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Journal of the American College of Clinical Pharmacy : JACCP最新文献

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A call to action: Warfarin patient self-management 行动呼吁:华法林患者自我管理
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-03-18 DOI: 10.1002/jac5.1937
Sarah A. Spinler Pharm.D., FCCP
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引用次数: 0
Here is my sequence: The pharmacist's role in interpreting pharmacogenomic results 这是我的序列:药剂师在解读药物基因组学结果中的作用
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-03-18 DOI: 10.1002/jac5.1928
Kelly E. Caudle Pharm.D., Ph.D., FCCP
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引用次数: 0
Identifying factors that influence the selection of a postgraduate year 2 ambulatory care residency program 确定影响选择研究生第二年非住院护理实习课程的因素
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-03-14 DOI: 10.1002/jac5.1946
Alexandra K. Statczar Pharm.D., Christine A. Schumacher Pharm.D., FCCP, Jill S. Borchert Pharm.D., FCCP, Ana C. Quiñones-Boex Ph.D.

Introduction

Studies have been conducted to evaluate motivating factors for pharmacy students in pursuing a postgraduate year 1 (PGY1) residency program. Currently, no literature assesses the factors driving the selection of a specific PGY2 ambulatory care (AC) pharmacy program.

Objectives

The primary objective of this study was to identify factors driving the selection of a specific PGY2 AC pharmacy residency program. Secondary objectives were to describe whether these driving factors have changed throughout the residency year, the impact of remote work in the selection of a PGY2 AC program, and the impact of resident well-being in the selection of a PGY2 AC program.

Methods

A questionnaire was electronically distributed to 199 American Society of Health-System Pharmacists residency program directors (RPDs) of PGY2 AC programs in March 2023. The RPDs were asked to forward the questionnaire and reminder emails to their current PGY2 AC residents. The questionnaire included a combination of categorical, Likert-type, open-ended, and demographic questions. Descriptive statistics were used to analyze the results.

Results

In total, 72 PGY2 AC residents responded, providing a response rate of 27%. The mean age was 26 (±1.30) years, 69% identified as female, and 57% practiced in an urban setting. The top three factors that influenced the selection prior to the ASHP Match were culture of the program, perceived positive resident morale, and mentorship provided by RPD and preceptors. These factors remained the most influential after being in residency for approximately 8–9 months. The ability to work from home or remotely, complete a teaching certificate program, and conduct telehealth visits were the least influential factors.

Conclusion

An understanding of the factors that were most influential in the selection of a PGY2 AC program provides a unique resource to RPDs, allowing them to better position their program for future candidates.

导言:已有研究评估了促使药剂学学生选择研究生一年级(PGY1)住院医师培训项目的因素。目前,还没有文献对选择特定 PGY2 非住院护理(AC)药学课程的驱动因素进行评估。 目标 本研究的首要目标是确定选择特定 PGY2 非住院护理药学住院实习项目的驱动因素。次要目标是描述这些驱动因素在整个住院医师培训年中是否发生了变化、远程工作对选择 PGY2 交流项目的影响以及住院医师福利对选择 PGY2 交流项目的影响。 方法 2023 年 3 月,向 199 位美国卫生系统药剂师协会 PGY2 交流项目的住院医师项目主任(RPDs)发放了电子问卷。要求住院医师项目主任将问卷和提醒邮件转发给他们目前的 PGY2 AC 住院医师。问卷包括分类问题、李克特问题、开放式问题和人口统计学问题。问卷结果采用描述性统计方法进行分析。 结果 共有 72 名住院医师回复了问卷,回复率为 27%。平均年龄为 26 (±1.30) 岁,69% 为女性,57% 在城市地区执业。在参加 ASHP Match 之前,影响选择的前三个因素是项目文化、住院医师积极的士气以及住院医师培训部和戒酒师提供的指导。在住院医师实习大约 8-9 个月后,这些因素仍然是影响最大的因素。在家工作或远程工作的能力、完成教学证书课程以及进行远程医疗访问是影响最小的因素。 结论 了解对选择 PGY2 交流项目影响最大的因素为住院医师提供了独特的资源,使他们能够为未来的候选人更好地定位自己的项目。
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引用次数: 0
HIV pre-exposure prophylaxis champion preceptorship training for pharmacists and nurses in the United States 美国药剂师和护士艾滋病毒暴露前预防冠军戒律培训
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-03-06 DOI: 10.1002/jac5.1939
Parya Saberi Pharm.D., MAS, Hoa Su MPH, Julian Mendiola, Cristina Gruta Pharm.D., Erin R. Lutes M.S., Betty Dong Pharm.D., Chris Bositis M.D., Carolyn Chu M.D., M.Sc.

Introduction

Relatively little has been published on human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) training efforts and outcomes among clinicians working at community health centers and safety net clinical settings.

Objectives

This study describes the National Clinician Consultation Center's (NCCC's) PrEP training content development and learning outcomes.

Methods

The training consisted of a multidisciplinary capacity-building program designed to increase PrEP-related clinical knowledge and skills among pharmacy and nursing professionals at community health centers in “Ending the HIV Epidemic” priority jurisdictions. Descriptive statistics were used to report on the results of this training.

Results

Two groups of learners completed the hybrid training program in 2022 (total, N = 50). A comparison of pretraining and posttraining evaluations indicated that, collectively, learners' self-rated knowledge increased across all assessment domains including PrEP eligibility, disparities, laboratory monitoring, medication options and pharmacotherapy decision-making, and delivery of person-centered care. Learners rated the experience favorably, particularly for large group case discussion sessions. Among the 15 learners who completed the 6-month follow-up survey, many indicated an increase in PrEP services as well as additional training of colleagues and clinic staff.

Conclusion

The NCCC's uniquely developed PrEP capacity-building program is a highly acceptable and valuable training program that can help increase PrEP-related clinical knowledge and skills among pharmacy and nursing professionals at community health centers across the United States.

本研究介绍了国家临床医师咨询中心(NCCC)的 PrEP 培训内容开发和学习成果。该培训包括一项多学科能力建设计划,旨在提高 "终结 HIV 流行 "优先辖区内社区卫生中心的药学和护理专业人员的 PrEP 相关临床知识和技能。两组学员于 2022 年完成了混合培训项目(总人数 = 50)。对培训前和培训后的评估结果进行比较后发现,总体而言,学员在所有评估领域(包括 PrEP 资格、差异、实验室监测、用药选择和药物治疗决策以及以人为本的护理服务)的自我评价知识都有所增长。学员们对这次培训给予了很高的评价,尤其是在大型小组案例讨论环节。在完成 6 个月跟踪调查的 15 名学员中,许多人表示 PrEP 服务有所增加,并表示将对同事和诊所员工进行更多培训。NCCC 独特开发的 PrEP 能力建设项目是一项可接受性很高且很有价值的培训项目,可帮助美国各地社区卫生中心的药学和护理专业人员增加 PrEP 相关的临床知识和技能。
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引用次数: 0
Pharmacist certification of drug therapy modification: A survey of pharmacist-reported practices, facilitators, and barriers in Georgia 药剂师对药物治疗调整的认证:佐治亚州药剂师报告的实践、促进因素和障碍调查
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-03-03 DOI: 10.1002/jac5.1938
Rebecca H. Stone Pharm.D., FCCP, Blake R. Johnson Pharm.D., MPH, Devin L. Lavender Pharm.D., Beth Bryles Phillips Pharm.D., FCCP, Chelsea A. Keedy Pharm.D., Russ Palmer Ph.D., Henry N. Young Ph.D., Sharmon P. Osae Pharm.D.
<div> <section> <h3> Introduction</h3> <p>Collaborative drug therapy management (CDTM) allows pharmacists to assess patients, administer medications, manage and adjust medication regimens, and order laboratory tests within a defined protocol. Pharmacist CDTM may aid in preventative care and chronic condition management.</p> </section> <section> <h3> Objectives</h3> <p>The primary objectives were to identify CDTM services provided by pharmacists in the state of Georgia, examine factors associated with the provision of CDTM services, and identify barriers and facilitators to CDTM service provision. The secondary objective was to assess differences in CDTM practice between pharmacists who completed a Registered Pharmacist (R.Ph.)/Doctor of Pharmacy (Pharm.D.), postgraduate year one (PGY1), or postgraduate year two (PGY2) residency.</p> </section> <section> <h3> Methods</h3> <p>Using the Dilman method, this cross-sectional study invited all 134 CDTM-licensed pharmacists in Georgia to complete a 30-min electronic survey. Data included demographics, training, services offered, disease states managed, and perceptions regarding CDTM implementation. Descriptive statistics, Welchs analysis of variance (ANOVA), and chi-square were conducted using SPSS v28.</p> </section> <section> <h3> Results</h3> <p>A total of 36 (26.9%) pharmacists completed the survey. Participants offered a median of three CDTM services. A majority offered medication therapy management (86.1%) and chronic care management (66.7%). A majority offered services for diabetes (58.3%), hyperlipidemia (55.6%), and hypertension (55.6%). There were differences in the mean ranked number of CDTM services offered between R.Ph./Pharm.D. and PGY2 groups (−11.667, <i>p</i> = 0.019), and the mean ranked number of disease states covered between R.Ph./Pharm.D. and PGY1 (−10.990, <i>p</i> = 0.029) and R.Ph./Pharm.D. and PGY2 (−12.640, <i>p</i> = 0.010, adjusted <i>p</i>-value) groups. Reported CDTM facilitators were job requirements, expanding patient care, job satisfaction/personal advancement, and expanding professional practice. Reported challenges were continuing education, clinical/interprofessional concerns, administration issues with the board of pharmacy or individual practice site, and regulations differing from other states.</p> </section> <section> <h3> Conclusion</h3> <p>Of those with CDTM licensure, a majority offer medication therapy management and chronic care management services covering dia
协作药物治疗管理 (CDTM) 允许药剂师评估患者、用药、管理和调整用药方案,并在规定的方案内开具化验单。主要目标是确定佐治亚州药剂师提供的 CDTM 服务,研究提供 CDTM 服务的相关因素,并确定提供 CDTM 服务的障碍和促进因素。次要目标是评估完成注册药剂师(R.Ph.)/药学博士(Pharm.D.)、研究生一年级(PGY1)或研究生二年级(PGY2)住院实习的药剂师在 CDTM 实践中的差异。这项横断面研究采用 Dilman 方法,邀请佐治亚州所有 134 名 CDTM 执业药剂师完成 30 分钟的电子调查。数据包括人口统计学、培训、提供的服务、管理的疾病状态以及对 CDTM 实施的看法。共有 36 名药剂师(26.9%)完成了调查。参与调查者提供的 CDTM 服务中位数为 3 项。大多数人提供药物治疗管理(86.1%)和慢性病护理管理(66.7%)。大多数人提供糖尿病(58.3%)、高脂血症(55.6%)和高血压(55.6%)服务。在博士/药学博士和 PGY2 组之间,所提供 CDTM 服务的平均数量排名存在差异(-11.667,p = 0.019),在博士/药学博士和 PGY1 组之间,所涵盖疾病状态的平均数量排名存在差异(-10.990,p = 0.029),在博士/药学博士和 PGY2 组之间,所涵盖疾病状态的平均数量排名存在差异(-12.640,p = 0.010,调整后的 p 值)。所报告的 CDTM 促进因素包括工作要求、扩大患者护理、工作满意度/个人发展以及扩大专业实践。据报告,面临的挑战包括继续教育、临床/专业间问题、药事委员会或个人执业地点的管理问题以及与其他州不同的法规。研究生培训可帮助药剂师为从事 CDTM 服务做好准备。
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引用次数: 0
2023 update to the American College of Clinical Pharmacy Pharmacotherapy Didactic Curriculum Toolkit 美国临床药剂学院药物治疗教学课程工具包 2023 年更新版
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-02-29 DOI: 10.1002/jac5.1930
Denise M. Kolanczyk Pharm.D., Jessica R. Merlo Pharm.D., Bridget Bradley Pharm.D., Alexander H. Flannery Pharm.D., Ph.D., FCCP, Caitlin M. Gibson Pharm.D., M.Ed., Sarah McBane Pharm.D., FCCP, Julie A. Murphy Pharm.D., FCCP, Jacob M. Noble Pharm.D., MPH, Melissa B. Noble Pharm.D., Hunter M. Patton Pharm.D., Jennifer L. Rosselli Pharm.D., Rebecca H. Stone Pharm.D., FCCP, Krisy-Ann Thornby Pharm.D.

The American College of Clinical Pharmacy (ACCP) Pharmacotherapy Didactic Curriculum Toolkit has been used by colleges and schools of pharmacy as a guide for curricular development and revisions since its inaugural publication in 2009. The toolkit was last revised and updated by the 2019 Publications Committee. The 2023 ACCP Publications Committee was charged with reviewing the 2019 Update to the ACCP Pharmacotherapy Didactic Curriculum Toolkit to determine any necessary revisions/updates. The committee revised tier classifications, shifting the focus of the 2023 toolkit to content within the Pharm.D. curriculum. Multiple literature sources were reviewed to assess conditions for inclusion in the 2023 toolkit, and external feedback was solicited from various practice disciplines. All topics were voted on by a simple majority rule during virtual meetings or by electronic votes. There are a total of 231 topics in the 2023 toolkit, a decrease of 77 (23.2%) from the 2019 edition. Topics in each tier are as follows: 68 as tier 1 (29%), 111 as tier 2 (48%), and 52 as tier 3 (23%). Although some topics were removed completely, others were combined with other line items or revised, which may further minimize curricular overload. Similar to the 2016 and 2019 toolkits, many tier 2 topics remain in the 2023 toolkit, emphasizing the continued need for additional training through postgraduate residencies or fellowships (or “on-the-job” equivalent experiences), board certifications, and various certificate training programs. The 2023 ACCP Pharmacotherapy Didactic Curriculum Toolkit is designed to assist individual faculty and colleges and schools of pharmacy with curricular development and revisions. It will continue to be reviewed every 3 years to identify needed revisions on the basis of the pharmacist's evolving role, advances in therapeutics and pharmacy practice, and changes to accreditation standards and recognized professional competencies.

美国临床药学院 (ACCP) 药物治疗学教学课程工具包自 2009 年首次出版以来,一直被各药学院用作课程开发和修订的指南。该工具包最近一次由 2019 年出版委员会进行了修订和更新。2023 年 ACCP 出版委员会负责审查 2019 年更新的 ACCP 药理学教学课程工具包,以确定任何必要的修订/更新。委员会修订了层级分类,将 2023 年工具包的重点转移到药学博士课程的内容上。委员会查阅了多种文献资料,以评估纳入 2023 年工具包的条件,并从各实践学科征集外部反馈意见。所有主题均在虚拟会议上以简单多数原则或电子投票方式进行表决。2023 年工具包中共有 231 个主题,比 2019 年版减少了 77 个(23.2%)。各层次的主题如下:68 个为第 1 层(29%),111 个为第 2 层(48%),52 个为第 3 层(23%)。虽然一些主题被完全删除,但其他主题与其他细列项目合并或进行了修订,这可能会进一步减少课程负担。与 2016 年和 2019 年的工具包类似,2023 年的工具包中保留了许多二级主题,强调了通过研究生住院医师或研究员(或 "在职 "同等经历)、委员会认证和各种证书培训计划进行额外培训的持续需求。2023 年 ACCP 药物治疗学教学课程工具包旨在协助个别教师和药学院进行课程开发和修订。它将继续每 3 年审查一次,以便根据药剂师不断发展的角色、治疗学和药学实践的进步以及认证标准和公认专业能力的变化来确定所需的修订。
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引用次数: 0
Securing administrative leadership commitment for anticoagulation stewardship programs 确保行政领导对抗凝血管理计划的承诺
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-02-20 DOI: 10.1002/jac5.1936
Jori E. May M.D., Darren M. Triller Pharm.D., Lauren Inglis Pharm.D., MBA, Anne E. Rose Pharm.D., Vicky DiLorenzo-Agramonte MSN, Allison E. Burnett Pharm.D., Glen T. Schumock Pharm.D., MBA, Ph.D., Scott Kaatz D.O., Geoffrey D. Barnes M.D., M.Sc, Jack E. Ansell M.D.

Anticoagulation is a leading cause of medication-related harm. As a result, there is increasing recognition of the importance of the development of anticoagulation stewardship programs to ensure safe and effective anticoagulation use across health care settings. Securing administrative leadership support to build such programs is a necessary first step but is often a significant barrier to implementation. Herein, we present a structured approach to guide providers advocating to leadership for stewardship programs at their institutions. We divide the approach into four phases: (1) Build the foundation, (2) Select stewardship initiatives, (3) Develop implementation plans, and (4) Prepare and present a business plan. Within each phase, we outline specific actions to consider, all leading up to the end goal of creating a compelling business plan to generate administrative leadership buy-in. We also provide resources to promote the understanding of institutional needs as well as broader trends across health systems that influence stewardship program development. Our aim is to provide stewardship advocates with the tools to effectively secure leadership support to facilitate the development of Anticoagulation Stewardship Programs across all health care institutions.

抗凝是造成药物相关伤害的主要原因。因此,越来越多的人认识到制定抗凝管理计划的重要性,以确保在各种医疗机构中安全有效地使用抗凝药物。获得行政领导的支持以建立此类计划是必要的第一步,但往往会成为实施的重大障碍。在此,我们提出了一种结构化方法,以指导医疗服务提供者向领导层宣传其所在机构的管理计划。我们将该方法分为四个阶段:(1)建立基础;(2)选择监管计划;(3)制定实施计划;(4)准备并提交业务计划。在每个阶段中,我们都会概述需要考虑的具体行动,所有这些行动都是为了实现最终目标,即制定一份令人信服的业务计划,以获得行政领导层的支持。我们还提供资源,以促进对机构需求的了解,以及对影响监管项目发展的整个医疗系统的更广泛趋势的了解。我们的目标是为抗凝管理倡导者提供有效确保领导层支持的工具,以促进所有医疗机构抗凝管理计划的发展。
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引用次数: 0
Integrating clinical pharmacists into transitions of care: A qualitative study of barriers and facilitators among federally qualified health centers 将临床药剂师纳入护理过渡:联邦合格医疗中心的障碍与促进因素定性研究
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-02-17 DOI: 10.1002/jac5.1927
Ben C. D. Weideman M.S., Katie M. White EdD, MBA, Joel F. Farley Ph.D., Lindsay A. Sorge Pharm.D., MPH, Swetha Pradeep Pharm.D., Athena Cannon Pharm.D., Kim Tran Pharm.D., Deborah L. Pestka Pharm.D., Ph.D.

Background

Comprehensive medication management (CMM) is a service provided by clinical pharmacists. CMM aims to optimize pharmacotherapy outcomes by ensuring patients' medications are indicated, effective, safe, and patients are able to adhere to the prescribed medication regimen and take the medications as intended. The goal of CMM is to optimize patients' medications to ensure they are meeting their medication and health-related goals.

Objective

The objective of this project is to evaluate facilitators and barriers to integrating CMM during transitions of care (ToC) at Federally Qualified Health Centers (FQHCs).

Design

Semistructured qualitative interviews were conducted with 22 key informants identified through purposive sampling at three FQHCs. Interviews were coded and analyzed deductively using a modified Consolidated Framework for Implementation Research (CFIR) adapted for ToC.

Key Results

Thirty-nine codes were identified across all CFIR constructs, including the addition of a new construct, “Patient characteristics.” Major facilitators included the perceived advantage and feasibility of the intervention, standardization of ToC processes, and organizational buy-in. Major barriers included health information technology system limitations, communication barriers with discharge facilities, technical and staffing challenges in applying criteria to identify patients for CMM, and low patient throughput.

Conclusions

Identifying early-stage barriers and facilitators are key to maximize facilitators and address barriers to support successful implementation. The findings of this work are being used to guide project adaptations to better integrate CMM into the ToC processes.

综合药物管理 (CMM) 是由临床药剂师提供的一项服务。CMM 旨在通过确保患者用药的适应症、有效性和安全性,并确保患者能够坚持按处方用药和按计划服药,从而优化药物治疗效果。本项目旨在评估在联邦合格医疗中心(FQHC)的护理过渡(ToC)过程中整合 CMM 的促进因素和障碍。我们在三家联邦合格医疗中心通过有目的的抽样确定了 22 位关键信息提供者,并对他们进行了半结构化定性访谈。访谈采用为 ToC 修改的实施研究综合框架(CFIR)进行编码和演绎分析。在所有 CFIR 结构中确定了 39 个编码,包括新增的 "患者特征 "结构。主要的促进因素包括干预措施的优势和可行性、ToC 流程的标准化以及组织的支持。主要障碍包括医疗信息技术系统的限制、与出院设施的沟通障碍、应用标准识别 CMM 患者的技术和人员挑战,以及患者吞吐量低。这项工作的结果将用于指导项目调整,以便更好地将 CMM 纳入 ToC 流程。
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引用次数: 0
Factors associated with attaining a pharmacy residency interview: A scoping review 获得药学住院医师资格面试的相关因素:范围审查
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-02-15 DOI: 10.1002/jac5.1929
Suzanne Whitten Pharm.D., Beth Bryles Phillips Pharm.D., FCCP, Sharmon P. Osae Pharm.D., Rebecca H. Stone Pharm.D., FCCP, Chelsea A. Keedy Pharm.D., Blake R. Johnson Pharm.D., MPH, Amber Prentiss MLIS, Devin L. Lavender Pharm.D.

Postgraduate pharmacy residencies are essential in preparing graduates for pharmacy careers. Residencies are highly competitive and despite efforts to increase the number of residency programs in the United States, the demand still outweighs the supply. Attaining a residency interview is a critical step in securing a residency position. The objective of this scoping review is to describe the published literature on factors associated with attaining a pharmacy residency interview. The updated Arksey and O'Malley scoping review framework was followed for this scoping review. The review is reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR). The search strategy contained a combination of medical subject headings (MeSH) and keywords from a review of article title and abstracts. The inclusion and exclusion criteria were created a priori. English language studies describing pharmacy residency interview, selection, rubrics, and descriptive, quantitative, or qualitative data were included. Title and abstracts were independently reviewed, followed by independent full-text reviews. Covidence©, an online systematic review platform, was used in the screening, review, and selection process. Thirteen studies assessing factors associated with a residency interview met inclusion criteria. The majority of these studies (n = 7) analyzed data from residency program director (RPD) surveys. Most of these studies found that RPDs highly value letters of recommendation when evaluating a candidate's application. Three studies analyzed retrospective data. Several studies focused on letters of recommendation. The studies described letters of recommendation, letters of intent, grade point average, and leadership experience as factors associated with attaining a residency interview. Most studies had limitations in generalizability, study design, and heterogeneous data.

药学研究生实习对于培养毕业生从事药学职业至关重要。住院实习竞争激烈,尽管美国努力增加住院实习项目的数量,但仍然供不应求。获得住院实习面试机会是获得住院实习职位的关键一步。本范围综述旨在描述已发表的与获得药学住院医师面试机会相关因素的文献。本范围界定综述遵循最新的 Arksey 和 O'Malley 范围界定综述框架。本综述根据《系统综述和元分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews,PRISMA-ScR)进行报告。检索策略包括医学主题词表(MeSH)以及文章标题和摘要中的关键词。事先制定了纳入和排除标准。包括描述药学住院医师面试、选拔、评分标准以及描述性、定量或定性数据的英文研究。对文章标题和摘要进行独立审阅,然后对全文进行独立审阅。在线系统综述平台 Covidence© 用于筛选、综述和选择过程。有 13 项评估住院医生面试相关因素的研究符合纳入标准。其中大部分研究(n = 7)分析了住院实习项目主任(RPD)调查的数据。这些研究大多发现,住院实习项目主任在评估候选人的申请时非常重视推荐信。三项研究分析了回顾性数据。有几项研究的重点是推荐信。这些研究将推荐信、意向书、平均成绩和领导经验描述为与获得住院医师面试机会相关的因素。大多数研究在可推广性、研究设计和数据异质性方面存在局限性。
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引用次数: 0
Impact of internal medicine pharmacists on antimicrobial stewardship 内科药剂师对抗菌药物管理的影响
Q4 PHARMACOLOGY & PHARMACY Pub Date : 2024-02-14 DOI: 10.1002/jac5.1926
Ashley Rizzo Pharm.D., Sujit Suchindran MD, MPH, Benjamin Albrecht Pharm.D., Nicole L. Metzger Pharm.D.

Introduction

Increased demands on infectious diseases (ID) pharmacists and providers may result in targeted antimicrobial stewardship (AMS) interventions. Internal medicine (IM) pharmacists frequently intervene on antimicrobials for their patients during general clinical care, although little is known regarding their overall impact on AMS.

Objective

Characterize AMS interventions made by IM pharmacists to identify areas of AMS that can be expanded to patients not covered by ID teams.

Methods

This was a prospective, dual-center, cross-sectional study where IM pharmacists, and their trainees were recruited to document routinely made AMS interventions that happened during daily patient care activities. These interventions were classified based on infection source, stewardship intervention type, whether recommendations were accepted or rejected by providers, and any barriers incurred during the implementation of interventions.

Results

Four IM pharmacists documented 386 interventions from February 2021 through May 2021. Physicians accepted pharmacist interventions 95.6% of the time. The most common interventions were for respiratory (n = 87, 22.5%), genitourinary (n = 80, 20.7%), and skin and skin structure infections (n = 65, 16.8%). The antimicrobials that IM pharmacists most frequently intervened on were vancomycin (n = 89, 23.1%) and ceftriaxone (n = 68, 17.6%). The most common interventions that were made were dose adjustment (n = 105, 27.2%), shortened duration of therapy (n = 86, 22.3%), and intravenous (IV) to oral (PO) conversions (n = 38, 9.8%). Of the 17 interventions not accepted, the most common barrier to implementation was physician concerns (n = 11, 52.4%), which were primarily associated with IV to PO recommendations (n = 7, 63.6%).

Conclusion

IM pharmacists participate in AMS for their patients and intervene frequently to adjust dosing for antimicrobials, shorten duration of therapy, and facilitate IV to PO conversions. IM pharmacists could serve as AMS extenders where additional AMS coverage is needed.

对传染病(ID)药剂师和医疗服务提供者的要求越来越高,这可能会导致有针对性的抗菌药物管理(AMS)干预措施。本研究是一项前瞻性、双中心、横断面研究,招募了内科药剂师及其受训人员,以记录日常患者护理活动中的常规抗菌药物管理干预措施。这些干预措施根据感染源、监管干预类型、医疗服务提供者是否接受或拒绝建议以及干预措施实施过程中遇到的任何障碍进行分类。从 2021 年 2 月到 2021 年 5 月,四名 IM 药剂师记录了 386 项干预措施。95.6%的情况下,医生接受了药剂师的干预措施。最常见的干预措施是呼吸道感染(87 人,22.5%)、泌尿生殖系统感染(80 人,20.7%)以及皮肤和皮肤结构感染(65 人,16.8%)。IM 药剂师最常干预的抗菌药物是万古霉素(89 人,23.1%)和头孢曲松(68 人,17.6%)。最常见的干预措施是调整剂量(n = 105,27.2%)、缩短疗程(n = 86,22.3%)以及将静脉注射(IV)改为口服(PO)(n = 38,9.8%)。在未被接受的 17 项干预措施中,最常见的实施障碍是医生的顾虑(11 人,52.4%),这主要与静脉注射转为口服药物的建议有关(7 人,63.6%)。IM 药剂师参与患者的 AMS,并经常进行干预,以调整抗菌药物的剂量、缩短疗程并促进静脉注射转为口服药物。IM 药剂师可在需要额外 AMS 覆盖范围时充当 AMS 扩展者。
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Journal of the American College of Clinical Pharmacy : JACCP
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