Beth Israel Lahey Health Pharmacy, Westwood, MA, USA.
Department of Emergency Medicine, Division of Medical Toxicology, Harvard Medical School, Boston, MA.
Am J Health Syst Pharm. 2022 Sep 22;79(19):1652-1662. doi: 10.1093/ajhp/zxac143.
Obtaining an accurate medication history is a vital component of medication reconciliation upon admission to the hospital. Despite the importance of this task, medication histories are often inaccurate and/or incomplete. We evaluated the association of a pharmacy-driven medication history initiative on clinical outcomes of patients admitted to the general medicine service of an academic medical center.
Comparing patients who received a pharmacy-driven medication history to those who did not, a retrospective stabilized inverse probability treatment weighting propensity score analysis was used to estimate the average treatment effect of the intervention on general medical patients. Fifty-two patient baseline characteristics including demographic, operational, and clinical variables were controlled in the propensity score model. Hospital length of stay, 7-day and 30-day unplanned readmissions, and in-hospital mortality were evaluated.
Among 11,576 eligible general medical patients, 2,234 (19.30%) received a pharmacy-driven medication history and 9,342 (80.70%) patients did not. The estimated average treatment effect of receiving a pharmacy-driven medication history was a shorter length of stay (mean, 5.88 days vs 6.53 days; P = 0.0002) and a lower in-hospital mortality rate (2.34% vs 3.72%, P = 0.001), after adjustment for differences in patient baseline characteristics. No significant difference was found for 7-day or 30-day all-cause readmission rates.
Pharmacy-driven medication histories reduced length of stay and in-hospital mortality in patients admitted to the general medical service at an academic medical center but did not change 7-day and 30-day all-cause readmission rates. Further research via a large, multisite randomized controlled trial is needed to confirm our findings.
在患者入院时，获取准确的用药史是药物重整的重要组成部分。尽管这项任务非常重要，但用药史往往不准确和/或不完整。我们评估了一项药房主导的用药史倡议对学术医疗中心综合医学服务入院患者临床结局的影响。
通过回顾性稳定逆概率治疗加权倾向评分分析，将接受药房主导的用药史与未接受的患者进行比较，以估计干预对综合医学患者的平均治疗效果。在倾向评分模型中控制了 52 个患者基线特征，包括人口统计学、运营和临床变量。评估了住院时间、7 天和 30 天非计划性再入院和院内死亡率。
在 11576 名符合条件的综合医学患者中，2234 名（19.30%）接受了药房主导的用药史，9342 名（80.70%）患者未接受。接受药房主导的用药史的估计平均治疗效果是住院时间更短（平均 5.88 天比 6.53 天；P=0.0002）和院内死亡率更低（2.34%比 3.72%；P=0.001），在调整患者基线特征差异后。7 天和 30 天全因再入院率无显著差异。
在学术医疗中心，药房主导的用药史减少了综合医学服务入院患者的住院时间和院内死亡率，但并未改变 7 天和 30 天全因再入院率。需要通过一项大型、多站点随机对照试验进一步研究以证实我们的发现。
