Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France.
Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France.
BMC Health Serv Res. 2023 Aug 30;23(1):927. doi: 10.1186/s12913-023-09512-6.
Preventable harm in healthcare is a growing public health challenge. In addition to the economic costs of safety failures, adverse drug events (ADE) may lead to complication or even death. Multidisciplinary care team involving a pharmacist appears to be an adequate response to prevention of adverse drug event. This qualitative systematic review aims to identify and describe multidisciplinary planned team-based care involving at least one pharmacist to limit or prevent adverse drug events in the adult patients.
To determine the type of interprofessional collaboration to prevent adverse drug event in which a pharmacist was involved, we conducted a qualitative systematic review of the literature of randomized controlled trials. Two independent reviewers screened trials in three databases: Medline, Web of Science, ScienceDirect. Prospective studies of at least three different health professionals' interventions, one of whom was a pharmacist in the last five years were included. Two reviewers performed data extraction and quality appraisal independently. We used TIDieR checklist to appraise articles quality.
In total 803 citations were retrieved, 34 were analysed and 16 full-text articles were reviewed. Only 3 studies published an implementation evaluation. More than half of the interventions (62%) targeted elderly patients including 6 whom lived in nursing homes. Studies outcomes were heterogeneous, and we did not perform a statistical analysis of the impact of these interventions. Most teams are composed of a physician/pharmacist/nurse trio (94%; 100%; 88%). Half of the teams were composed of the primary care physician. Other professionals were included such as physical therapists (25%), social worker (19%), occupational therapists (12%), and community health educator (6%). Multidisciplinary medication review was the most common intervention and was generally structured in four steps: data collection and baseline assessment, appraisal report by health professionals, a multidisciplinary medication review meeting and a patient follow-up.
The most common multidisciplinary intervention to prevent ADE in the adult population is the multidisciplinary drug review meeting at least the physician/pharmacist/nurse trio. Interventions target mostly elderly people in nursing homes, although complex chronic patients could benefit from this type of assessment.
PROSPERO registration: CRD42022334685.
医疗保健中的可预防伤害是一个日益严重的公共卫生挑战。除了安全故障的经济成本外，药物不良事件（ADE）可能导致并发症甚至死亡。涉及药剂师的多学科护理团队似乎是预防药物不良事件的适当对策。本定性系统评价旨在确定和描述至少涉及一名药剂师的多学科计划团队护理，以限制或预防成年患者的药物不良事件。
为了确定涉及药剂师的预防药物不良事件的专业间协作类型，我们对过去五年中涉及至少三名不同卫生专业人员干预措施的随机对照试验进行了定性系统评价。两名独立审查员在三个数据库中筛选试验：Medline、Web of Science、ScienceDirect。纳入的前瞻性研究有至少 3 名不同卫生专业人员的干预措施，其中 1 名为药剂师。两名审查员独立进行数据提取和质量评估。我们使用 TIDieR 清单评估文章质量。
共检索到 803 条引文，分析了 34 条，审查了 16 篇全文文章。只有 3 项研究发表了实施评估。超过一半的干预措施（62%）针对老年人，其中 6 人居住在养老院。研究结果具有异质性，我们没有对这些干预措施的影响进行统计分析。大多数团队由医生/药剂师/护士三人组组成（94%；100%；88%）。一半的团队由初级保健医生组成。还包括其他专业人员，如物理治疗师（25%）、社会工作者（19%）、职业治疗师（12%）和社区健康教育者（6%）。多学科药物审查是最常见的干预措施，通常分为四个步骤：数据收集和基线评估、卫生专业人员的评估报告、多学科药物审查会议和患者随访。
预防成年人群药物不良事件的最常见多学科干预措施是至少由医生/药剂师/护士三人组组成的多学科药物审查会议。干预措施主要针对养老院的老年人，但此类评估也可使复杂慢性病患者受益。
PROSPERO 注册：CRD42022334685。
