De Guzman Keshia R, Long Duncan, Theodos Alexander, Karlovic Alexandra, Falconer Nazanin
Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.
School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
J Pharm Pract. 2025 Feb;38(1):28-34. doi: 10.1177/08971900241262376. Epub 2024 Jun 13.
The increasing aging population in Australia has created a higher demand for specialist geriatric services within hospitals. A Geriatric Evaluation and Management in the Home (GEMITH) service was implemented at a quaternary Queensland hospital. The GEMITH service was unique as it incorporated a specialist pharmacist into the multidisciplinary team. To determine the medication safety and quality impact of the GEMITH service by evaluating the type and clinical significance of specialist pharmacist interventions. This was retrospective observational study of clinical interventions made by the GEMITH pharmacist for patients admitted to the service between October 2020 to April 2021. All pharmacist interventions were rated for their clinical significance using the Society of Hospital Pharmacists of Australia (SHPA) risk classification system. The ratings were undertaken by a panel of three pharmacists that independently assessed the interventions, coming together for final discussion. A narrative analysis of the interventions were derived through group consensus. There was a total of 119 admissions to the GEMITH service, with 132 clinical interventions made by the specialist geriatric pharmacist. The majority (47%) of interventions were considered as low risk interventions, although high- (21%) and extreme-risk (2%) interventions still occurred. The most common type of intervention (32%) involved medication reconciliation. Other intervention types included monitoring recommendations, dosing interventions, and deprescribing suggestions. Multiple clinical interventions were made by the GEMITH pharmacist, which prevented possible and significant medication-related harm. This demonstrated the quality impact of the specialist pharmacist in improving medication safety for geriatric patients.
澳大利亚人口老龄化加剧，使得医院对老年专科服务的需求增加。昆士兰州一家四级医院实施了居家老年评估与管理（GEMITH）服务。GEMITH服务独具特色，因为它将专科药剂师纳入了多学科团队。通过评估专科药剂师干预措施的类型和临床意义，来确定GEMITH服务对用药安全和质量的影响。这是一项对2020年10月至2021年4月期间入住该服务的患者由GEMITH药剂师进行的临床干预的回顾性观察研究。所有药剂师的干预措施均使用澳大利亚医院药剂师协会（SHPA）风险分类系统对其临床意义进行评级。评级由三名药剂师组成的小组进行，他们独立评估干预措施，然后共同进行最终讨论。通过小组共识对干预措施进行叙述性分析。GEMITH服务共收治119例患者，老年专科药剂师进行了132次临床干预。大多数干预措施（47%）被视为低风险干预，不过高风险（21%）和极高风险（2%）的干预仍然存在。最常见的干预类型（32%）涉及用药核对。其他干预类型包括监测建议、剂量干预和减药建议。GEMITH药剂师进行了多次临床干预，预防了可能的重大用药相关危害。这证明了专科药剂师对提高老年患者用药安全的质量影响。
