The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization.
The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization.
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DOI：
10.1016/j.cct.2021.106419
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发表时间：
2021-07
影响因子：
2.2
通讯作者：
Schnipper JL
中科院分区：
文献类型：
--
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
老年人在住院后通常面临着理解、获得、管理和监测药物治疗方案的挑战。这些困难可能导致可避免的发病率、死亡率和再次入院。药师主导的出院前后干预可以减少药物不良事件，但很少有大型随机试验研究其在减少再入院方面的有效性。证明减少30天的再入院可以为在医院实施药剂师主导的项目提供财政支持。PHARMacist出院护理或PHARM-DC干预包括入院和出院时的药物核对，药物审查，增加与护理人员，提供者和零售药店的沟通，以及出院期间和出院后的患者教育和咨询。这项干预措施正在两家大医院实施：雪松-西奈医疗中心和布里格姆妇女医院。为了评估干预措施，我们使用务实的随机临床试验设计，在患者层面进行随机化。主要结局是出院后30天内的利用率，包括意外的急诊室访视、观察停留和再入院。将9，776例患者随机分组，将达到80%的把握度，以检测相对于估计基线发生率27.5%的绝对降低2.5%。定性分析将使用与关键利益相关者的访谈来研究实施PHARM-DC的障碍和促进因素。使用时间和运动研究来估计花费在干预上的时间的成本效益分析将突出每次再入院的潜在成本节省。如果这项试验证明了PHARM-DC干预的商业案例，并且实施障碍很少，医院可能更有可能采用药剂师领导的出院前药物管理计划。ClinicalTrials.gov标识符：NCT 04071951
Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals. The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. The intervention is being implemented in two large hospitals: Cedars-Sinai Medical Center and the Brigham and Women’s Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30 days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9,776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission. If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs. ClinicalTrials.gov Identifier: NCT04071951
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影响因子：
7.2
作者：
Halfon, P;Eggli, Y;Burnand, B
通讯作者：
Burnand, B
影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3
作者：
Feigenbaum, Paul;Neuwirth, Estee;Bellows, Jim
通讯作者：
Bellows, Jim
影响因子：
5.7
作者：
Forster, AJ;Murff, HJ;Bates, DW
通讯作者：
Bates, DW