Impact of a Pharmacist-Facilitated Hospital Discharge Program A Quasi-Experimental Study
Impact of a Pharmacist-Facilitated Hospital Discharge Program A Quasi-Experimental Study
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DOI：
10.1001/archinternmed.2009.398
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发表时间：
2009-11-23
影响因子：
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通讯作者：
Flanders, Scott A.
中科院分区：
文献类型：
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作者：
Walker, Paul C.;Bernstein, Steven J.;Flanders, Scott A.
背景资料：出院时用药差异很常见，可能导致不良事件、再入院和急诊室就诊。我们的目标是表征药物治疗的差异在医院出院和测试的影响，药剂师的干预对医疗保健利用率以下discharge.Methods：我们采用了前瞻性的，交替月准实验设计，比较结果的患者接受干预（n = 358）与对照组（n = 366）。所有患者均出院回家，出院后药物相关问题的风险较高，因为他们处方的药物数量或类型，住院期间多次药物变化或药物管理问题。干预措施包括药物治疗评估、药物协调、依从性问题筛查、患者咨询和教育以及出院后电话随访。主要结果是14天和30天的再入院率以及出院后72小时内的急诊就诊率。结果：33.5%的干预组患者和59.6%的对照组患者出院时发现用药差异（P <0.001）。尽管干预组在出院前所有的差异都得到了解决，但在14天时，两组之间的再入院率没有显著差异（12.6% vs 1.1.5%; P = 0.65）和30天（22.1%对18%; P = .17），急诊室就诊率也没有（分别为2.8%和2.2%; P = 0.60）。虽然我们的干预措施通过识别和协调出院时的用药差异来提高患者出院质量，但对出院后医疗保健资源利用没有影响。
Background: Medication discrepancies are common at hospital discharge and can result in adverse events, hospital readmissions, and emergency department visits. Our objectives were to characterize medication discrepancies at hospital discharge and test the effects of a pharmacist intervention on health care utilization following discharge.Methods: We used a prospective, alternating month quasi-experimental design to compare outcomes of patients receiving the intervention (n = 358) with controls (n = 366). All patients were discharged to home and were at high risk for medication-related problems following discharge because of the number or types of medications they were prescribed, multiple medication changes during hospitalization, or problems managing medications. The intervention consisted of medication therapy assessment, medication reconciliation, screening for adherence concerns, patient counseling and education, and postdischarge telephone follow-up. The primary outcomes were 14-day and 30-day readmission rates and emergency department visits within 72 hours of discharge. Medication discrepancies occurring at discharge were also characterized.Results: Medication discrepancies at discharge were identified in 33.5% of intervention patients and 59.6% of control patients (P < .001). Although all discrepancies were resolved in the intervention group prior to discharge, readmission rates did not differ significantly between groups at 14 days (12.6% vs 1.1.5%; P = .65) and 30 days (22.1% vs 18%; P = .17), nor did emergency department visits (2.8% vs 2.2%, respectively; P = .60).Conclusion: While our intervention improved the quality of patient discharge by identifying and reconciling medication discrepancies at discharge, there was no effect on postdischarge health care resource utilization.