Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, People's Republic of China.
Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, 1215 Wilbraham Road, Springfield, MA, 01119, USA.
Int J Clin Pharm. 2020 Aug;42(4):1237-1241. doi: 10.1007/s11096-020-01081-6. Epub 2020 Jun 30.
Background Patients with ischemic stroke are often taking multiple medications and are at increased risk for drug-related problems (DRPs). However, the prevalence and nature of DRPs in these patients in China and the impact of pharmacist interventions to resolve DRPs in this population are unknown. Objective To investigate the prevalence and nature of DRPs in ischemic stroke patients. Setting A neurology ward at an academic teaching hospital in Shanghai, China. Methods This was a prospective observational study conducted from September to November 2017. A total of 274 ischemic stroke adult patients were included. Pharmacists provided pharmaceutical care activities in the multi-disciplinary team. DRPs were categorized by the Pharmaceutical Care Network Europe classification V8.0. Main outcome measure The number, types, and causes of DRPs. Results We identified 88 DRPs related to 89 causes, an average rate of 0.32 DRP per patient. The rates of DRPs were higher in patients with renal impairment (0.91), liver impairment (0.65), or patients younger than 60 years (0.39). The primary cause of the DRPs was drug selection (66.3%), and the most common problem was treatment safety (60.2%). Among the top medications associated with DRPs were proton pump inhibitors (17.2%) followed by cerebrovascular/nootropics (16.1%) and sedative-hypnotics (13.9%). The acceptance rate of pharmacists' inventions reached 94.0%, and 90.0% of these accepted inventions were fully implemented (DRP status solved). Conclusion Drug-related problems are relatively common in hospitalized ischemic stroke patients in China, and treatment safety is the major DRP type. Pharmacist intervention can identify and resolve pertinent DRPs to optimize medication therapy.
缺血性脑卒中患者常同时服用多种药物，发生药物相关问题（DRP）的风险增加。然而，中国此类患者的 DRP 发生率和类型，以及药师干预对解决该人群中 DRP 的作用尚不清楚。目的：调查缺血性脑卒中患者的 DRP 发生率和类型。设置：中国上海一家教学医院的神经内科病房。方法：这是一项于 2017 年 9 月至 11 月开展的前瞻性观察性研究。共纳入 274 例成年缺血性脑卒中患者。药师在多学科团队中提供药学服务活动。DRP 按照欧洲药学监护网络分类 V8.0 进行分类。主要结局指标：DRP 的数量、类型和原因。结果：我们共发现 88 个与 89 个原因相关的 DRP，平均每个患者发生 0.32 个 DRP。肾功能不全（0.91）、肝功能不全（0.65）或年龄<60 岁（0.39）的患者 DRP 发生率更高。DRP 的主要原因是药物选择（66.3%），最常见的问题是治疗安全性（60.2%）。与 DRP 相关的首要药物为质子泵抑制剂（17.2%），其次为脑血管病/脑功能改善药（16.1%）和镇静催眠药（13.9%）。药师建议的采纳率为 94.0%，且 90.0%的采纳建议得到了完全实施（DRP 得到解决）。结论：药物相关问题在中国住院缺血性脑卒中患者中较为常见，治疗安全性是主要的 DRP 类型。药师干预可发现并解决相关 DRP，从而优化药物治疗。
