Luetsch Karen, Rowett Debra, Twigg Michael J
School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
BMJ Qual Saf. 2020 Oct 30;30(5):418-30. doi: 10.1136/bmjqs-2020-011418.
Medication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes.
A realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital.
The realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms.
The synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients.
Medication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.
对于从一种医疗环境过渡到另一种医疗环境的患者，进行药物评估可能会改善健康结局，尽管结局获益的证据各不相同。目前尚不清楚基层医疗中的药剂师在患者从医院转回社区时进行药物评估的时间和原因，以及这为何会带来有益的结局。
进行一项实在论综合分析，以建立一种理论，阐明药剂师在基层医疗中为出院患者进行药物评估时，什么有效、对谁有效、为何有效以及在何种情况下有效。
实在论综合分析是按照实在论与元叙事证据综合：不断发展的标准报告标准进行的。一个初始的项目理论为对数据库（PubMed、Embase、护理及相关健康文献累积索引、国际药学文摘、OpenGrey、Trove）的系统文献检索提供了指导，并辅以机构和政府信息来源。通过探索背景、干预措施、结局和因果机制之间的相互作用来综合文献资料。
该综合分析确定了9种背景，在这些背景下，可以激活10种机制来影响基层医疗出院后药剂师进行药物评估的结局。要进行药物评估，这些因素包括患者对医护人员的信任、出院后的医疗保健优先事项、参与能力、对获益和努力程度的认知，以及所有相关人员所需的认知。对于药物评估过程，那些促使医护人员之间发出合作邀请、使药剂师能够运用临床技能并对药物评估结果负责等机制，与患者更积极的结局相关联。
出院后的药物评估若根据患者偏好进行、相关项目促进医护人员之间的协调与合作并建立信任，且药剂师对结果负责，似乎就能成功发挥作用。这一实在论综合分析的结果可为出院后药物评估服务模式提供参考。
