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加利福尼亚州姑息治疗药师干预措施和结果的多中心评估。

Multicentered Evaluation of Palliative Care Pharmacists' Interventions and Outcomes in California.

机构信息

Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Department of Pharmacy, Community Hospital of the Monterey Peninsula, Monterey, California, USA.

出版信息

J Palliat Med. 2021 Sep;24(9):1358-1363. doi: 10.1089/jpm.2020.0566. Epub 2021 Feb 24.

Abstract

The palliative care (PC) pharmacist's role within PC teams is increasingly recognized with favorable outcomes being reported. Retrospective study evaluated hospitalized adults seen by PC pharmacists, as part of PC consultation team at three California institutions. The primary objective was to categorize pharmacists' interventions. Secondary end points included length from admission to PC pharmacist involvement and symptom improvement following pharmacist intervention. Data were collected for a total of 557 patients. Over the study period, the PC pharmacists provided 1466 medication recommendations and 2545 nonsymptom-based interventions. Average length of stay (LOS) was 15.6 days with mean time to PC service referral of 3.6 days. PC pharmacist consult occurred after a mean of 4.3 days after PC team consulted. LOS was significantly lower if seen by PC pharmacist within 72 hours of PC consultation, 12.3 days versus 24.5 days ( < 0.001), as well as when serving as lead clinician 9.3 days versus 15.5 days ( < 0.001). Achievement of severity goal was significantly higher at 24 and 72 hours assessment periods when received a medication recommendation for pain, dyspnea, anxiety, and constipation. PC pharmacists provide substantial transdisciplinary interventions. Significantly decreased LOS was found when PC pharmacist was involved within 72 hours of initial PC consultation and when served as lead clinician. Improved symptom goal attainment was demonstrated for pain, dyspnea, anxiety, and constipation. In summary, integration of a PC pharmacist on a PC team can be relied upon to provide patient-centered, transdisciplinary care and enhance symptom management.

摘要

姑息治疗(PC)药剂师在 PC 团队中的角色越来越受到认可,并且已经报告了良好的结果。这项回顾性研究评估了在加利福尼亚的三个机构中,姑息治疗药师作为姑息治疗咨询团队的一部分,为住院成人提供服务的情况。主要目标是对药剂师的干预措施进行分类。次要终点包括从入院到姑息治疗药师参与的时间以及药师干预后症状改善的情况。共收集了 557 名患者的数据。在研究期间,姑息治疗药师共提供了 1466 项药物建议和 2545 项非症状相关的干预措施。平均住院时间(LOS)为 15.6 天,平均到姑息治疗服务转介的时间为 3.6 天。在姑息治疗团队咨询后,平均 4.3 天后进行姑息治疗药师咨询。如果在姑息治疗咨询后 72 小时内接受姑息治疗药师的治疗,住院时间明显更短,为 12.3 天,而不是 24.5 天(<0.001),并且如果担任首席临床医生,住院时间为 9.3 天,而不是 15.5 天(<0.001)。在接受疼痛、呼吸困难、焦虑和便秘的药物治疗建议后,在 24 小时和 72 小时评估期,达到严重程度目标的比例明显更高。结果表明,当姑息治疗药师在首次姑息治疗咨询后 72 小时内参与治疗,并且担任首席临床医生时,患者的住院时间显著缩短,症状目标的实现也得到改善。姑息治疗药师在姑息治疗团队中的整合可以提供以患者为中心的跨学科护理,并加强症状管理。

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