标题：药师在急诊科提供干预措施对药品合理使用的影响：系统评价和荟萃分析摘要：目的：评价药师在急诊科提供干预措施对患者药品合理使用的影响。方法：检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库、维普数据库和中国知网，搜集药师在急诊科提供干预措施对患者药品合理使用影响的随机对照试验，检索时限均从建库至 2022 年 9 月。由 2 位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 RevMan 5.4 软件进行荟萃分析。结果：共纳入 20 项研究，包括 19244 例患者。Meta 分析结果显示，与常规治疗相比，药师干预可提高患者对药物的认知（RR=1.23，95%CI：1.06~1.43，P=0.007）、用药依从性（RR=1.31，95%CI：1.14~1.50，P<0.0001）、药物相关知识（RR=1.31，95%CI：1.06~1.62，P=0.01）、正确用药率（RR=1.24，95%CI：1.08~1.42，P=0.002）和降低药物不良事件发生率（RR=0.69，95%CI：0.51~0.94，P=0.02）。结论：药师在急诊科提供干预措施能提高患者对药物的认知、用药依从性、药物相关知识、正确用药率，降低药物不良事件发生率。

Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis.

机构信息

School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia

School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia.

出版信息

Emerg Med J. 2023 Feb;40(2):120-127. doi: 10.1136/emermed-2021-211660. Epub 2022 Aug 1.

DOI:10.1136/emermed-2021-211660

PMID:35914923

Abstract

BACKGROUND

Pharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well characterised.

OBJECTIVE

This systematic review aimed to synthesise evidence from studies examining the impact of interventions provided by pharmacists on the quality use of medicines in adults presenting to ED.

METHODS

A systematic literature search was conducted in MEDLINE, EMBASE and CINAHL. Two independent reviewers screened titles/abstracts and reviewed full texts. Studies that compared the impact of interventions provided by pharmacists with usual care in ED and reported medication-related primary outcomes were included. Cochrane Risk of Bias-2 and Newcastle-Ottawa tools were used to assess the risk of bias. Summary estimates were pooled using random-effects meta-analysis, along with sensitivity and sub-group analyses.

RESULTS

Thirty-one studies involving 13 242 participants were included. Pharmacists were predominantly involved in comprehensive medication review, advanced pharmacotherapy assessment, staff and patient education, identification of medication discrepancies and drug-related problems, medication prescribing and co-prescribing, and medication preparation and administration. The activities reduced the number of medication errors by a mean of 0.33 per patient (95% CI -0.42 to -0.23, I=51%) and the proportion of patients with at least one error by 73% (risk ratio (RR)=0.27, 95% CI 0.19 to 0.40, I=85.3%). The interventions were also associated with more complete and accurate medication histories, increased appropriateness of prescribed medications by 58% (RR=1.58, 95% CI 1.21 to 2.06, I=95%) and quicker initiation of time-critical medications.

CONCLUSION

The evidence indicates improved quality use of medicines when pharmacists are included in ED care teams.

PROSPERO REGISTRATION NUMBER

CRD42020165234.

摘要

背景

药剂师在急诊科（ED）团队中扮演着越来越重要的角色。然而，ED 基础药学干预对药物合理使用的影响尚未得到充分描述。

目的

本系统评价旨在综合评估药师在 ED 提供干预措施对成人患者药物合理使用的影响。

方法

在 MEDLINE、EMBASE 和 CINAHL 中进行系统文献检索。两名独立评审员筛选标题/摘要并审查全文。纳入了比较药师干预与 ED 常规护理对药物相关主要结局影响的研究。使用 Cochrane 偏倚风险-2 工具和纽卡斯尔-渥太华量表评估偏倚风险。使用随机效应荟萃分析汇总汇总估计值，并进行敏感性和亚组分析。

结果

纳入了 31 项研究，涉及 13242 名参与者。药师主要参与全面药物审查、高级药物治疗评估、员工和患者教育、识别药物差异和药物相关问题、药物处方和共处方、药物准备和管理。这些活动使每位患者的药物错误数量平均减少 0.33（95%置信区间-0.42 至-0.23，I=51%），至少有一次错误的患者比例降低了 73%（风险比（RR）=0.27，95%置信区间 0.19 至 0.40，I=85.3%）。干预措施还与更完整和准确的药物史相关，使处方药物的适当性增加 58%（RR=1.58，95%置信区间 1.21 至 2.06，I=95%），并更快地开始使用时间关键药物。