J Am Pharm Assoc (2003). 2019 May-Jun;59(3):319-328. doi: 10.1016/j.japh.2019.01.005. Epub 2019 Feb 26.
The primary objective was to measure the impact of a pharmacist-provided medication therapy management program on 30-day postdischarge readmission rates. The secondary study objectives were to characterize the number and types of pharmacist interventions, to determine the impact of the intervention on primary and secondary medication nonadherence, and to measure patient satisfaction with the intervention.
Randomized, clinical trial.
Six hospitals and a supermarket pharmacy chain with 60 pharmacies.
Four hundred patients discharged from a participating hospital with acute myocardial infarction, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, or diabetes.
Primary outcome measure was 30-day readmission rate. Secondary outcomes were pharmacist interventions, primary and secondary medication nonadherence, and patient satisfaction.
Four hundred patients were enrolled. There was not a significant difference in 30-day readmission rates between intervention and control groups (11.3% vs. 10.7%; P = 0.49). A large portion of patients randomized to the intervention did not attend their appointment. In a per protocol (PP) analysis, which included the 62 intervention patients who attended their appointment and the 187 patients in the control group, there was a significant difference in 30-day readmission rates (1.6% vs. 10.7%; P = 0.02). In the PP analysis, controlling for baseline differences, patients in the intervention group were significantly less likely to experience a readmission (odds ratio, 0.126; 95% confidence interval, 0.016-0.968; P = 0.046). In the PP analysis, the percentage of prescriptions not picked up in the intervention group compared with the control group was reduced by 2.5%, (6.4% vs. 8.9%; P = 0.59). Pharmacists identified many interventions, averaging 6 per patient.
This study successfully implemented a large-scale transition of care program between multiple health systems and community pharmacies that reduced hospital readmissions. Pharmacists identified many interventions for patients. The transmission of patient information from the inpatient setting to the community pharmacy is key to transitioning patients successfully.
主要目的是衡量药剂师提供的药物治疗管理计划对出院后 30 天内再入院率的影响。次要研究目的是描述药剂师干预的数量和类型，确定干预对主要和次要药物不依从的影响，并衡量患者对干预的满意度。
随机临床试验。
六家医院和一家拥有 60 家药店的超市连锁药店。
400 名从参与医院出院的急性心肌梗死、肺炎、充血性心力衰竭、慢性阻塞性肺疾病或糖尿病患者。
主要观察指标是 30 天再入院率。次要结局指标是药剂师干预、主要和次要药物不依从以及患者满意度。
共纳入 400 例患者。干预组和对照组的 30 天再入院率无显著差异（11.3%比 10.7%；P=0.49）。很大一部分随机分配到干预组的患者没有参加他们的预约。在符合方案（PP）分析中，包括参加预约的 62 名干预患者和对照组的 187 名患者，30 天再入院率有显著差异（1.6%比 10.7%；P=0.02）。在 PP 分析中，控制基线差异后，干预组患者再入院的可能性显著降低（优势比，0.126；95%置信区间，0.016-0.968；P=0.046）。在 PP 分析中，与对照组相比，干预组未取处方的比例降低了 2.5%（6.4%比 8.9%；P=0.59）。药剂师为每位患者确定了许多干预措施，平均每位患者 6 项。
本研究成功实施了一项在多个卫生系统和社区药店之间进行的大规模过渡护理计划，该计划降低了医院的再入院率。药剂师为患者确定了许多干预措施。将患者信息从住院环境传输到社区药店是成功过渡患者的关键。
