Smythe M A, Shah P P, Spiteri T L, Lucarotti R L, Begle R L
Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI, USA.
Ann Pharmacother. 1998 Mar;32(3):294-9. doi: 10.1345/aph.17068.
To develop, implement, and assess the outcomes of a system for providing pharmaceutical care to medical progressive care patients.
A system for providing pharmaceutical care was developed and implemented for an 8-week period beginning in June 1995. Both patient care outcomes and drug therapy cost change from the intervention period were compared with those of an 8-week baseline period. Variables compared included unit length of stay, hospital length of stay, transfers to the intensive care unit, readmissions, and adverse drug reactions requiring treatment. Differences between periods for these variables were assessed by using chi 2 tests and t-tests with alpha set at p less than 0.05. The clinical significance of the interventions were assessed independently by four physicians: two intensivists and two internists. The total drug therapy cost change from the intervention period was calculated as follows: total cost avoidance from individual recommendations subtracted from the total cost incurred from individual recommendations.
The pharmacist evaluated 152 patients during the intervention period. A total of 235 pharmacotherapy recommendations were made on 103 patients, of whom 86.4% were accepted. Significantly fewer adverse drug reactions (ADRs) received treatment during the intervention period (p = 0.027). The mean unit length of stay was lower during the intervention period (4.8 +/- 3.7 d) than during the baseline period (6.0 +/- 5.6 d); however, this difference was not significant (p = 0.053). Individual physician assessment of the pharmacists' recommendations revealed that 75.8% were considered somewhat significant, significant, or very significant. The total drug therapy cost change from the intervention period was -$6534.53. The projected annual drug therapy cost reduction from this study is $42,474.45.
The provision of pharmaceutical care to medical progressive care patients was associated with a substantial decrease in drug therapy cost and a decrease in the number of ADRs that required treatment.
开发、实施并评估为内科重症监护患者提供药学服务的系统效果。
1995年6月起，开发并实施了一个为期8周的药学服务提供系统。将干预期间的患者护理结果和药物治疗成本变化与8周基线期进行比较。比较的变量包括住院单元时长、住院总时长、转入重症监护病房情况、再入院情况以及需要治疗的药物不良反应。通过卡方检验和t检验评估这些变量在不同时期的差异，设定α为p<0.05。由四位医生（两位重症医学专家和两位内科医生）独立评估干预措施的临床意义。干预期间药物治疗总成本变化计算如下：从个体建议产生的总成本中减去个体建议避免的总成本。
干预期间药师评估了152例患者。共对103例患者提出235条药物治疗建议，其中86.4%被采纳。干预期间接受治疗的药物不良反应（ADR）明显减少（p = 0.027）。干预期间平均住院单元时长（4.8±3.7天）低于基线期（6.0±5.6天）；然而，这种差异不显著（p = 0.053）。医生对药师建议的个体评估显示，75.8%的建议被认为具有一定意义、显著意义或非常显著意义。干预期间药物治疗总成本变化为 -6534.53美元。本研究预计每年可减少药物治疗成本42474.45美元。
为内科重症监护患者提供药学服务与药物治疗成本大幅降低以及需要治疗的ADR数量减少相关。
