Sorrento T A, Bonanza K C, Salisbury D W
General Apothecary, Rochester General Hospital, NY, USA.
Am J Health Syst Pharm. 1996 Dec 1;53(23):2848-52. doi: 10.1093/ajhp/53.23.2840.
A hospital outpatient pharmacy's planning and implementation of pharmaceutical services for a capitated geriatric care program are described. The hospital's director of pharmacy and pharmacy ambulatory care manager proposed providing distributive and clinical services for enrollees in Independent Living for Seniors (ILS), a program designed to help elderly persons to continue living at home instead of in nursing homes. ILS receives pooled monthly payments from Medicare and Medicaid; a copayment is required of enrollees not eligible for Medicaid. Medical and social services are offered, primarily through adult daycare centers. Nurses at the centers monitor ILS enrollees regularly and help them manage their medications. After a year of negotiations with the program, the outpatient satellite of the hospital's inpatient pharmacy began providing services; one pharmacist was assigned to ILS. Problems with medication stock at the daycare centers were corrected. Conservative supplies of stock drugs (mostly nonprescription items) and medications to meet patients' needs between daily pharmacy deliveries were established. A new computerized medication administration record was developed. Once distributive services were in place, a pharmacy and therapeutics committee began establishing a formulary. The pharmacist functions as part of an interdisciplinary care team, providing education on drug use and managing costs; he reviews all patients' charts every four months and meets weekly with ILS staff to recommend changes in drug therapy. The cost of services provided by the hospital outpatient pharmacy averaged $77 per patient per month in the first year, compared with about $120 for the previous vendor. A hospital's ambulatory care pharmacy improved the pharmaceutical services provided to a capitated geriatric care program.
本文描述了一家医院门诊药房为一项老年医保计划规划并实施药学服务的情况。该医院的药房主任和门诊护理经理提议为“老年人独立生活”（ILS）项目的参保者提供分发和临床服务，该项目旨在帮助老年人继续居家生活而非入住养老院。ILS每月从医疗保险和医疗补助计划获得汇总付款；不符合医疗补助资格的参保者需自付费用。主要通过成人日间护理中心提供医疗和社会服务。中心的护士定期监测ILS参保者并帮助他们管理用药。经过与该项目一年的谈判，医院住院药房的门诊卫星药房开始提供服务，安排了一名药剂师负责ILS项目。日间护理中心的药品库存问题得到纠正。建立了库存药品（大多为非处方药）的保守供应以及在每日药房配送之间满足患者需求的药品供应。开发了一种新的计算机化用药管理记录。一旦分发服务就绪，一个药学与治疗学委员会开始制定药品处方集。药剂师作为跨学科护理团队的一员发挥作用，提供用药教育并管理成本；他每四个月查看所有患者的病历，并每周与ILS工作人员会面，以建议调整药物治疗方案。医院门诊药房提供的服务成本在第一年平均为每位患者每月77美元，而之前的供应商约为120美元。一家医院的门诊护理药房改善了为一项老年医保计划提供的药学服务。
