通过远程药房获取用药史：一项观察性研究。

Obtaining medication histories via telepharmacy: an observational study.

作者信息

Francis Martina, Francis Peter, Patanwala Asad E, Penm Jonathan

机构信息

Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.

Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.

出版信息

J Pharm Policy Pract. 2023 Jun 8;16(1):69. doi: 10.1186/s40545-023-00573-w.

DOI:10.1186/s40545-023-00573-w

PMID:37291672

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10248974/

Abstract

BACKGROUND

Medication reconciliation is an effective strategy to reduce medication errors upon hospital admission. The process involves obtaining a best possible medication history (BPMH), which can be both time-consuming and resource-intensive. During the COVID-19 pandemic, telepharmacy was used to reduce the risk of viral transmission. Telepharmacy is the remote provision of pharmacy-led clinical services, such as obtaining BPMHs, using telecommunications. However, the accuracy of telephone-obtained BPMHs has not yet been evaluated. Therefore, the primary aim of this study was to evaluate the proportion of patients who have an accurate BPMH from the telephone-obtained BPMH compared to an in-person obtained BPMH.

METHODS

This prospective, observational study took place in a large tertiary hospital. Recruited patients or carers had their BPMH obtained by a pharmacist over the telephone. The same patients or carers then had their BPMH conducted in-person to identify any deviations between the telephone-obtained and in-person obtained BPMH. All telephone-obtained BPMHs were timed with a stopwatch. Any deviations were categorised according to their potential consequence. An accurate BPMH was defined as having no deviations. Descriptive statistics were used to report all quantitative variables. A multivariable logistic regression was conducted to identify risk factors for patients and medications for having medication deviations.

RESULTS

In total, 116 patients were recruited to receive both a telephone-obtained and in-person obtained BPMH. Of these, 91 patients (78%) had an accurate BPMH with no deviations. Of the 1104 medications documented across all the BPMHs, 1064 (96%) had no deviation. Of the 40 (4%) medication deviations, 38 were deemed low-risk (3%) and 2 high-risk (1%). A patient was more likely to have a deviation if they are taking more medications (aOR: 1.11; 95% CI: 1.01-1.22; p < 0.05). A medication was more likely to have a deviation if it was regular non-prescription medication (aOR: 4.82; 95% CI: 2.14-10.82; p < 0.001) or 'when required' non-prescription medication (aOR: 3.12; 95% CI: 1.20-8.11; p = 0.02) or a topical medication (aOR: 12.53; 95% CI: 4.34-42.17; p < 0.001).

CONCLUSIONS

Telepharmacy represents a reliable and time-efficient alternative to in-person BPMHs.

摘要

背景

用药核对是一种减少住院时用药错误的有效策略。该过程需要获取尽可能完整的用药史（BPMH），这既耗时又耗费资源。在新冠疫情期间，远程药房被用于降低病毒传播风险。远程药房是通过电信远程提供由药剂师主导的临床服务，例如获取BPMH。然而，通过电话获取的BPMH的准确性尚未得到评估。因此，本研究的主要目的是评估通过电话获取的BPMH与亲自获取的BPMH相比，具有准确BPMH的患者比例。

方法

这项前瞻性观察性研究在一家大型三级医院进行。招募的患者或护理人员由药剂师通过电话获取其BPMH。然后，同一名患者或护理人员再接受亲自进行的BPMH，以确定电话获取的BPMH与亲自获取的BPMH之间的任何偏差。所有通过电话获取的BPMH都用秒表计时。任何偏差都根据其潜在后果进行分类。准确的BPMH定义为无偏差。使用描述性统计报告所有定量变量。进行多变量逻辑回归以确定患者和药物出现用药偏差的风险因素。

结果

总共招募了116名患者，他们既接受了电话获取的BPMH，也接受了亲自获取的BPMH。其中，91名患者（78%）有准确的BPMH，无偏差。在所有BPMH记录的1104种药物中，1064种（96%）无偏差。在40种（4%）用药偏差中，38种被视为低风险（3%），2种为高风险（1%）。服用更多药物的患者更有可能出现偏差（调整后比值比：1.11；95%置信区间：1.01 - 1.22；p < 0.05）。如果是常规非处方药（调整后比值比：4.82；95%置信区间：2.14 - 10.82；p < 0.001）或“按需”非处方药（调整后比值比：3.12；95%置信区间：1.20 - 8.11；p = 0.02）或外用药物（调整后比值比：12.53；95%置信区间：4.34 - 42.17；p < 0.001），药物更有可能出现偏差。