Riley Karen, Yap Katherine, Foley Gaelan, Lambe John, Lund Sean
Hogan Pharmacy Partners LTD, Sarnia, Ontario, Canada.
KD Riley Pharmacist Professional Corporation, Sarnia, Ontario, Canada.
J Eval Clin Pract. 2025 Mar;31(2):e14123. doi: 10.1111/jep.14123. Epub 2024 Aug 13.
To evaluate the impact of a clinical decision support system (CDSS) to identify drug-related problems (DRPs) during community pharmacist medication reviews.
Pilot 3-phase (group), open-label study.
Two community pharmacies in Sarnia, Ontario, with pharmacists providing medication reviews to patients.
Five pharmacists participated in three phases (groups). During Phase 1, pharmacists conducted medication reviews in 25 adult patients using the usual approaches. In Phase 2, pharmacists were trained to use a CDSS to identify DRPs, and then conducted medication reviews using the tool in a different group of 25 adult patients. In Phase 3, pharmacists conducted medication reviews without the aid of the CDSS in 25 additional adult patients.
The primary outcome was recommendation to the primary care physician to alter pharmacotherapy based on medication review, assessed using mean number and frequency (yes/no) of recommendations by patient. Secondary outcomes included number of potential DRPs, actual DRPs, medication review duration time, pharmacist's perceptions of the CDSS and patient satisfaction with medication review.
The mean number of recommendations to primary care physicians to alter pharmacotherapy per patient in Phases 1, 2 and 3 did not differ: 1.0 (SD = I.2) versus 1.5 (1.0) versus 1.5 (1.0), respectively; p = 0.223. The percentage of patients with a pharmacy recommendation sent to physicians across the phases, however, differed: 52% versus 80% versus 88%, respectively; p = 0.010, with more in Phases 2 and 3 compared to 1. There were more potential DRPs in group 2 compared to other groups. There were no differences in actual DRPs and medication review time. Pharmacists had positive attitudes about the CDSS. Patients were generally satisfied with their medication review.
This small pilot study provides some preliminary evidence for performance and feasibility of a CDSS to identify DRPs that pharmacists will act on. Future research is recommended to validate these findings in a larger sample.
评估临床决策支持系统（CDSS）在社区药师药物评估过程中识别药物相关问题（DRP）的影响。
三阶段（分组）开放标签试验研究。
安大略省萨尼亚市的两家社区药房，药师为患者提供药物评估服务。
五名药师参与三个阶段（分组）。在第1阶段，药师采用常规方法对25名成年患者进行药物评估。在第2阶段，药师接受使用CDSS识别DRP的培训，然后使用该工具对另外25名成年患者进行药物评估。在第3阶段，药师在没有CDSS辅助的情况下对另外25名成年患者进行药物评估。
主要结局是根据药物评估结果向初级保健医生提出改变药物治疗方案的建议，通过每位患者的建议平均数和频率（是/否）进行评估。次要结局包括潜在DRP的数量、实际DRP的数量、药物评估持续时间、药师对CDSS的看法以及患者对药物评估的满意度。
第1、2和3阶段向初级保健医生提出改变每位患者药物治疗方案的建议平均数无差异：分别为1.0（标准差=1.2）、1.5（1.0）和1.5（1.0）；p=0.223。然而，各阶段向医生发送药房建议的患者百分比不同：分别为52%、80%和88%；p=0.010，第2和3阶段的比例高于第1阶段。与其他组相比，第2组的潜在DRP更多。实际DRP和药物评估时间无差异。药师对CDSS持积极态度。患者总体上对药物评估感到满意。
这项小型试点研究为CDSS识别药师将采取行动的DRP的性能和可行性提供了一些初步证据。建议未来开展研究以在更大样本中验证这些发现。
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