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（ADEs）而住院和急诊就诊的最常见原因。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。25%的门诊患者发生ade， 17%的老年人住院。建议扩大药剂师的作用以减少ade。先前的研究检查了住院病人和社区药剂师之间的信息传递，样本量小，没有包括初级保健医生，也没有评估沟通对不良事件、住院或计划外就诊的影响。为了确定改善治疗和减少不良反应的最佳策略，需要解决研究中的这些信息差距。本应用程序的主要目的是测试提供药房病例管理器是否能够：1)调和入院和出院时的药物，2)增加患者的理解，3)提供出院后药物使用的随访，以及4)增加与社区医生和药剂师的出院药物计划沟通，从而减少特定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、前瞻性研究，以评估增强药房护理连续性对治疗适宜性、不良事件、住院或计划外就诊的影响。入读大学医院的患者（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)将出院总结数据传递给社区医生和药剂师，4)出院后3-5天的电话随访，5)与社区医生和药剂师沟通并提出建议。最小干预组将收到：1)入院用药史；2)出院总结和教育。该研究将是迄今为止对ADEs及其预防进行的最全面的描述之一。这种干预措施很有可能通过减轻药物相关问题高风险的老年患者的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.