急诊科启动的针对慢性病患者的药学服务项目对药物相关不良结局的影响：一项随机对照试验。
Impact of a pharmaceutical care programme for patients with chronic disease initiated at the emergency department on drug-related negative outcomes: a randomised controlled trial.
作者信息
Juanes Ana, Garin Noe, Mangues Maria Antonia, Herrera Sergio, Puig Mireia, Faus Maria Jose, Baena Maria Isabel
机构信息
Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Instituto de Salud Carlos III, Centro de Investigacin Biomdica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
出版信息
Eur J Hosp Pharm. 2018 Sep;25(5):274-280. doi: 10.1136/ejhpharm-2016-001055. Epub 2017 Feb 23.
BACKGROUND
The resolution of potential drug-related problems is a priority of pharmaceutical care programmes.
OBJECTIVES
To assess the clinical impact on drug-related negative outcomes of a pharmaceutical care programme focusing on the resolution of potential drug-related problems, initiated in the emergency department for patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD).
METHODS
Controlled trials, in which older adults (≥65 years) receiving four or more medications admitted to the emergency department for ≥12 hours for worsening of HF and/or COPD were randomised (1:1) to either a pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department (intervention group (IG)) or standard care (control group). Comparisons between the groups were made for the proportion of patients with drug-related negative outcomes, number of drug-related negative outcomes per patient, mean stay, patients readmitted within 180 days and 180-day mortality.
RESULTS
118 patients were included, 59 in each group. Fewer patients in the IG had drug-related negative outcomes (37 (62.7%) vs 47 (79.7%) in the control group (p=0.042)). Fewer drug-related negative outcomes per patient occurred in the IG (56 (0.95 per patient) vs 85 (1.44 per patient) in the control group (p=0.01)). The mean stay was similar between groups (194.7 hours in the IG vs 242.5 hours in the control group (p=0.186)). No difference in revisits within 180 days was found (32 (54.24%) in the IG vs 22 (37.3%) in the control group (p=0.065)). 180-Day mortality was detected in 11 (18.6%) patients in the IG compared with 13 (22%) in the control group (p=0.647).
CONCLUSION
A pharmaceutical care programme focusing on resolving potential drug-related problems initiated at the emergency department has a favourable clinical impact, as it reduces the number and prevalence of drug-related negative outcomes. No difference was found in other outcome variables.Trial registration number NCT02368548.
背景
解决潜在的药物相关问题是药学服务项目的重点。
目的
评估一项在急诊科针对心力衰竭（HF）和/或慢性阻塞性肺疾病（COPD）患者开展的、聚焦于解决潜在药物相关问题的药学服务项目对药物相关负面结果的临床影响。
方法
进行对照试验，将因HF和/或COPD病情恶化而入住急诊科≥12小时、服用四种或更多药物的老年人（≥65岁）随机（1:1）分为两组，一组接受在急诊科启动的聚焦于解决潜在药物相关问题的药学服务项目（干预组（IG）），另一组接受标准护理（对照组）。比较两组患者药物相关负面结果的比例、每位患者药物相关负面结果的数量、平均住院时间、180天内再次入院的患者数量以及180天死亡率。
结果
共纳入118例患者，每组59例。干预组出现药物相关负面结果的患者较少（37例（62.7%），对照组为47例（79.7%），p = 0.042）。干预组每位患者的药物相关负面结果较少（56例（每位患者0.95个），对照组为85例（每位患者1.44个），p = 0.01）。两组的平均住院时间相似（干预组为194.7小时，对照组为242.5小时，p = 0.186）。180天内再次入院情况无差异（干预组为32例（54.24%），对照组为22例（37.3%），p = 0.065）。干预组11例（18.6%）患者在180天内死亡，对照组为13例（22%）（p = 0.647）。
结论
一项在急诊科启动的聚焦于解决潜在药物相关问题的药学服务项目具有良好的临床影响，因为它减少了药物相关负面结果的数量和发生率。在其他结果变量方面未发现差异。试验注册号NCT02368548。
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