Effects of Pharmacist Participation in Intensive Care Units on Clinical and Economic Outcomes of Critically Ill Patients with Thromboembolic or Infarction-Related Events
Effects of Pharmacist Participation in Intensive Care Units on Clinical and Economic Outcomes of Critically Ill Patients with Thromboembolic or Infarction-Related Events
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DOI：
10.1592/phco.29.7.761
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发表时间：
2009-07-01
期刊：
影响因子：
4.1
通讯作者：
Bond, C. A.
中科院分区：
文献类型：
--
作者：
MacLaren, Robert;Bond, C. A.
Objective.评估临床药师参与治疗发生血栓栓塞或梗死相关事件（TIE）的危重医疗保险患者对临床和经济结局的影响。在这项回顾性数据库审查（2004年9月1日至2005年8月31日）中，从2004年扩展的改良医疗保险提供者分析和审查数据库中检索患者数据。评估的结果数据包括死亡率、重症监护室（ICU）住院时间、医疗保险总费用、药物和实验室费用以及出血并发症发生率。此外，还评估了与出血并发症（输血、死亡率）相关的结局。将有临床药学服务的ICU患者结局与无这些服务的ICU患者结局进行比较。临床药学服务被定义为由专门致力于ICU的药剂师提供的直接患者护理服务;其他服务，如订单处理或药物分发不属于这些服务的一部分。ICU药房服务的描述是从2004年的全国调查中获得的。我们确定了141，079例TIE患者，其中7987例也有出血并发症。在具有ICU临床药学服务的医院中，仅TIE和TIE伴出血并发症患者的死亡率分别比具有临床药学服务的ICU高37%（比值比[OR] 1.41，95%置信区间[CI] 1.36-1.46）和31%（OR 1.35，95% CI 1.13-1.61）。ICU住院时间延长14.8%（平均+/- SD 7.28 +/- 8.17 vs 6.34 +/- 7.80天，p
Objective. To assess the effects of clinical pharmacist participation in the care of critically ill Medicare patients with thromboembolic or infarction-related events (TIE) on clinical and economic outcomes.Methods. In this retrospective database review (September 1, 2004-August 31, 2005), patient data were retrieved from the 2004 Expanded Modified Medicare Provider Analysis and Review database. Outcomes data evaluated included mortality rates, length of intensive care unit (ICU) stay, total Medicare charges, drug and laboratory charges, and rates of bleeding complications. In addition, outcomes related to the bleeding complications (transfusions, mortality rate) were assessed. Patient outcomes in ICUs with clinical pharmacy services were compared with patient outcomes in ICUs without these services. Clinical pharmacy services were defined as direct patient care services provided by a pharmacist specifically devoted to the ICU; other services such as order processing or drug distribution were not part of these services. A description of ICU pharmacy services was obtained from a 2004 national survey.Results. We identified 141,079 patients with TIE, of whom 7987 also had bleeding complications. In hospitals with ICU clinical pharmacy services, mortality rates in patients with TIE only and TIE with bleeding complications were higher by 37% (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.36-1.46) and 31% (OR 1.35, 95% CI 1.13-1.61), respectively, than in ICUs with clinical pharmacy services. Lengths of ICU stay were longer by 14.8% (mean +/- SD 7.28 +/- 8.17 vs 6.34 +/- 7.80 days, p