Aljabri Ahmed
Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Pharmacy Practice, University of Tabuk, Tabuk, Saudi Arabia.
Saudi Pharm J. 2021 Apr;29(4):337-342. doi: 10.1016/j.jsps.2021.03.008. Epub 2021 Mar 25.
Despite dramatic improvements in the management of heart failure (HF), hospital readmissions due to HF exacerbation remain high. To improve quality of care, many hospitals have developed interventions to reduce HF readmission rates. The aim of this study was to evaluate the impact of an inpatient multidisciplinary educational approach utilizing pharmacist to reduce 30-day HF readmissions.
Retrospective observational study conducted at a tertiary-hospital in Tucson-Arizona, USA. It included adult patients admitted with a documented diagnosis of HF and excluded patients discharged to hospice. Patents were divided into two groups: intervention and control group. Intervention components included: (1) pharmacy student counseling; (2) HF education provided jointly by a pharmacist and a nurse as a group class to patients and caregivers and/or one-on-one education with a nurse; and (3) follow-up phone calls 1-3 days post-discharge reinforcing HF education. The main outcome was the rate of hospital readmission within 30 days post HF discharge.
A total of 221 patients were identified in the intervention and 183 in the control groups. Of the patients in the intervention group, 44.8% received pharmacy student counseling, 47.1% received HF education, 25.3% were contacted 1-3 days post-discharge; and 5% received all intervention components. The difference in the primary outcome was not statistically different, with 3.8% readmission rate in the control group compared to 4.5% in the intervention group (p = 0.73). It is worth to notice that none of the 11 patients who received all components of the interventions were readmitted. Univariate analysis demonstrated a significant association between pharmacy student counseling and 30-day HF readmissions (p = 0.03); however, no difference was observed after adjusting for all variables.
The readmission rate in both groups was below national rate, and neither the intervention nor components were associated with a significant reduction in the primary outcome. Another study is needed to assess the rate of HF readmission in patients receiving all components of the multidisciplinary interventions.
尽管心力衰竭（HF）的管理有了显著改善，但因HF恶化导致的医院再入院率仍然很高。为了提高护理质量，许多医院已经制定了降低HF再入院率的干预措施。本研究的目的是评估利用药剂师的住院多学科教育方法对降低30天HF再入院率的影响。
在美国亚利桑那州图森市的一家三级医院进行回顾性观察研究。研究对象包括确诊为HF的成年住院患者，排除出院至临终关怀机构的患者。患者分为两组：干预组和对照组。干预措施包括：（1）药学专业学生辅导；（2）药剂师和护士以小组授课形式为患者及其护理人员提供HF教育，和/或护士进行一对一教育；（3）出院后1 - 3天进行随访电话，强化HF教育。主要结局是HF出院后30天内的医院再入院率。
干预组共纳入221例患者，对照组183例。干预组患者中，44.8%接受了药学专业学生辅导，47.1%接受了HF教育，25.3%在出院后1 - 3天接受了随访；5%接受了所有干预措施。主要结局的差异无统计学意义，对照组再入院率为3.8%，干预组为4.5%（p = 0.73）。值得注意的是，接受所有干预措施的11例患者均未再入院。单因素分析显示药学专业学生辅导与30天HF再入院之间存在显著关联（p = 0.03）；然而，在对所有变量进行调整后未观察到差异。
两组的再入院率均低于全国水平，干预措施及其组成部分均未使主要结局显著降低。需要另一项研究来评估接受多学科干预所有组成部分的患者的HF再入院率。
