Emergency Department/Surveillance Ward Leipzig University Hospital.
Pharmacy Department Leipzig University Hospital.
Eur J Emerg Med. 2024 Feb 1;31(1):9-17. doi: 10.1097/MEJ.0000000000001070. Epub 2023 Aug 25.
Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions.
The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support.
DESIGN/SETTING/PARTICIPANTS: This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related.
The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated.
A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25-Q75) 63.5-83.5] and took 7 [(Q25-Q75) 5-8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25-Q75) 66-83] and number of drugs taken was 9 [(Q25-Q75) 5.25-11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35-5.38). An intervention on the patient's pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group.
In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.
药物不良反应带来了重大负担。这些药物不良反应可能导致住院，但在急诊科（ED）往往无法得到正确识别。临床药师虽然没有常规实施，但可以帮助识别药物不良反应。
主要目的是检查与 ED 就诊相关的药物与在 ED 团队中整合临床药师的制药组相比，与没有额外支持的标准组相比。
设计/设置/参与者：这项前瞻性干预研究在德国莱比锡的一家三级保健大学医院的 ED 进行。纳入年龄≥50 岁的患者。从 2020 年 3 月 1 日至 5 月 31 日，标准组纳入患者。从 2021 年 3 月 1 日至 2021 年 5 月 31 日，纳入制药组。临床药师通过患者详细的用药史和药物分析为 ED 团队提供支持。在两组中，均评估患者的 ED 就诊是否与药物相关。
比较两组中确定的与药物相关的 ED 就诊人数。评估了对药物不良反应管理、因果药物和患者特征的干预措施。
标准组共纳入 798 例患者，制药组纳入 827 例患者。ED 就诊与药物相关的患者中位年龄为 77 岁[（Q25-Q75）63.5-83.5]，标准组服用 7[（Q25-Q75）5-8]种药物。在制药组中，中位年龄为 78 岁[（Q25-Q75）66-83]，服用药物 9[（Q25-Q75）5.25-11]种。在标准组中，确定了 31 例（3.9%）与药物相关的 ED 就诊，而在制药组中，有 104 例（12.6%）与药物相关的 ED 就诊（OR 3.56；95%CI 2.35-5.38）。在标准组中，对 16 例与药物相关的 ED 就诊患者进行了药物治疗干预，而在制药组中则进行了 77 例。
在这项研究中，实施临床药师与提高识别与药物相关的 ED 就诊相关。与标准护理组相比，制药组中因果药物的停药和剂量减少显著更高。
