Role of pharmacist counseling in preventing adverse drug events after hospitalization
Role of pharmacist counseling in preventing adverse drug events after hospitalization
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DOI：
10.1001/archinte.166.5.565
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发表时间：
2006-03-13
影响因子：
--
通讯作者：
Bates, DW
中科院分区：
文献类型：
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作者：
Schnipper, JL;Kirwin, JL;Bates, DW
背景：住院和出院后往往涉及护理的中断、用药方案的多次改变和患者教育的不足，这些都可能导致药物不良事件（ADEs）和可避免的医疗保健利用。我们的目的是确定住院期间和住院后的药物相关问题，并确定患者咨询和药剂师随访对可预防的ade的影响。方法：我们对某大型教学医院普通内科出院的178例患者进行了随机试验。干预组患者出院时接受药师咨询，3 ~ 5天后电话随访。干预措施侧重于阐明药物治疗方案；审查药物的适应症、方向和潜在的副作用；筛查依从性障碍和早期副作用；并在适当的时候提供患者咨询和/或医生反馈。主要观察指标为可预防ade发生率。结果：药师观察到干预组存在以下药物相关问题：49%的患者入院前用药方案与出院用药单不一致，29%的患者出院用药清单与出院后用药方案不一致，23%的患者服药不遵医嘱。对比出院后30天的试验结果，对照组和干预组分别有11%和1%的患者检测到可预防的ade (P=。01)。在总不良事件或总医疗保健利用方面，两组间无差异。结论：药师用药回顾、患者咨询和电话随访与出院后30天可预防ade发生率降低相关。出院前后用药差异是常见的干预目标。
Background: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs.Methods: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs.Results: Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P=. 01). No differences were found between groups in total ADEs or total health care utilization.Conclusions: Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.