Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA.
Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA.
J Pharm Pract. 2023 Jun;36(3):668-678. doi: 10.1177/08971900211064155. Epub 2021 Dec 28.
Transitions of care (ToC) aim to provide continuity while preventing loss of information that may result in poor outcomes such as hospital readmission. Readmissions not only burden patients, they also increase costs. Given the high prevalence of coronary artery diseases (CAD) in the United States (US), patients with CAD often make up a significant portion of hospital readmissions. To conduct a systematic review evaluating the impact of pharmacist-driven ToC interventions on post-hospital outcomes for patients with CAD. MEDLINE, Scopus, and CINAHL were searched from database inception through 03/2020 using key words for CAD and pharmacists. Studies were included if they: (1) identified adults with CAD at US hospitals, (2) evaluated pharmacist-driven ToC interventions, and (3) assessed post-discharge outcomes. Outcomes were summarized qualitatively. Of the 1612 citations identified, 11 met criteria for inclusion. Pharmacist-driven ToC interventions were multifaceted and frequently included medication reconciliation, medication counseling, post-discharge follow-up and initiatives to improve medication adherence. Hospital readmission and emergency room visits were numerically lower among patients receiving vs not receiving pharmacist-driven interventions, with statistically significant differences observed in 1 study. Secondary prevention measures and adherence tended to be more favorable in the pharmacist-driven intervention groups. Eleven studies of multifaceted, ToC interventions led by pharmacists were identified. Readmissions were numerically lower and secondary prevention measures and adherence were more favorable among patients receiving pharmacist-driven interventions. However, sufficiently powered studies are still required to confirm these benefits.
过渡护理（ToC）旨在提供连续性，同时防止可能导致不良后果（如住院再入院）的信息丢失。住院再入院不仅给患者带来负担，还增加了成本。鉴于冠心病（CAD）在美国的高患病率，CAD 患者通常占医院再入院的很大一部分。 进行了一项系统评价，评估药剂师主导的 ToC 干预对 CAD 患者出院后结局的影响。 使用 CAD 和药剂师的关键词，从数据库建立到 2020 年 3 月，在 MEDLINE、Scopus 和 CINAHL 上进行了搜索。如果研究符合以下标准，则将其纳入：（1）在美国医院确定患有 CAD 的成年人，（2）评估药剂师主导的 ToC 干预，以及（3）评估出院后结局。结果以定性方式总结。 在确定的 1612 条引用中，有 11 条符合纳入标准。药剂师主导的 ToC 干预措施是多方面的，通常包括药物重整、药物咨询、出院后随访以及提高药物依从性的举措。接受与未接受药剂师主导的干预措施的患者相比，住院再入院和急诊就诊的人数较低，在 1 项研究中观察到有统计学意义的差异。二级预防措施和依从性在药剂师主导的干预组中往往更为有利。 确定了 11 项由药剂师主导的多方面 ToC 干预措施的研究。接受药剂师主导的干预措施的患者，再入院的人数较低，二级预防措施和依从性更为有利。然而，仍需要进行足够有力的研究来证实这些益处。
