Programa de Pos-Graduacao em Ciencias Farmaceuticas, Universidade Federal do Parana, Curitiba, PR, BR.
Department of Social Pharmacy, Institute for Medicines Research (iMed. ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
Clinics (Sao Paulo). 2019 Nov 25;74:e1091. doi: 10.6061/clinics/2019/e1091. eCollection 2019.
This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil.
At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge.
A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: "incorrect time of taking" (p=0.003), "use higher dose of medication" (p=0.007), "use lower dose of medication" (p=0.014), "restart discontinued medication" (p=0.011), and "underdosing prescription" (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems.
We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.
这是一项随机对照试验，旨在评估药剂师主导的出院咨询对减少巴西一家三级医院心内科患者出院后 30 天内药物治疗问题的影响。
在出院时，两名心血管药房住院医师对干预组进行了一次药物咨询，随后通过电话（出院后第 3 天和第 15 天）进行随访。在出院后 30 天，由药剂师进行门诊咨询评估药物治疗问题的数量。
共有 66 名和 67 名患者分别随机分配到干预组和对照组，但只有每组的 51 名患者进行了分析，所有患者的基线特征均相似。与对照组相比，干预组的药物治疗问题明显减少（p<0.001），且 100%的患者至少存在一个问题。我们观察到对照组中五个问题明显更频繁：“服用时间不正确”（p=0.003）、“使用更高剂量的药物”（p=0.007）、“使用更低剂量的药物”（p=0.014）、“重新开始停用的药物”（p=0.011）和“药物剂量不足”（p=0.009）。辛伐他汀、依那普利、卡维地洛和阿托伐他汀是与药物治疗问题更相关的药物。
我们得出结论，药剂师主导的出院咨询应该是一项不可或缺的服务，因为患者在出院后 30 天内的药物治疗问题较少，特别是与药物给药和依从性有关。
