中国县级医院开展药师主导的用药重整评估：一项多中心、开放标签、评估者设盲、非随机对照研究。

Evaluation of pharmacist-led medication reconciliation at county hospitals in China: A multicentre, open-label, assessor-blinded, nonrandomised controlled study.

机构信息

Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.

Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China.

出版信息

J Glob Health. 2024 Apr 12;14:04058. doi: 10.7189/jogh.14.04058.

DOI:10.7189/jogh.14.04058

PMID:38602274

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11007753/

Abstract

BACKGROUND

Due to a lack of related research, we aimed to determine the effectiveness of a pharmacist-led medication reconciliation intervention in China.

METHODS

We conducted a multicentre, prospective, open-label, assessor-blinded, cluster, nonrandomised controlled study at six county-level hospitals, with hospital wards serving as the clusters. We included patients discharged from the sampled hospitals who were aged ≥60 years; had ≥1 studied diagnoses; and were prescribed with ≥3 medications at discharge. Patients in the intervention group received a pharmacist-led medication reconciliation intervention and those in the control group received standard care. We assessed the incidence of medication discrepancies at discharge, patients' medication adherence, and health care utilisation within 30 days after discharge.

RESULTS

There were 429 patients in the intervention group (mean age = 72.5 years, standard deviation (SD) = 7.0) and 526 patients in the control group (mean age = 73.6 years, SD = 7.1). Of the 1632 medication discrepancies identified at discharge, fewer occurred in the intervention group (1.9 per patient on average) than the control group (2.6 per patient on average).The intervention significantly reduced the incidence of medication discrepancy by 9.6% (95% confidence interval (CI) = -15.6, -3.6, P = 0.002) and improved patients' medication adherence, with an absolute decrease in the mean adherence score of 2.5 (95% CI = -2.8, -2.2, P < 0.001). There was no significant difference in readmission rates between the intervention and control groups.

CONCLUSIONS

Pharmacist-led medication reconciliation at discharge from Chinese county-level hospitals reduced medication discrepancies and improved patients' adherence among patients aged 60 years or above, though no impact on readmission after discharge was observed.

REGISTRATION

ChiCTR2100045668.

摘要

背景

由于相关研究的缺乏，我们旨在确定药剂师主导的药物重整干预在中国的效果。

方法

我们在中国六家县级医院进行了一项多中心、前瞻性、开放标签、评估者设盲、整群、非随机对照研究，以医院病房为单位进行分组。我们纳入了从抽样医院出院的年龄≥60 岁的患者；有≥1个研究诊断；出院时处方≥3 种药物的患者。干预组患者接受了药剂师主导的药物重整干预，对照组患者接受了标准护理。我们评估了出院时的药物差异发生率、患者的药物依从性以及出院后 30 天内的医疗保健利用情况。

结果

干预组有 429 例患者（平均年龄 72.5 岁，标准差 7.0），对照组有 526 例患者（平均年龄 73.6 岁，标准差 7.1）。出院时共发现 1632 种药物差异，干预组（平均每位患者 1.9 种）比对照组（平均每位患者 2.6 种）少。该干预措施显著降低了 9.6%（95%置信区间（CI）：-15.6，-3.6，P=0.002）的药物差异发生率，并提高了患者的药物依从性，平均依从评分绝对降低了 2.5（95%CI：-2.8，-2.2，P<0.001）。干预组和对照组的再入院率无显著差异。