药剂师与医生发起的入院药物和解:对药物不良事件的影响

Kari A. Mergenhagen PharmD , Sharon S. Blum PharmD , Anne Kugler PharmD , Elayne E. Livote PhD , Jonathan R. Nebeker MS, MD , Michael C. Ott PharmD , Daniel Signor BA , Soojin Sung PharmD , Jessica Yeh PharmD , Kenneth S. Boockvar MD, MS
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引用次数: 58

摘要

药物和解(MR)已被证明是许多医院难以完成的任务。在资源有限的医院环境中,了解医生与药剂师发起的磁共振的临床影响是很重要的。方法本研究于2005年12月至2006年2月在美国一家城市退伍军人事务医院进行。在2个类似的普通医疗单位实施MR:一个接受医生发起的MR,另一个接受药剂师发起的MR,研究药师通过结构化记录回顾确定所有住院患者的药物不良事件(ADEs)和72小时用药风险评分。对多变量模型进行干预效果检验,考虑准实验设计和聚类观察,并对患者和遭遇协变量进行调整。结果102例住院患者中药师完成磁共振检查,116例住院患者中内科医生完成磁共振检查。在完成MR过程中,药剂师记录的入院药物变化统计上多于医生(3.6 vs 0.8;P & lt;0.001)。与内科医生发起的MR相比,由药剂师发起的MR引起的入院处方改变导致ADE的调整几率为1.04,95% CI为0.53至2.0。由药剂师发起的MR与医生发起的MR相比,由处方错误引起的入院处方变更引起ADE的调整几率为0.38,置信区间为0.14至1.05。72小时处方风险评分差异无统计学意义(系数= 0.10;95% CI,−0.54 ~ 0.75)。结论与内科医生相比,药师进行的磁共振检查更全面,因入院处方错误而发生不良事件的几率更低,但所有类型的不良事件的几率相似。有必要进一步研究如何在临床医生之间最佳地分配MR任务,以及MR影响后续ade可能性的机制。ClinicalTrials.gov识别码:NCT00370916。
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Pharmacist- Versus Physician-Initiated Admission Medication Reconciliation: Impact on Adverse Drug Events

Background

Medication reconciliation (MR) has proven to be a problematic task for many hospitals to accomplish. It is important to know the clinical impact of physician- versus pharmacist-initiated MR in the resource-limited hospital environment.

Methods

This quasi-experimental study took place from December 2005 to February 2006 at an urban US Veterans Affairs hospital. MR was implemented on 2 similar general medical units: one received physician-initiated MR and the other received pharmacist-initiated MR. Adverse drug events (ADEs) and a 72-hour medication-prescribing risk score were ascertained by research pharmacists for all admitted patients by structured record review. Multivariable models were tested for intervention effect, accounting for quasi-experimental design and clustered observations, and were adjusted for patient and encounter covariates.

Results

Pharmacists completed the MR process in 102 admissions and physicians completed the process in 116 admissions. In completing the MR process, pharmacists documented statistically more admission medication changes than physicians (3.6 vs 0.8; P < 0.001). The adjusted odds of an ADE caused by an admission prescribing change with pharmacist-initiated MR compared with a physician-initiated MR were 1.04 with a 95% CI of 0.53 to 2.0. The adjusted odds of an ADE caused by an admission prescribing change that was a prescribing error with pharmacist-initiated MR compared with a physician-initiated MR were 0.38 with a confidence interval of 0.14 to 1.05. No difference was observed in 72-hour prescribing risk score (coefficient = 0.10; 95% CI, −0.54 to 0.75).

Conclusion

MR performed by pharmacists versus physicians was more comprehensive and was followed by lower odds of ADEs from admission prescribing errors but with similar odds of all types of ADEs. Further research is warranted to examine how MR tasks may be optimally divided among clinicians and the mechanisms by which MR affects the likelihood of subsequent ADEs. ClinicalTrials.gov identifier: NCT00370916.

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来源期刊
American Journal Geriatric Pharmacotherapy
American Journal Geriatric Pharmacotherapy GERIATRICS & GERONTOLOGY-PHARMACOLOGY & PHARMACY
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