Pharmacy Practice, Chapman University, Irvine, CA.
Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, and Department of Pharmaceutical Services, UCSF Medical Center San Francisco, CA.
Am J Health Syst Pharm. 2018 Sep 1;75(17 Supplement 3):S77-S81. doi: 10.2146/ajhp170465.
Results of an evaluation of therapeutic interchange (TI) program outcomes with use of prescriber alerts alone or in combination with pharmacist prescribing are reported.
A retrospective single-center study was conducted to compare TI outcomes before incorporation of prescriber alerts encouraging formulary agent use into the electronic medical record (period 1), after alert implementation (period 2), and after implementation and expansion of TI protocols including pharmacist prescribing authority (period 3). The evaluation focused on TI orders for 3 drug classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA RIs). The primary outcome was formulary medication utilization.
In total, 2,881, 2,700, and 3,088 prescriptions for medications in the ACEI, ARB, or HMG-CoA RI class were ordered during periods 1, 2, and 3, respectively. Overall formulary adherence improved from 78.3% in period 1 to 97.6% in period 2 and 99.2% in period 3 ( < 0.001 for both comparisons with period 1). The percentages of inappropriate dosing conversions were 51.6%, 37.2%, and 2.4% in periods 1, 2, and 3, respectively; the corresponding percentages of inappropriate discharge medications were 64.5%, 16.3%, and 2.4%.
Percentages of formulary medications in 3 medication classes, considered separately and together, increased with the implementation of TI alerts for prescribers and the addition of TI-related pharmacist prescribing authority. Over the same study periods, percentages of inappropriate dosing conversions and inappropriate discharge medications decreased.
报告一项关于单独使用处方警示或联合药剂师处方进行治疗性替换（TI）项目结果评估的情况。
开展一项回顾性单中心研究，以比较在将鼓励使用处方集药物的处方警示纳入电子病历之前（第1阶段）、警示实施之后（第2阶段）以及TI方案实施并扩大至包括药剂师处方权之后（第3阶段）的TI结果。评估聚焦于三类药物的TI医嘱：血管紧张素转换酶抑制剂（ACEI）、血管紧张素II受体阻滞剂（ARB）和3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（HMG-CoA RI）。主要结果是处方集药物的使用情况。
在第1、2和3阶段，分别开出了2881、2700和3088份ACEI、ARB或HMG-CoA RI类药物的处方。总体处方集依从性从第1阶段的78.3%提高到第2阶段的97.6%和第3阶段的99.2%（与第1阶段相比，两次比较的P均<0.001）。在第1、2和3阶段，不适当剂量转换的百分比分别为51.6%、37.2%和2.4%；相应的不适当出院用药百分比分别为64.5%、16.3%和2.4%。
随着对处方者实施TI警示以及增加与TI相关的药剂师处方权，三类药物单独及综合考虑时的处方集药物百分比均有所增加。在相同的研究期间，不适当剂量转换和不适当出院用药的百分比有所下降。
