Design, implementation, and evaluation of a pharmacist-led outpatient benzodiazepine-tapering clinic.
Design, implementation, and evaluation of a pharmacist-led outpatient benzodiazepine-tapering clinic.
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DOI：
10.1016/j.japh.2022.09.025
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发表时间：
2023-01
影响因子：
2.1
通讯作者：
Keller, Michelle S.
中科院分区：
文献类型：
--
作者：
Gregorian, Tania;Bradley, Kristin;Campbell, Scott;Mashburn, Rachel;Beuttler, Richard;Keller, Michelle S.
苯二氮卓类药物通常用于老年人，尽管其风险众所周知。临床药剂师可以领导逐渐减少的努力，利用他们的临床专业知识和减轻时间压力的初级保健提供者。目的是描述门诊药师主导的苯二氮卓类药物减量门诊的设计、实施和评价。该诊所是基于一个社区医疗集团与一个大型学术卫生系统在洛杉矶，加州。该诊所由临床药剂师组成，并由一名精神病医生监督。首次访视包括患者教育、患者驱动的减量时间表设计和病史回顾。后续电话/视频访问用于监测戒断症状并提供支持。我们使用图表回顾来评估参加逐渐减少诊所的患者与未参加的患者之间的逐渐减少状态。我们使用双变量统计比较了两组的结果。从2017年3月到2019年5月，176名患者被转诊到诊所; 17名被认为不合格。在联系的159例患者中，62例患者入组诊所; 97例患者未入组。在门诊患者中，13例（27%）患者逐渐减少，29例（60%）完全逐渐减少，6例（13%）无法逐渐减少，14例（23%）正在逐渐减少。相比之下，在未入组的患者中，3例（4%）患者逐渐减量，15例（20%）完全减量，57例（76%）无法减量，22例（22%）正在减量过程中。90%的患者在入组时至少有一些苯二氮卓类药物逐渐减少，而未入组的患者为41%（p<0.001）。一个药剂师领导的苯二氮卓类药物逐渐减少诊所可以是一个有效的方式来吸引病人的动机逐渐减少。经验教训包括确保转诊提供者在转诊前向患者提供充分咨询的重要性。
Benzodiazepines are commonly used among older adults, despite well-known risks. Clinical pharmacists can lead tapering efforts, leveraging their clinical expertise and relieving time-pressured primary care providers. The objective is to describe the design, implementation, and evaluation of an outpatient pharmacist-led benzodiazepine tapering clinic. The clinic is based within a community medical group associated with a large academic health system in Los Angeles, California. The clinic is staffed by clinical pharmacists and supervised by a psychiatrist. The initial visit consists of patient education, design of patient-driven tapering schedule, and medical history review. Follow-up phone/video visits are used to monitor withdrawal symptoms and provide support. We used chart review to assess tapering status among those enrolled in the tapering clinic versus those who did not enroll. We compared outcomes across the two groups using bivariate statistics. From March 2017- May 2019, 176 patients were referred to the clinic; 17 were deemed ineligible. Of the 159 patients contacted, 62 patients enrolled in the clinic; 97 patients did not enroll. Among patients in the clinic, 13 (27%) of patients were tapered down, 29 (60%) completely tapered off, 6 (13%) were unable to taper, and 14 (23%) were in the process of tapering. In contrast, among patients who did not enroll, 3 (4%) of patients were tapered down, 15 (20%) completely tapered off, 57 (76%) were unable to taper, and 22 (22%) were in the process of tapering. 90% of patients had at least some benzodiazepine tapering when enrolled in the clinic compared to 41% among not enrolled in the clinic (p<0.001). A pharmacist-led benzodiazepine tapering clinic can be an effective way to engage patients motivated to taper down. Lessons learned include the importance of ensuring referring providers adequately counsel patients prior to referral.
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影响因子：
2.2
作者：
Pevnick JM;Keller MS;Kennelty KA;Nuckols TK;Ko EM;Amer K;Anderson L;Armbruster C;Conti N;Fanikos J;Guan J;Knight E;Leang DW;Llamas-Sandoval R;Matta L;Moriarty D;Murry LT;Muske AM;Nguyen AT;Phung E;Rosen O;Rosen SL;Salandanan A;Shane R;Schnipper JL
通讯作者：
Schnipper JL
影响因子：
--
作者：
Kuntz, Jennifer L;Schneider, Jennifer L;Smith, David H
通讯作者：
Smith, David H
影响因子：
2.9
作者：
Keller MS;Truong L;Mays AM;Needleman J;Heilemann MSV;Nuckols TK
通讯作者：
Nuckols TK
DOI：
10.1097/xeb.0000000000000161
发表时间：
2019-06-01
影响因子：
--
作者：
Rowan-Robinson, Kate
通讯作者：
Rowan-Robinson, Kate
影响因子：
3.1
作者：
Whitman, Andrew;DeGregory, Kathlene;Ramsdale, Erika
通讯作者：
Ramsdale, Erika