Duedahl Tina Hoff, Hansen Wiebke Boman, Kjeldsen Lene Juel, Graabæk Trine
Hospital Pharmacy, Lillebaelt Hospital, Vejle, Denmark.
SAFE, Amgros I/S, Copenhagen, Denmark.
Eur J Hosp Pharm. 2018 Mar;25(e1):e40-e45. doi: 10.1136/ejhpharm-2016-001166. Epub 2017 Jun 19.
This study aims to investigate the effects on quality of the medicine-related healthcare service provided at hospital discharge after implementing a pharmacist-led patient-centred discharge service.
Medical in-patients ready for discharge and prescribed at least six medicines were eligible for inclusion in this descriptive intervention study. A ward-based clinical pharmacist provided a patient-centred discharge service which comprised medication review (including reconciliation if appropriate), medication counselling and verification of the medication discharge summary plans. Satisfaction with the pharmacist-led interventions was collected by questionnaires and follow-up telephone interviews. A quality audit on the medical information stated in the discharge summary plans was conducted.
A total of 313 medical records were prospectively reviewed by the clinical pharmacist, and 745 medicine-related problems each leading to a clinical recommendation were identified. The total rate of acceptance by the physicians was found to be 84%. The quality audit revealed a significantly higher quality of the medication discharge summary plans sent to primary care regarding content of updated lists of medication after the pharmacist's intervention. The involved physicians stated that contributions from the pharmacist had eased their workload and helped them to obtain a more rational prescribing practice. The interviewed patients felt secure and well-informed about their medicines.
Contributions from clinical pharmacists can improve both the quality of and satisfaction with the medicine-related healthcare service provided at hospital discharge and secure continuity of medical care at transitions.
本研究旨在调查实施以药师为主导的以患者为中心的出院服务后，对出院时提供的药物相关医疗服务质量的影响。
准备出院且开具了至少六种药物的住院患者符合纳入本描述性干预研究的条件。一名病房临床药师提供以患者为中心的出院服务，包括药物审查（酌情包括药物重整）、用药咨询以及对出院用药总结计划的核实。通过问卷调查和随访电话访谈收集对药师主导干预措施的满意度。对出院总结计划中陈述的医疗信息进行质量审核。
临床药师前瞻性地审查了共313份病历，识别出745个与药物相关的问题，每个问题均产生一项临床建议。发现医生的总体接受率为84%。质量审核显示，在药师干预后，发送给基层医疗的出院用药总结计划在更新用药清单内容方面质量显著提高。参与的医生表示，药师的贡献减轻了他们的工作量，并帮助他们形成更合理的处方习惯。接受访谈的患者对自己的药物感到放心且信息充足。
临床药师的贡献可以提高出院时提供的药物相关医疗服务的质量和满意度，并确保医疗护理在转归过程中的连续性。
