药剂师干预对纠正应激相关黏膜损伤预防措施的经济影响。
Economic impact of pharmacist interventions on correction of stress-related mucosal damage prophylaxis practice.
作者信息
Mahmoudi Laleh, Mohammadi Rahim, Niknam Ramin
机构信息
Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
出版信息
Clinicoecon Outcomes Res. 2019 Jan 25;11:111-116. doi: 10.2147/CEOR.S191304. eCollection 2019.
INTRODUCTION
Stress-related mucosal damage (SRMD) is described as the damage of gastric mucosa due to physiological stress that is a very common complication in critically ill patients. SRMD prophylactic medications are widely prescribed all over the world, while numerous studies have revealed that a large percentage of patients admitted to non-intensive care unit (ICU) services do not need to receive these medications. The aim of this study was to determine the frequency and type of medication errors and the economic impact of clinical pharmacist intervention on stress ulcer prophylaxis (SUP).
METHODS
This prospective interventional study was conducted on adult patients admitted to internal, surgical, and critical care units at two large academic medical centers over 6 months. Risk factors of stress ulcer were recorded daily during hospital stay, and appropriateness of SUP administration was assessed according to the American Society of Health-System Pharmacists (ASHP) criteria. An intervention was performed by a clinical pharmacist in the case of contradictions. The rate of inappropriate SUP and the economic impact of a pharmacist intervention were recorded.
RESULTS
In this study, 178 out of 219 (81.2%) patients received prophylactic treatments. Averagely, prophylactic therapy was compatible with standard treatment guidelines in 67.1% of cases. The implementation of ASHP guideline by a clinical pharmacist resulted in a cost saving of >18,000 USD monthly in this study, which would result in an estimated cost saving of >216,000 USD annually.
CONCLUSION
Although treatment guidelines are available for the prophylaxis of SRMD, failure to observe these guidelines could increase the cost of treatment and adverse effects. The clinical pharmacists' intervention in order to implement standard protocols has a significant impact on the reduction of unintended mistakes in prescribing prophylaxis, as well as significant cost savings.
引言
应激相关黏膜损伤（SRMD）被描述为由于生理应激导致的胃黏膜损伤，这是重症患者中非常常见的并发症。SRMD预防药物在全球范围内被广泛处方，然而大量研究表明，许多入住非重症监护病房（ICU）的患者并不需要接受这些药物治疗。本研究的目的是确定用药错误的频率和类型，以及临床药师干预对应激性溃疡预防（SUP）的经济影响。
方法
这项前瞻性干预研究在两家大型学术医疗中心的内科、外科和重症监护病房收治的成年患者中进行，为期6个月。住院期间每天记录应激性溃疡的危险因素，并根据美国卫生系统药师协会（ASHP）标准评估SUP给药的适宜性。如有矛盾情况，由临床药师进行干预。记录不适当SUP的发生率和药师干预的经济影响。
结果
在本研究中，219名患者中有178名（81.2%）接受了预防性治疗。平均而言，67.1%的病例中预防性治疗符合标准治疗指南。在本研究中，临床药师实施ASHP指南每月节省成本超过18,000美元，估计每年节省成本超过216,000美元。
结论
尽管有预防SRMD的治疗指南，但不遵守这些指南可能会增加治疗成本和不良反应。临床药师为实施标准方案而进行的干预，对减少预防性用药中的意外错误有显著影响，同时也能大幅节省成本。
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