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药师主导的心力衰竭教育项目评估:增强患者自我管理疾病的能力

Evaluation of a Pharmacist-Managed Heart Failure Education Project: Empowering Patients to Self-Manage Their Disease.

作者信息

Shepherd Megan Riddle, Thomas Dustin, Herald Michael, Adane Eyob D

机构信息

Hazard ARH Regional Medical Center, Hazard, KY, USA.

出版信息

J Pharm Technol. 2015 Jun;31(3):120-126. doi: 10.1177/8755122514563177. Epub 2014 Dec 16.

Abstract

Recent reimbursement cuts for hospitals with higher 30-day heart failure (HF)-related readmission rates call for means of reducing those readmissions. To determine if pharmacist-initiated education increases HF knowledge and assess if an increase in HF knowledge decreases HF readmission. This was a prospective interventional study. Participants were ≥18 years old admitted through the emergency department of a 322-bed community hospital with a diagnosis and/or past medical history of HF. Terminal/palliative care patients, patients residing in an assisted-living environment, or patients with a mental illness that deemed them incapable of participating were excluded. Forty-eight patients received pharmacist-initiated HF education on HF pathophysiology and its pharmacologic and nonpharmacologic treatment. Medication assistance and ancillary services were consulted when necessary. Patients' knowledge of HF was assessed using the same questionnaire prior to education and through a follow-up phone call within 7 days postdischarge. Posteducation HF knowledge scores were 13.7 points higher than preeducation scores ( < .05). Twenty-five patients (52%) had HF as a primary discharge diagnosis. Of those patients, 9 (36%) were readmitted within 30 days for any cause. Only 3 patients (12%) had a HF-related diagnosis at readmission. There was a statistical difference in the level of knowledge but that was not translated into a statistical difference in readmission rates. Patients' HF knowledge scores increased after pharmacist education. Improvements in HF knowledge could not be correlated with readmission rates. However, the majority of HF patients in this study did not have a HF-related diagnosis at the time of readmission.

摘要

近期,针对30天心力衰竭(HF)相关再入院率较高的医院,报销额度有所削减,这就需要采取措施降低再入院率。目的是确定由药剂师发起的教育是否能增加HF知识,并评估HF知识的增加是否能降低HF再入院率。这是一项前瞻性干预研究。研究对象为年龄≥18岁、通过一家拥有322张床位的社区医院急诊科入院、诊断为HF和/或有HF既往病史的患者。终末期/姑息治疗患者、居住在辅助生活环境中的患者或患有精神疾病而被认为无能力参与的患者被排除在外。48名患者接受了药剂师发起的关于HF病理生理学及其药物和非药物治疗的教育。必要时会提供药物援助和辅助服务。在教育前使用相同问卷评估患者对HF的了解情况,并在出院后7天内通过随访电话进行评估。教育后HF知识得分比教育前得分高13.7分(P<0.05)。25名患者(52%)的主要出院诊断为HF。在这些患者中,9名(36%)在30天内因任何原因再次入院。再次入院时只有3名患者(12%)有与HF相关的诊断。知识水平存在统计学差异,但这并未转化为再入院率的统计学差异。药剂师教育后患者的HF知识得分有所提高。HF知识的改善与再入院率没有相关性。然而,本研究中的大多数HF患者在再次入院时没有与HF相关的诊断。

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