在一家门诊伤口愈合中心实施临床药师主导的综合药物管理计划。
Implementation of a clinical pharmacist-driven comprehensive medication management program in an outpatient wound healing center.
出版信息
J Am Pharm Assoc (2003). 2022 Mar-Apr;62(2):475-480.e3. doi: 10.1016/j.japh.2021.10.021. Epub 2021 Oct 22.
BACKGROUND
The role of the pharmacist in wound healing management among patients with diabetic and nondiabetic foot ulcers (DFU) is unclear. We sought to implement and evaluate an integrated pharmacist-driven comprehensive medication management (CMM) program in a multidisciplinary podiatrist-led wound healing center (WHC).
OBJECTIVES
The objectives were to determine the role of the clinical pharmacist in a WHC and evaluate the impact of CMM interventions on prescribing rates and wound healing rates.
METHODS
A pharmacist-driven CMM program was implemented in a podiatrist-led WHC, and an evaluation spanning 6 years was conducted.
RESULTS
Overall, 1018 patients were treated over 6 years, and 515 received wound treatment after the CMM period, of which, 309 received CMM services. A total of 441 medication related problems (MRPs) were identified; most were related to medication safety (35.1%) and inappropriate or ineffective therapy (31.3%), and problems with adherence accounted for 22.5% of documented MRPs. An average of 3.41 interventions per patient were documented, and most were related to patient education (40.8%). Only metformin (20.3 vs. 34.2%; P < 0.001) and insulin prescription (57.3 vs. 73.8%; P < 0.001) prevalence increased after CMM implementation. Other prescriptions were not significantly different among patients presenting in the pre- and post-CMM periods, respectively. Wound healing rates among patients with DFU were similar before and after implementation (55 vs. 52%; P = 0.49). Likewise, wound healing rates among those with non-DFUs were similar before- and after implementation (56 vs. 53%; P = 0.56).
CONCLUSION
The implementation of a novel pharmacist-driven CMM program embedded within a multidisciplinary podiatrist-managed WHC provided the initial evidence of the potential benefits of providing pharmacist-driven CMM services to patients with lower extremity ulcers. Prospective studies of CMM in this patient population are needed.
背景
药剂师在糖尿病和非糖尿病足溃疡（DFU）患者的伤口愈合管理中的作用尚不清楚。我们试图在多学科足病医生主导的伤口愈合中心（WHC）中实施和评估一种综合的药剂师驱动的综合药物管理（CMM）计划。
目的
确定临床药剂师在 WHC 中的作用，并评估 CMM 干预对处方率和伤口愈合率的影响。
方法
在足病医生主导的 WHC 中实施了药剂师驱动的 CMM 计划，并进行了为期 6 年的评估。
结果
总体而言，在 6 年内治疗了 1018 名患者，其中 515 名在 CMM 期后接受了伤口治疗，其中 309 名接受了 CMM 服务。共发现 441 个药物相关问题（MRP）；大多数与药物安全（35.1%）和不适当或无效治疗（31.3%）有关，而与药物依从性有关的问题占记录的 MRP 的 22.5%。记录的每位患者平均有 3.41 个干预措施，大多数与患者教育有关（40.8%）。只有二甲双胍（20.3%比 34.2%；P<0.001）和胰岛素处方（57.3%比 73.8%；P<0.001）的患病率在 CMM 实施后增加。在分别在 CMM 前后就诊的患者中，其他处方没有显著差异。DFU 患者的伤口愈合率在实施前后相似（55%比 52%；P=0.49）。同样，非 DFU 患者的伤口愈合率在实施前后相似（56%比 53%；P=0.56）。
结论
在多学科足病医生管理的 WHC 中实施新型的药剂师驱动的 CMM 计划提供了为下肢溃疡患者提供药剂师驱动的 CMM 服务的潜在益处的初步证据。需要对该患者群体中的 CMM 进行前瞻性研究。
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