Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs (IPITCH Study)
Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs (IPITCH Study)
复制标题
DOI：
10.1002/jhm.2493
复制
发表时间：
2016-01-01
影响因子：
2.6
通讯作者：
Postelnick, Michael
中科院分区：
文献类型：
--
作者：
Phatak, Arti;Prusi, Rachael;Postelnick, Michael
研究背景既往数据表明，药剂师通过药物核对、出院咨询和出院后电话与患者直接互动，减少了药物不良事件（ADE）的数量，并在过渡期护理中发挥了总体积极作用。以前的研究已经评估了药剂师参与改善过渡期护理，但这些研究没有包括多个出院后随访电话。结论本研究的目的是评估药剂师参与过渡期护理的影响，通过减少用药错误（ME）和ADE来衡量，通过医院消费者对医疗保健提供者和系统的评估（HCAHPS）评分的改善来衡量患者对药物沟通的了解，和30天的全因住院再入院和急诊科（艾德）visits. METHODS这是一项前瞻性、随机、单周期纵向研究，发生在2012年11月至2013年6月的城市、三级、学术医疗中心。入组2个指定内科单位接受高风险药物治疗或出院时接受3种以上处方药治疗的患者进行随机化。对照组接受常规的医院护理标准。研究组在第3、14和30天接受面对面的药物核对、患者特定的药物护理计划、出院咨询和出院后电话咨询，以提供教育和评估研究终点。最终分析包括278例患者，其中对照组141例，研究组137例。对照组中有55例患者（39%）在出院后30天内再次住院或接受艾德访视，而研究组中有34例患者（24.8%）（P=0.01）。对照组18例（12.8%）患者发生ADE或ME，研究组11例（8%）患者发生ADE或ME（P>0.05）。在研究期间的HCAHPS评分显示，9%的改善评估问卷域（P>0.05）。CONCLUSIONSSThis study demonstrated，药剂师参与出院过渡护理有积极的影响，减少复合住院再入院和艾德访问。未观察到药物相关事件和HCAHPS评分的统计学显著差异。中度复杂的药物治疗方案的患者受益于护理过渡期间涉及药房团队的连续性护理。医院医学杂志2016;11：39-44。(c)2015年医院医学学会
BACKGROUNDPrevious data suggest that direct pharmacist interaction with patients through medication reconciliation, discharge counseling, and postdischarge phone calls decreases the number of adverse drug events (ADEs) and plays an overall positive role in transitional care. Previous studies have evaluated pharmacist involvement in improving transitional care, but these studies did not include multiple postdischarge follow-up phone calls.OBJECTIVESThe objectives of this study were to assess the impact of pharmacist involvement in transitions of care as measured by decreased medication errors (MEs) and ADEs, patients' knowledge related to communication about their medications as measured by improvement in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and 30-day all-cause inpatient readmissions and emergency department (ED) visits.METHODSThis was a prospective, randomized, single-period longitudinal study that occurred from November 2012 through June 2013 at an urban, tertiary, academic medical center. Patients admitted to 2 designated internal medicine units on high-risk medications or with greater than 3 prescription medications upon discharge were included for randomization. The control group received the usual hospital standard of care. The study group received face-to-face medication reconciliation, a patient-specific pharmaceutical care plan, discharge counseling, and postdischarge phone calls on days 3, 14, and 30 to provide education and assess study endpoints.RESULTSA total of 278 patients were included in the final analysis, with 141 in the control group and 137 in the study group. Fifty-five patients (39%) in the control arm experienced an inpatient readmission or ED visit within 30-days postdischarge compared to 34 patients (24.8%) in the study arm (P=0.01). Eighteen patients (12.8%) in the control group experienced an ADEs or MEs compared to 11 patients (8%) in the study group (P>0.05). The HCAHPS scores during the study period showed a 9% improvement for the assessed questionnaire domain (P>0.05).CONCLUSIONSThis study demonstrated that pharmacist involvement in hospital discharge transitions of care had a positive impact on decreasing composite inpatient readmissions and ED visits. Statistically significant difference in medication-related events and HCAHPS scores were not observed. Patients with moderately complex medication regimens benefited from a continuity of care involving a pharmacy team during transitions in care. Journal of Hospital Medicine 2016;11:39-44. (c) 2015 Society of Hospital Medicine