Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach
Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach
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DOI：
10.2215/cjn.01420213
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发表时间：
2013-11-07
影响因子：
9.8
通讯作者：
Mehrotra, Rajnish
中科院分区：
文献类型：
--
作者：
Pai, Amy Barton;Cardone, Katie E.;Mehrotra, Rajnish
与一般医疗保险人群相比，接受透析的终末期肾病患者的药物治疗方案非常复杂，总护理成本也高得不成比例。多项研究表明，依赖透析的患者出现药物相关问题的风险特别高。提供药物协调和治疗管理服务对于避免与药物相关问题（例如 ESRD 人群的药物不良事件和住院治疗）相关的费用至关重要。 2003 年《医疗保险现代化法案》包括一项无资金资助的授权，规定向参加医疗保险 D 部分的高风险患者提供药物治疗管理。药物管理服务不同于药物配发，涉及对所有疾病状态的完整药物审查。透析设施是药物管理服务（如药物治疗管理）的逻辑协调中心，并且它可能是患者在护理过渡后前往的第一个医疗保健设施。需要一名专门且训练有素的临床医生（例如药剂师）来提供一致、高质量的药物管理服务。能够一致、系统地识别和解决药物相关问题的药物协调和药物管理服务可能会改善 ESRD 患者的治疗结果并降低总护理成本。在此，这项工作回顾了以透析设施为中心的模型中为 ESRD 患者提供最佳药物管理服务的现有证据和建议。
Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.