Enhanced Continuity of Pharmacy Care for Cardiovascular or Pulmonary Diseases

描述（由申请人提供）：用于治疗心血管或肺部疾病或糖尿病的药物是由于次优治疗或药物不良事件（ADE）导致住院和急诊的最常见原因。住院设置和社区设置之间缺乏沟通和协调，导致这些问题。ADE发生在25%的非卧床患者中，可能导致老年人17%的住院率。建议扩大药剂师的作用，以减少ADE。以前的研究检查了住院和社区药剂师之间的信息传递，样本量小，不包括初级保健医生，也没有评估沟通对ADE，住院或计划外访视的影响。研究中的这些信息缺口需要得到解决，以确定改善治疗和减少ADE的最佳策略。本申请的主要目的是测试提供药房病例管理器以：1）在入院和出院时核对药物，2）增加患者理解，3）提供出院后药物使用随访，以及4）增加与社区医生和药剂师的出院药物计划沟通是否会减少选定心血管或肺部疾病或糖尿病患者的ADE。这是一项随机、前瞻性研究，旨在评价加强药房护理连续性对治疗适当性、ADE、住院或计划外访视的影响。大学医院收治的患者（n = 1000）将被随机分配到对照组、最小干预组或强化干预组。对于强化干预组，医院药剂师病例管理员将提供：1）入院用药史，2）出院总结和患者教育，3）将出院总结数据传输给社区医生和药剂师，4）出院后3-5天的电话随访，以及5）与社区医生和药剂师的沟通和建议。最小干预组将接受：1）入院用药史，2）出院总结和教育。这项研究将是有史以来对ADE及其预防进行的最全面的描述之一。这种干预很有可能通过减少药物相关问题高风险老年患者的ADE负担来影响患者护理。

DESCRIPTION (provided by applicant): Drugs used to treat cardiovascular or pulmonary diseases, or diabetes are the most frequent causes of hospitalizations and emergency department visits due to suboptimal therapy or adverse drug events (ADEs). The lack of communication and coordination between the inpatient setting and the community setting contributes to these problems. ADEs occur in 25% of ambulatory patients and may cause 17% of hospital admissions among the elderly. Expanded roles for pharmacists have been suggested to reduce ADEs. Previous studies that examined information transfer between inpatient and community pharmacists had small sample sizes, did not include the primary care physician, nor did they evaluate the effect of the communication on ADEs, hospitalizations or unscheduled visits. These information gaps in the research need to be addressed in order to identify optimal strategies to improve therapy and reduce ADEs. The primary objective of this application is to test whether providing a pharmacy case manager to: 1) reconcile medications on admission and discharge, 2) increase patient understanding, and 3) provide post-discharge follow-up of medication use, and 4) increasing communication of discharge medication plans to community physicians and pharmacists will reduce ADEs in patients with selected cardiovascular or pulmonary diseases or diabetes. This will be a randomized, prospective study to evaluate the impact of enhanced continuity of pharmacy care on appropriateness of therapy, ADEs, hospitalizations or unscheduled visits. Patients (n = 1000) admitted to the university hospital will be randomized to a control, minimal intervention or enhanced intervention group. For the enhanced intervention group, a hospital pharmacist case manager will provide: 1) an admission medication history, 2) a discharge summary and patient education, 3) transfer of discharge summary data to the community physician and pharmacist, 4) telephone follow-up 3-5 days post-discharge, and 5) communication and recommendations to the physician and pharmacist in the community. The minimal intervention group will receive: 1) the admission medication history, and 2) a discharge summary and education. The study will be one of the most comprehensive characterizations of ADEs and their prevention ever conducted. There is a high probability that this intervention can impact patient care by reducing the burden of ADEs in older patients who are at high risk for medication-related problems.