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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge
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Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge

机译：药剂师通过在医院放电后通过综合药物管理确定药剂师的药物治疗问题

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Background: Pharmacists influence health care outcomes through the identification and resolution of drug therapy problems (DTPs). Objective: The objectives of this study were to describe number, type, and severity of DTPs based on clinical significance and likelihood of harm in patients transitioning from hospital to home as assessed during a comprehensive medication management (CMM) visit with a pharmacist. Secondary objectives were to assess intrarater reliability in severity ratings and assess likelihood of harm for adverse drug reactions (ADR) by drug classes. Methods: Retrospective review of 408 patients having a face-to-face, telephonic, or virtual CMM visit within the Fairview Health System. Teams of 3 investigators reviewed each DTP from the electronic medical record for each of the 408 patients and assigned a severity score (0-10) for clinical significance and likelihood of harm. Main Results: The highest severity DTP classes were adherence and ADR. The lowest severity DTP class was unnecessary drug therapy. An average of 2.5 DTPs was found per patient at the index CMM visit following hospital discharge. The most common DTP classes were needs additional therapy and dose too low. There were statistically significant differences in DTP severity scoring between reviewer types, though differences were <5%. Drug classes with the highest severity ADR included diabetes, cardiovascular, and anticoagulant/antiplatelet agents. Conclusions: The DTP severity ratings indicated that reviewers found ADR and adherence DTPs were potentially the most severe. There were differences in DTP ratings between reviewer types, though clinical significance of these differences is unclear.
机译：背景：药品专家通过鉴定和解决药物治疗问题（DTP）来影响医疗保健结果。目的：本研究的目的是根据临床意义和患者伤害的临床意义和患者的伤害似然，在综合药剂师（CMM）访问中评估的临床意义和伤害患者的伤害可能性。次要目标是评估严重程度评级的内在可靠性，并评估药物课程对不良药物反应（ADR）的伤害可能性。方法：在孔法卫生系统中对面对面，电话或虚拟CMM访问的408名患者的回顾性审查。 3个调查人员的团队从408名患者中的每一个审查了每种DTP，并为临床意义和伤害可能性分配了严重性评分（0-10）。主要结果：最严重的DTP类是遵守和ADR。最严重的DTP类是不必要的药物治疗。在医院放电后指数CMM访问，每位患者发现平均每位患者2.5 DTP。最常见的DTP类需要额外的治疗和剂量太低。审阅者类型之间的DTP严重性评分存在统计学意义差异，但差异分别<5％。具有最高严重性ADR的药物课程包括糖尿病，心血管和抗凝血剂/抗血管涂层剂。结论：DTP严重程度评级表明，审阅者发现ADR和粘附DTP可能是最严重的。审稿人类型之间的DTP评级存在差异，尽管这些差异的临床意义尚不清楚。

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