Department of Pharmacy, Baylor University Medical Center At Dallas, Dallas, TX, USA.
Department of Pharmacy, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Int J Clin Pharm. 2021 Jun;43(3):673-680. doi: 10.1007/s11096-020-01179-x. Epub 2020 Oct 29.
Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED. Methods: This was a retrospective observational study of patients discharged with prescriptions from the ED over two months. EM pharmacists reviewed discharge prescriptions and provided drug therapy recommendations. Two independent reviewers rated the clinical significance of interventions. High risk criteria were proposed a priori and included in a multivariable logistic regression analysis to identify variables independently associated with pharmacist intervention. Main Outcome Measure The primary outcome measure was the rate, type, and clinical significance of interventions associated with EM pharmacist review of discharge prescriptions. Results A total of 3107 prescriptions for 1648 patients were reviewed. Interventions occurred for 7.3% of patients with 29% of interventions rated as significant. The intervention rate was higher in patients with at least 1 high risk criteria versus those without (9.6% vs. 3.7%, p < 0.0001). An incremental increase in the number of discharge prescriptions was independently associated with pharmacist intervention. The 30 day readmission rates did not differ between patients with and without pharmacist review (27.4% vs. 26.2%, p = 0.38). Conclusion: Pharmacist review of discharge prescriptions resulted in clinically significant interventions but did not impact readmission rates. An incremental increase in the number of discharge prescriptions was associated with pharmacist intervention.
急诊医学（EM）药师可能具有独特的优势，可以优化急诊科（ED）患者的出院处方，但干预的临床意义及其与患者结局的关系尚未得到很好的描述。目的：评估 EM 药师在审查 ED 出院处方时完成的干预措施的临床意义。设置：本研究在一家学术医疗中心的 ED 进行。方法：这是一项对两个月内从 ED 出院并开具处方的患者进行的回顾性观察性研究。EM 药师审查出院处方并提供药物治疗建议。两名独立的审查员对干预措施的临床意义进行评分。高风险标准是预先提出的，并纳入多变量逻辑回归分析，以确定与药师干预独立相关的变量。主要观察指标：主要观察指标是与 EM 药师审查出院处方相关的干预措施的发生率、类型和临床意义。结果：共审查了 1648 名患者的 3107 张处方。7.3%的患者进行了干预，其中 29%的干预被评为显著。与无高风险标准的患者相比，有至少 1 项高风险标准的患者的干预率更高（9.6% vs. 3.7%，p<0.0001）。出院处方数量的递增与药师干预独立相关。有和没有药师审查的患者 30 天再入院率无差异（27.4% vs. 26.2%，p=0.38）。结论：出院处方审查后，药师进行了有临床意义的干预，但并未影响再入院率。出院处方数量的递增与药师干预相关。
