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手术室药剂师整合的成本节约与医护人员认知:一项混合方法横断面研究。

Cost Saving and Health Workers Perceptions of Pharmacist Integration in Operating Rooms: A Mixed-Methods Cross-Section Study.

作者信息

Buma Deus, Ngasa Solobi, Ndesangia Arnold

机构信息

Muhimbili National Hospital, Dar es Salaam, Tanzania.

出版信息

Inquiry. 2025 Jan-Dec;62:469580251343776. doi: 10.1177/00469580251343776. Epub 2025 May 31.

Abstract

Developed nations maximize pharmacists, while developing nations underutilize them, especially in operating rooms (ORs), necessitating cost-effectiveness and feedback evaluations. We investigated the impact of pharmacist involvement in operating rooms (OR) at Muhimbili National Hospital. We contrasted a "before era" (BE) without pharmacists to an "after era" (AE) with their presence. We conducted a comparative observational analysis. We examined data from April 1, 2016, to June 30, 2018 (BE), and July 1, 2018, to September 2020 (AE). We interviewed 127 OR Health workers to appreciate pharmacist presence during AE. We performed statistical analysis using Stata 12/IC. We used chi-square and Student's -tests for categorical and continuous data, respectively. We set statistical significance at  < .05. In the BE, 32 568 patients underwent surgery, with 31.7% being male, while in the AE, 40 195 patients were operated on, with 40.2% being male. Patient payment method distribution did not significantly differ between eras ( = .68351). The total medication and medical supply costs decreased from TZS 8 631 547 372 in the BE to TZS 6 695 832 350 in the AE. Despite an additional cost of TZS 1 409 400 000 for pharmacist integration, a net cost saving of TZS 526 315 022 was achieved, resulting in an incremental cost-effectiveness ratio (ICER) of TZS 69 007 cost savings per patient served during AE. Health workers satisfaction regarding the inclusion of 40 pharmacists was high, with 98.4% reporting satisfaction. During the AE, 92.9% of OR Health workers were content with pharmacist performance. However, some Health workers did not understand about pharmacist roles in OR due to their limited numbers and suggested prioritizing supply management over direct OR presence. Pharmacists are indispensable members of healthcare teams, particularly in ORs, where their contributions significantly improve patient outcomes and reduce costs. The findings strongly support increased pharmacist deployment in healthcare facilities and further research to explore their impact on healthcare resource utilization.

摘要

发达国家充分利用药剂师,而发展中国家对药剂师利用不足,尤其是在手术室,因此需要进行成本效益和反馈评估。我们调查了穆希姆比利国家医院药剂师参与手术室工作的影响。我们将没有药剂师的“之前时期”(BE)与有药剂师的“之后时期”(AE)进行了对比。我们进行了一项比较观察性分析。我们检查了2016年4月1日至2018年6月30日(BE)以及2018年7月1日至2020年9月(AE)的数据。我们采访了127名手术室医护人员,以了解AE期间药剂师的存在情况。我们使用Stata 12/IC进行统计分析。对于分类数据和连续数据,我们分别使用卡方检验和学生t检验。我们将统计学显著性设定为p < 0.05。在BE期间,32568名患者接受了手术,其中31.7%为男性,而在AE期间,40195名患者接受了手术,其中40.2%为男性。不同时期患者支付方式的分布没有显著差异(p = 0.68351)。药品和医疗用品的总成本从BE期间的8631547372坦桑尼亚先令降至AE期间的6695832350坦桑尼亚先令。尽管整合药剂师增加了1409400000坦桑尼亚先令的成本,但仍实现了526315022坦桑尼亚先令的净成本节约,导致AE期间每位服务患者的增量成本效益比(ICER)为69007坦桑尼亚先令的成本节约。医护人员对纳入40名药剂师的满意度很高,98.4%的人表示满意。在AE期间,92.9%的手术室医护人员对药剂师的表现感到满意。然而,一些医护人员由于药剂师数量有限,不了解他们在手术室中的作用,并建议优先进行供应管理而非直接在手术室工作。药剂师是医疗团队中不可或缺的成员,尤其是在手术室,他们的贡献显著改善了患者的治疗效果并降低了成本。研究结果有力地支持了在医疗机构增加药剂师的部署,并进一步开展研究以探索他们对医疗资源利用的影响。

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