Zimmerman David E, Covvey Jordan R, Nemecek Branden D, Guarascio Anthony J, Wilson Laura, Freedy Henry R, Yassin Mohamed H
Division of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, PA, USA.
University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, PA, USA.
Int J Pharm Pract. 2019 Jun;27(3):279-285. doi: 10.1111/ijpp.12497. Epub 2018 Dec 11.
To compare pharmacist-led prescribing changes and associated 30-day revisit rates across different regimens for patients discharged from an emergency department (ED) with a diagnosis of community-acquired pneumonia (CAP).
An observational, retrospective cohort analysis was conducted of patients who were discharged from an ED over a 4-year period with a diagnosis of CAP. Patient demographics, clinical characteristics, antibiotic selection and comorbidity and condition severity scores were collected for two cohorts: 2012-13 (before protocol change) and 2014-15 (post-protocol change). During January 2014, a pharmacist-led protocol change with prescriber education was implemented to better align ED treatment practices with clinical practice guidelines. The primary endpoint was the change in prescribing practices across the two cohorts.
A total of 741 patients with CAP were identified, including 411 (55.5%) patients in 2012-13 and 330 (44.5%) in 2014-15. Prescribing of macrolide monotherapy regimens decreased significantly following protocol change (70.1% versus 42.7%; difference: 27.4%, 95% CI: 23.8-31.0%) with a reciprocal increase in macrolide/β-lactam combination prescribing (6.3-21.8%; difference: 15.5%, 95% CI: 12.9-18.1%). A total of 12.2% of patients who received macrolide/β-lactam combination treatment revisited a network ED within 30 days due to worsening pneumonia, compared to 8.6% of patients who received macrolide monotherapy treatment (P = NS).
The current study showed a significant increase in antibiotic prescribing compliance following a pharmacist-driven protocol change and education, but no statistical difference in rates of return for macrolide monotherapy versus other regimens.
比较药剂师主导的处方变更以及急诊科（ED）出院诊断为社区获得性肺炎（CAP）的患者在不同治疗方案下的30天复诊率。
对4年间从急诊科出院且诊断为CAP的患者进行观察性回顾性队列分析。收集了两个队列（2012 - 13年，方案变更前；2014 - 15年，方案变更后）患者的人口统计学资料、临床特征、抗生素选择以及合并症和病情严重程度评分。2014年1月，实施了由药剂师主导的方案变更并对开处方者进行教育，以使急诊科治疗实践更好地符合临床实践指南。主要终点是两个队列之间处方实践的变化。
共识别出741例CAP患者，其中2012 - 13年有411例（55.5%），2014 - 15年有330例（44.5%）。方案变更后，大环内酯类单药治疗方案的处方显著减少（70.1%对42.7%；差异：27.4%，95%CI：23.8 - 31.0%），而大环内酯类/β-内酰胺类联合处方则相应增加（6.3% - 21.8%；差异：15.5%，95%CI：12.9 - 18.1%）。接受大环内酯类/β-内酰胺类联合治疗的患者中有12.2%因肺炎恶化在30天内再次前往网络急诊科就诊，而接受大环内酯类单药治疗的患者这一比例为8.6%（P = 无统计学意义）。
当前研究表明，在药剂师推动的方案变更和教育后，抗生素处方依从性显著提高，但大环内酯类单药治疗与其他方案的复诊率无统计学差异。
