J Am Pharm Assoc (2003). 2022 Nov-Dec;62(6):1919-1924. doi: 10.1016/j.japh.2022.06.011. Epub 2022 Jun 28.
The primary objective was to evaluate chronic obstructive pulmonary disease (COPD) interventions in a pharmacist-led telemedicine clinic. Secondary objectives were to quantify emergency department (ED) visits and hospitalizations for COPD exacerbations.
A single-center, outpatient telemedicine clinic within the Veterans Affairs (VA) Tennessee Valley Healthcare System from January 2021 to June 2021.
Patients with an active COPD diagnosis and assigned to a primary care team within the local VA were reviewed for enrollment. Visits were conducted through VA video connect or telephone. During these appointments, pertinent information was collected and pharmacotherapy and nonpharmacotherapy interventions were implemented to optimize COPD management.
Visits were conducted by a postgraduate year 2 ambulatory care pharmacy resident under supervision of a clinical pharmacy specialist with a scope of practice. Appointments were virtual to reduce coronavirus disease 2019 exposure and increase access to care. Patients were identified through a COPD patient report and provider referral to target high-risk patients.
Interventions made were documented at each visit. Chart review and patient interview were used to quantify ED visits or hospitalizations for COPD exacerbations occurring the year before or during clinic enrollment.
Of 82 charts reviewed, 18 patients were eligible for enrollment. Eleven were followed as 7 patients did not show for initial visits. A total of 31 COPD interventions occurred including 13 nonpharmacotherapy (i.e., inhaler education, smoking cessation) and 18 pharmacotherapy (i.e., optimization of COPD regimens). An average of 3 COPD interventions were completed per patient followed. No ED visits and 2 hospitalizations for a COPD exacerbation occurred during the study period. This cohort had 1 ED visit and 10 hospitalizations the year before enrollment.
This telemedicine clinic experience, albeit a small study population, suggests an opportunity for pharmacists to provide pharmacotherapy and nonpharmacotherapy interventions, which may improve COPD-related outcomes and access to care.
主要目的是评估由药剂师主导的远程医疗诊所中治疗慢性阻塞性肺疾病（COPD）的干预措施。次要目的是量化 COPD 加重的急诊（ED）就诊次数和住院次数。
从 2021 年 1 月至 6 月，在退伍军人事务部（VA）田纳西流域医疗保健系统内的一个单一中心、门诊远程医疗诊所。
对在当地 VA 内有活跃 COPD 诊断且被分配到初级保健团队的患者进行入组评估。通过 VA 视频连线或电话进行就诊。在这些预约中，收集了相关信息，并实施了药物治疗和非药物治疗干预措施，以优化 COPD 管理。
由一名住院药师（PGY2）在临床药剂专家的监督下进行就诊，其实践范围包括。预约为虚拟的，以减少 2019 年冠状病毒病的暴露并增加获得护理的机会。通过 COPD 患者报告和提供者转诊来识别患者，以针对高风险患者。
每次就诊时都会记录干预措施。通过病历回顾和患者访谈来量化 COPD 加重导致的 ED 就诊次数或住院次数，这些就诊或住院发生在入组前一年或入组期间。
在审查的 82 份病历中，有 18 名患者符合入组条件。11 名患者入组，7 名患者未参加初始就诊。共发生 31 次 COPD 干预，包括 13 次非药物治疗（如吸入器教育、戒烟）和 18 次药物治疗（如 COPD 方案优化）。随访的每位患者平均完成 3 次 COPD 干预。在研究期间，没有发生 ED 就诊和 COPD 加重住院。该队列在入组前一年有 1 次 ED 就诊和 10 次住院。
尽管这项远程医疗诊所的经验研究规模较小，但表明药剂师有机会提供药物治疗和非药物治疗干预措施，这可能改善 COPD 相关结局和获得护理的机会。
