Sloeserwij Vivianne M, Zwart Dorien L M, Hazen Ankie C M, Poldervaart Judith M, Leendertse Anne J, de Bont Antoinette A, Bouvy Marcel L, de Wit Niek J, de Gier Han J
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
Erasmus School of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
Int J Clin Pharm. 2020 Oct;42(5):1293-1303. doi: 10.1007/s11096-020-01075-4. Epub 2020 Aug 13.
Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practitioners' prescribing quality. Setting This study was conducted in 25 primary care practices in the Netherlands. Methods Non-randomised, controlled, multi-centre, complex intervention study with pre-post comparison. First, we identified potential prescribing quality indicators from the literature and assessed their feasibility, validity, acceptability, reliability and sensitivity to change. Also, an expert panel assessed the indicators' health impact. Next, using the final set of indicators, we measured the quality of prescribing in practices where non-dispensing pharmacists were integrated in the team (intervention group) compared to usual care (two control groups). Data were extracted anonymously from the healthcare records. Comparisons were made using mixed models correcting for potential confounders. Main outcome measure Quality of prescribing, measured with prescribing quality indicators. Results Of 388 eligible indicators reported in the literature we selected 8. In addition, two more indicators relevant for Dutch general practice were formulated by an expert panel. Scores on all 10 indicators improved in the intervention group after introduction of the non-dispensing pharmacist. However, when compared to control groups, prescribing quality improved solely on the indicator measuring monitoring of the renal function in patients using antihypertensive medication: relative risk of a monitored renal function in the intervention group compared to usual care: 1.03 (95% CI 1.01-1.05, p-value 0.010) and compared to usual care plus: 1.04 (1.01-1.06, p-value 0.004). Conclusion This study did not demonstrate a consistent effect of the introduction of non-dispensing clinical pharmacists in the primary care team on the quality of physician's prescribing.This study is part of the POINT-study, which was registered at The Netherlands National Trial Register with trial registration number NTR-4389.
背景 尤其是在服用多种药物的老年人中，药物可能会造成伤害。融入基层医疗团队的临床药师可能会提高药学服务质量。目的 评估融入基层医疗团队的非配药临床药师对全科医生处方质量的影响。背景 本研究在荷兰的25家基层医疗机构开展。方法 采用非随机、对照、多中心、复杂干预研究，并进行前后比较。首先，我们从文献中确定潜在的处方质量指标，并评估其可行性、有效性、可接受性、可靠性和对变化的敏感性。此外，一个专家小组评估了这些指标对健康的影响。接下来，使用最终确定的指标集，我们测量了药师融入团队的医疗机构（干预组）与常规护理（两个对照组）的处方质量。数据从医疗记录中匿名提取。使用混合模型进行比较，并对潜在的混杂因素进行校正。主要结局指标 用处方质量指标衡量的处方质量。结果 在文献报道的388个合格指标中，我们选择了8个。此外，专家小组制定了另外两个与荷兰全科医疗相关的指标。引入非配药药师后，干预组所有10个指标的得分均有所提高。然而，与对照组相比，仅在使用抗高血压药物患者的肾功能监测指标方面处方质量有所改善：干预组与常规护理相比，肾功能监测的相对风险为1.03（95%CI 1.01-1.05，p值0.010），与常规护理加相比为1.04（1.01-1.06，p值0.004）。结论 本研究未证明在基层医疗团队中引入非配药临床药师对医生处方质量有一致的影响。本研究是POINT研究的一部分，该研究已在荷兰国家试验注册中心注册，试验注册号为NTR-4389。
