Nguyen Tu Nhat Thien, Bui Quynh Thi Huong, Tran Van-Anh Thi, Tran Nhu Quynh, Nguyen Nhi Truc Y, Nguyen Hai Thanh, Pham Cam Thi Le, Pham Hien Thi Thu, Tran Mai Thi Phuong, Dau Hien Thi Thanh, Nguyen Tien Thi Thuy
Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam.
Trop Med Int Health. 2023 Aug;28(8):612-619. doi: 10.1111/tmi.13911. Epub 2023 Jun 30.
To evaluate the impact of clinical pharmacist-led interventions on the switch from intravenous (IV) to oral (PO) antibiotics among inpatients with infectious diseases.
A before-and-after study was conducted among inpatients aged 18 or older who were diagnosed with infectious diseases and received IV antibiotics for at least 24 h at the Thong Nhat Hospital during the pre-intervention (between January 2021 and June 2021) and intervention (between January 2022 and June 2022) periods. Information on patient characteristics, antibiotic usage, length of hospital stay and treatment outcomes was obtained from medical records. The interventions included introducing IV-to-PO switch guidelines to physicians and clinical pharmacists' feedback on eligible cases. The impact of the pharmacists' interventions was evaluated by comparing primary outcomes (switch rate and appropriateness of switching) and secondary outcomes (duration of IV therapy, length of hospital stay and treatment outcomes) between the two study periods.
We included 99 patients in the pre-intervention and 80 patients in the intervention period. The proportion of patients who switched from IV-to-PO antibiotics increased from 44.4% in the pre-intervention period to 67.8% in the intervention period (p = 0.008). The overall rate of appropriate conversion increased significantly from 43.8% to 67.5% (p = 0.043). There were no statistically significant differences between the two periods with respect to the median duration of IV therapy (9 days vs. 8 days), length of hospital stay (10 days vs. 9 days) and treatment outcomes. Logistic regression analysis showed that the interventions resulted in a higher switch rate, whereas age was negatively associated with the switching rate.
The implementation of clinical pharmacist-led interventions was effective in promoting IV-to-PO antibiotic conversion.
评估临床药师主导的干预措施对传染病住院患者从静脉注射（IV）抗生素转换为口服（PO）抗生素的影响。
在统华医院对年龄18岁及以上、被诊断为传染病且在干预前（2021年1月至2021年6月）和干预期间（2022年1月至2022年6月）接受静脉抗生素治疗至少24小时的住院患者进行了一项前后对照研究。从病历中获取患者特征、抗生素使用情况、住院时间和治疗结果等信息。干预措施包括向医生介绍静脉转口服转换指南以及临床药师对符合条件病例的反馈。通过比较两个研究期间的主要结局（转换率和转换的适宜性）和次要结局（静脉治疗持续时间、住院时间和治疗结果）来评估药师干预的影响。
干预前纳入99例患者，干预期间纳入80例患者。从静脉注射抗生素转换为口服抗生素的患者比例从干预前的44.4%增至干预期间的67.8%（p = 0.008）。适宜转换的总体率从43.8%显著增至67.5%（p = 0.043）。两个时期在静脉治疗的中位持续时间（9天对8天）、住院时间（10天对9天）和治疗结果方面无统计学显著差异。逻辑回归分析表明，干预导致更高的转换率，而年龄与转换率呈负相关。
临床药师主导的干预措施的实施在促进静脉到口服抗生素转换方面是有效的。
