Rahimtoola H, Timmers A, Dessing R, Hudson S
Department of Pharmaceutical Sciences, University of Strathclyde, Glasgow, U.K.
Pharm World Sci. 1997 Apr;19(2):105-13. doi: 10.1023/a:1008608317131.
An electronic patient database linking prescribes with a Dutch community pharmacy consortium was evaluated in a subset of the population of Noordwijk (11,760 patients out of a total of 25,600). The pharmacy database (a file of 41 disease contra-indications representing a subset of the prescribers' medical diagnosis) was studied in order to assess its value for the accurate discrimination of target patient groups within the community and for support to the pharmaceutical care of individual patients. The aim was to examine the application of the pharmacy records to pharmaceutical care, tested by measuring the accuracy of the pharmacy database to predict the community public health profile; and, more specifically, the accuracy to identify three potential target groups for pharmaceutical care. The records of patients with angina, chronic respiratory disease and diabetes (n = 1116), representing 65% of the total pharmacy morbidity records, were studied in detail and verified by the files and texts of the prescriber's individual patient records. From samples of patients (n = 273) from the three patient groups, the extent and nature of co-morbidity, polypharmacy (drug entities prescribed annually) and drug therapy instability (prescription changes to dose or dose form annually) were characterised. Angina patients showed the most comorbidity, 46% having three or more additional diseases; chronic respiratory disease patients showed most drug therapy instability; and insulin-dependent diabetic patients received most polypharmacy per disease. The pharmacy database predicted the prevalence of 10 of 23 relevant disease categories (representing 51% of the total morbidity on the medical records). However, the prevalences of eight categories were underestimated and of five categories overestimated. Of the three patient groups, 73% of patients appeared on both the pharmacy and the medical database. Of the total co-morbidity recorded for these patients, 68% of records were common to both databases. The database discrepancies (32%) were due to morbidity omitted (12%) and morbidity unverified (10%) on the pharmacy database, together with morbidity omitted from the medical database (10%). The current pharmacy database provides a limited view of morbidity. A strategic approach to pharmaceutical care requires pharmacists and prescribers to verify and share patient information if patient groups and individuals within a group are to be usefully targeted.
一个将开处方者与荷兰社区药房联盟相连接的电子患者数据库，在诺德韦克的部分人群中（总共25600名患者中的11760名）进行了评估。研究了药房数据库（一个包含41种疾病禁忌的文件，代表开处方者医疗诊断的一个子集），以评估其在社区内准确区分目标患者群体以及支持个体患者药学服务方面的价值。目的是研究药房记录在药学服务中的应用，通过测量药房数据库预测社区公共卫生概况的准确性来进行测试；更具体地说，是识别三个潜在药学服务目标群体的准确性。对患有心绞痛、慢性呼吸道疾病和糖尿病的患者记录（n = 1116）进行了详细研究，这些记录占药房总发病记录的65%，并通过开处方者的个体患者记录文件和文本进行了核实。从这三个患者群体的患者样本（n = 273）中，对合并症的程度和性质、多药治疗（每年开具的药物实体）以及药物治疗不稳定性（每年剂量或剂型的处方变化）进行了特征描述。心绞痛患者的合并症最多，46%的患者还有三种或更多其他疾病；慢性呼吸道疾病患者的药物治疗不稳定性最高；胰岛素依赖型糖尿病患者每种疾病的多药治疗最多。药房数据库预测了23种相关疾病类别中的10种的患病率（占病历总发病率的51%）。然而，有8个类别的患病率被低估，5个类别的患病率被高估。在这三个患者群体中，73%的患者同时出现在药房数据库和医疗数据库中。在为这些患者记录的所有合并症中，68%的记录在两个数据库中是相同的。数据库差异（32%）是由于药房数据库中遗漏的发病率（12%）和未核实的发病率（10%），以及医疗数据库中遗漏的发病率（10%）。当前的药房数据库对发病率的呈现有限。如果要有效地针对患者群体和群体中的个体，药学服务的战略方法要求药剂师和开处方者核实并共享患者信息。
