Pharmacy department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
BMJ Open. 2022 Apr 8;12(4):e053010. doi: 10.1136/bmjopen-2021-053010.
Early switch from intravenous to oral therapy of bioequivalent drugs has major advantages but remains challenging. At our hospital, a basic clinical rule was designed to automatically alert the physician to review potential intravenous to oral switch (IVOS). A rather low acceptance rate was observed. In this study, we aimed to develop, validate and investigate the effect of more advanced clinical rules for IVOS, as part of a centralised pharmacist-led medication review service.
A quasi-experimental study was performed in a large teaching hospital in Belgium using an interrupted time series design.
A definite set of 13 criteria for IVOS, focusing on the ability of oral absorption and type of infection, was obtained by literature search and validated by a multidisciplinary expert panel. Based on these criteria, we developed a clinical rule for paracetamol and one for ten bioequivalent antibiotics to identify patients with potentially inappropriate intravenous prescriptions (PIVs). Postintervention, the clinical rule alerts were reviewed by pharmacists, who provided recommendations to switch in case of eligibility.
A regression model was used to assess the impact of the intervention on the number of persistent PIVs between the preintervention and the postintervention period. The total number of recommendations, acceptance rate and financial impact were recorded for the 8-month postintervention period.
At baseline, a median number of 11 (range: 7-16) persistent PIVs per day was observed. After the intervention, the number reduced to 3 (range: 1-7) per day. The advanced IVOS clinical rules showed an immediate relative reduction of 79% (incidence rate ratio=0.21, 95% CI 0.13 to 0.32; p<0.01) in the proportion of persistent PIVs. No significant underlying time trends were observed during the study. Postintervention, 1091 recommendations were provided, of which 74.1% were accepted, resulting in a total 1-day cost saving of €4648.35.
We showed the efficacy of advanced clinical rules combined with a pharmacist-led medication review for IVOS of bioequivalent drugs.
从静脉治疗转换为生物等效药物的口服治疗具有重大优势，但仍然具有挑战性。在我们医院，设计了一项基本的临床规则，以自动提醒医生审查潜在的静脉到口服转换（IVOS）。但观察到接受率相当低。在这项研究中，我们旨在开发、验证和研究更先进的 IVOS 临床规则的效果，作为集中式药剂师主导的药物审查服务的一部分。
在比利时的一家大型教学医院进行了一项准实验研究，采用中断时间序列设计。
通过文献检索获得了一套针对口服吸收能力和感染类型的 13 项 IVOS 明确标准，并由多学科专家小组进行了验证。基于这些标准，我们为扑热息痛开发了一个临床规则，并为 10 种生物等效抗生素开发了一个临床规则，以确定潜在不适当的静脉处方（PIVs）患者。干预后，药剂师审查了临床规则警报，并在符合条件的情况下提供了转换建议。
使用回归模型评估干预对干预前后持续 PIV 数量的影响。记录了 8 个月干预后期间的建议总数、接受率和财务影响。
在基线时，每天观察到中位数为 11 例（范围：7-16 例）持续 PIV。干预后，数量减少到每天 3 例（范围：1-7 例）。先进的 IVOS 临床规则显示持续 PIV 的比例立即相对减少 79%（发病率比=0.21，95%CI 0.13 至 0.32；p<0.01）。在研究期间未观察到明显的潜在时间趋势。干预后，提供了 1091 条建议，其中 74.1%被接受，总节省 1 天费用为 4648.35 欧元。
我们展示了先进的临床规则与药剂师主导的药物审查相结合，用于生物等效药物的 IVOS 的疗效。
