在综合医疗系统中的门诊药房实施加州参议院法案 493：药师指令的实验室检查的操作和临床效果评估。
Implementing California Senate Bill 493 in an Outpatient Pharmacy Within an Integrated Health System: Evaluation of the Operational and Clinical Effect of Pharmacist-Ordered Laboratory Tests.
机构信息
Kaiser Permanente, Los Angeles, California.
出版信息
J Manag Care Spec Pharm. 2020 Mar;26(3):320-324. doi: 10.18553/jmcp.2020.26.3.320.
BACKGROUND
Under California Senate Bill 493, pharmacists can order patient laboratory tests (labs). Currently, it is unknown if this service affects patient outcomes or pharmacy operations. Does lab ordering by pharmacists improve access to care, improve quality outcomes, and/or affect pharmacy operational functions?
PROGRAM DESCRIPTION
A 13-month pilot study was conducted at 2 Kaiser Permanente (KP) outpatient pharmacies where pharmacists provided extended adherence consultations and ordered hemoglobin A1c (HbA1c) labs for patients nonadherent to their oral diabetic medications with an HbA1c ≥ 8% or missing annual labs. Clinical outcomes of the pilot study were compared with a similar patient population at KP who concurrently received lab orders from their primary providers, defined here as the "usual care model."
OBSERVATION
Of the 793 HbA1c lab orders, 87 (11.0%) were generated by a pharmacist, and 706 (89.0%) were generated by the usual care group. Forty-three (49.4%) patients in the pharmacist group completed their labs compared with 279 (39.5%) patients in the usual care group ( = 0.10). A significantly greater proportion of patients in the pharmacist group achieved an HbA1c < 8% within the follow-up period of 30-180 days (34.9%), compared with the usual care group (12.2%, < 0.01). Of the patients who completed labs during the evaluation period, 38 (43.7%) patients in the pharmacist group and 111 (15.7%) patients in the usual care group had prelaboratory values ≥ 8% within the previous 12 months. The average pre-HbA1c value was 9.47% in the pharmacist group, and the average post-HbA1c value was 8.68% ( < 0.01). For the usual care group, the average pre-HbA1c value was 9.70%, and the average post-HbA1c value was 9.43% ( = 0.06). When comparing the difference in HbA1c reduction between the 2 groups, there was a larger decrease in HbA1c in the pharmacist group, but this difference was not significantly different ( = 0.06). The pilot study added an average of 5 minutes per patient encounter to the pharmacy workflow but did not affect overall patient wait times for receiving outpatient prescriptions.
IMPLICATIONS
Laboratory ordering by pharmacists in the outpatient setting improved access to care, improved quality outcomes, and did not adversely affect pharmacy operations.
DISCLOSURES
No outside funding supported this project. The authors have nothing to disclose.
背景
根据加利福尼亚州参议院法案 493，药剂师可以为患者订购实验室检测（实验室检测）。目前，尚不清楚这项服务是否会影响患者的治疗结果或药房的运营情况。药剂师开具实验室检测单是否可以改善患者的就医机会，提高治疗质量，以及/或者影响药房的运营功能？
项目描述
在 Kaiser Permanente（KP）的两家门诊药房进行了为期 13 个月的试点研究，在这两家药房中，药剂师为未遵医嘱使用口服糖尿病药物且糖化血红蛋白（HbA1c）≥8%或未进行年度实验室检测的患者提供了增强的药物依从性咨询，并为这些患者开具了 HbA1c 检测单。试点研究的临床结果与同时期 KP 中接受常规治疗的类似患者群体进行了比较，即“常规治疗模式”。
观察结果
在 793 份 HbA1c 检测单中，有 87 份（11.0%）由药剂师开具，706 份（89.0%）由常规治疗组开具。在药剂师组中，有 43 名（49.4%）患者完成了实验室检测，而在常规治疗组中，有 279 名（39.5%）患者完成了实验室检测（ = 0.10）。在 30-180 天的随访期间，药剂师组中达到 HbA1c<8%的患者比例明显高于常规治疗组（34.9%比 12.2%，<0.01）。在评估期间完成实验室检测的患者中，药剂师组中有 38 名（43.7%）患者和常规治疗组中有 111 名（15.7%）患者在过去 12 个月内的实验室检测值≥8%。药剂师组的平均 HbA1c 检测前值为 9.47%，平均 HbA1c 检测后值为 8.68%（<0.01）。对于常规治疗组，HbA1c 检测前值的平均值为 9.70%，HbA1c 检测后值的平均值为 9.43%（ = 0.06）。比较两组 HbA1c 降低的差异，药剂师组的 HbA1c 降低幅度更大，但差异无统计学意义（ = 0.06）。试点研究为药房的工作流程增加了平均每位患者 5 分钟的时间，但并未影响患者接受门诊处方的总体等待时间。
结论
在门诊环境中，药剂师开具实验室检测单改善了患者的就医机会，提高了治疗质量，且不会对药房的运营产生不利影响。
披露
本项目无外部资金支持。作者没有要披露的内容。
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