J Am Pharm Assoc (2003). 2020 Jul-Aug;60(4):e47-e51. doi: 10.1016/j.japh.2019.12.022. Epub 2020 Feb 7.
To evaluate provider acceptance of pharmacist interventions within the Discharge Companion Program (DCP) and its association with hospital readmissions.
This retrospective record review included patients referred to the DCP between January and October 2018. DCP pharmacists' interventions were assessed for provider acceptance on follow-up consultation or readmission. A chi-square test assessed the association between provider acceptance, communication modality, and technology used. A logistic regression model assessed the association between readmission risk and variables of interest. An a priori alpha level of 0.05 was used.
Of the 197 patients referred to the DCP, 102 met inclusion criteria. DCP pharmacists made a total of 271 interventions; 185 (68.7%) required provider action. The most common intervention type was medication addition or discontinuation (n = 74, 40%); the communication mode was between DCP nurses and primary care provider offices or skilled nursing facilities (n = 56, 54.9%); and the preferred technology was the telephone (n = 58, 56.9%). Provider acceptance rate was 30.8% (n = 57) of actionable interventions, although it was not significantly associated with 30-day readmission reductions (P = 0.833) and did not differ significantly when interventions were communicated to other health care professionals (P = 0.53). The specific intervention communication mode (i.e., telephone, facsimile, or both) of pharmacist interventions did not significantly affect provider acceptance (P = 0.133). The overall readmission rate was 22.5% (n = 23), and the only significant predictor of 30-day readmission was the number of comorbidities (odds ratio 1.28 [95% CI 1.03-1.58], P = 0.024).
Provider acceptance of pharmacists' interventions did not significantly affect 30-day readmission rates, regardless of communication mode (telephone or facsimile) or technology used. However, the DCP successfully identified numerous medication-related problems. Further study is warranted regarding provider acceptance of pharmacist recommendations on 30-day readmission reduction.
评估药师在出院陪伴计划（DCP）中的干预措施在多大程度上被医务人员接受，并评估其与住院再入院率的关系。
本回顾性病历研究纳入了 2018 年 1 月至 10 月期间被转诊至 DCP 的患者。根据随访咨询或再入院情况，评估 DCP 药师干预措施的医务人员接受程度。采用卡方检验评估医务人员接受程度与沟通方式和使用技术之间的关系。采用逻辑回归模型评估再入院风险与感兴趣变量之间的关系。预先设定的 alpha 水平为 0.05。
在 197 名被转诊至 DCP 的患者中，有 102 名符合纳入标准。DCP 药师共进行了 271 次干预，其中 185 次（68.7%）需要医务人员采取行动。最常见的干预类型是药物的添加或停用（n=74，40%）；沟通模式是 DCP 护士与初级保健提供者办公室或熟练护理设施之间（n=56，54.9%）；首选技术是电话（n=58，56.9%）。虽然医务人员接受率为 30.8%（n=57），但行动性干预措施与 30 天内再入院率降低无关（P=0.833），当干预措施传达给其他医疗保健专业人员时，差异也无统计学意义（P=0.53）。药师干预措施的具体沟通模式（即电话、传真或两者兼有）并未显著影响医务人员的接受程度（P=0.133）。总体再入院率为 22.5%（n=23），30 天再入院的唯一显著预测因素是合并症的数量（优势比 1.28[95%CI 1.03-1.58]，P=0.024）。
无论沟通模式（电话或传真）或使用的技术如何，医务人员对药师干预措施的接受程度均未显著影响 30 天再入院率。然而，DCP 成功地发现了许多与药物相关的问题。关于药师对降低 30 天再入院率的建议的接受程度，还需要进一步的研究。
