Enhanced Continuity of Pharmacy Care for Cardiovascular or Pulmonary Diseases

描述(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最常见的住院和急诊科就诊原因，原因是治疗效果不佳或药物不良事件(ADE)。住院环境和社区环境之间缺乏沟通和协调是造成这些问题的原因之一。ADS发生在25%的门诊患者中，可能导致17%的老年人住院。有人建议扩大药剂师的角色，以减少ADE。以前研究住院患者和社区药剂师之间的信息传递的研究样本量较小，没有包括初级保健医生，也没有评估沟通对ADE、住院或计划外就诊的影响。需要解决研究中的这些信息差距，以便确定改进治疗和减少不良反应的最佳策略。该应用程序的主要目标是测试提供一名药房病例经理来：1)协调入院和出院时的用药情况，2)增加患者对药物使用的理解，3)提供用药情况的出院后跟踪，以及4)增加向社区医生和药剂师传达出院用药计划是否将减少选定的心血管或肺部疾病或糖尿病患者的不良反应。这将是一项随机的前瞻性研究，旨在评估加强药房护理的连续性对治疗、ADE、住院或计划外就诊的适当性的影响。住进大学医院的患者(n=1000)将被随机分为对照组、最小干预组或强化干预组。对于强化干预组，医院药剂师案例经理将提供：1)入院用药史；2)出院总结和患者教育；3)向社区医生和药剂师传输出院总结数据；4)出院后3-5天电话随访；以及5)向社区医生和药剂师沟通和建议。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不良反应及其预防进行的最全面的表征之一。这种干预很可能会通过减轻老年患者的ADE负担来影响患者的护理，这些患者存在与药物相关的问题的高风险。

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.