J Am Pharm Assoc (2003). 2021 May-Jun;61(3):351-359. doi: 10.1016/j.japh.2021.01.006. Epub 2021 Mar 5.
There is a critical need in primary care to proactively prevent, identify, and resolve poor medication-related outcomes. However, more than 80% of primary care practices do not have clinical pharmacists as members of expanded care teams. The emergence of eConsult services in primary care settings presents an opportunity for primary care providers (PCPs) to consult with clinical pharmacists as "on-demand" pharmacotherapy specialists.
The objectives were to (1) determine the use of a clinical pharmacist in an existing eConsult network, (2) characterize the use and type of clinical pharmacist eConsults sent by PCPs, and (3) measure the implementation percentage of pharmacist recommendations by PCPs.
The study was conducted in a federally qualified health center using an existing eConsult platform. A clinical pharmacist was contracted to receive eConsults and was expected to respond within 2 business days. PCPs were introduced to the pharmacist eConsult service through presentations that reviewed the clinical pharmacist's education/training, suitable pharmacist eConsult topics, and workflow for sending a pharmacist eConsult.
A total of 57 eConsults containing 123 individual questions were answered. Advanced practice nurses (APRNs) sent 3 times the number of eConsults and individual questions per eConsult compared with physicians (P < 0.0001). Most eConsult questions from APRNs related to adverse drug events/drug interactions (44%), drug or dosage changes to reach therapeutic goals (18%), and renal/hepatic dosage adjustments (13%). However, physician eConsult questions were primarily targeted on patient-specific drug or dosage adjustments (62%) and comprehensive medication regimen reviews (17%). A total of 74% of the pharmacist eConsult responses had at least 50% of the recommendations implemented by PCPs.
This study revealed the use of a pharmacist eConsult service for medication-related questions in an existing eConsult network for PCPs. As more practices enroll in value-based plans, pharmacist eConsults can improve the quality and safety of prescribing and chronic medication management.
在初级保健中，积极预防、识别和解决与用药相关的不良后果至关重要。然而，超过 80%的初级保健实践没有将临床药师纳入扩大的护理团队。电子咨询服务在初级保健环境中的出现为初级保健提供者（PCP）提供了一个机会，可以将临床药师作为“按需”的药物治疗专家进行咨询。
本研究旨在（1）确定在现有的电子咨询网络中使用临床药师的情况，（2）描述 PCP 发送的临床药师电子咨询的使用情况和类型，以及（3）衡量 PCP 实施药师建议的百分比。
该研究在一家经联邦政府认证的合格健康中心进行，使用现有的电子咨询平台。聘请了一名临床药师来接收电子咨询，并期望在 2 个工作日内做出回应。通过介绍临床药师的教育/培训、适合药师电子咨询的主题以及发送药师电子咨询的工作流程，向 PCP 介绍药师电子咨询服务。
共收到 57 份包含 123 个单独问题的电子咨询。与医生相比，高级执业护士（APRNs）发送的电子咨询数量和每份电子咨询的问题数量是其三倍（P < 0.0001）。APRN 发送的大多数电子咨询问题与药物不良反应/药物相互作用（44%）、为达到治疗目标而改变药物或剂量（18%）以及调整肾脏/肝脏剂量（13%）有关。然而，医生的电子咨询问题主要针对患者特定的药物或剂量调整（62%）和全面药物治疗方案审查（17%）。药师电子咨询回复中，有 74%的建议至少有 50%被 PCP 实施。
本研究揭示了在现有的电子咨询网络中，PCP 针对药物相关问题使用了药师电子咨询服务。随着更多的实践加入基于价值的计划，药师电子咨询可以提高处方和慢性病药物管理的质量和安全性。
