PDF(Pubmed)
Abstract：
Patients with schizophrenia often experience symptoms such as poor insight and disorganized thought, which limit their ability to seek and receive care consistently. In rural settings, systemic factors, including limited resources and transportation, further contribute to difficulties in health care access. Long-acting injectable antipsychotics (LAIs) can improve medication adherence and reduce hospitalizations from relapse. Opportunities exist for pharmacists to provide individualized care and improved health care access. The pilot service took place in ambulatory care clinics and home care settings. Pharmacists performed weekly reviews of patients with active orders for LAIs, coordinated care with nonadherent patients, and offered follow-up appointments in the Patient Centered Medical Home (PCMH). For patients unable to be reached, outreach pharmacists provided psychiatric assessment and LAI medication administration at home visits. There were 10 patients with LAI prescriptions in the past year selected for review. The period reviewed was 90 days before and after start of service. Pharmacist interventions resulted in 4 patients reestablished with care who were previously lost to follow-up. The percentage of days covered by LAI fills increased from an average 26% to 67% of days covered (P = .06). Total emergency room visits related to mental health episodes decreased from 11 to 2 visits (P = .03). Four patients who did not have metabolic lab monitoring in more than 1 year received lab monitoring as indicated. PCMH pharmacy services, including home visits by outreach pharmacists, may improve access and bridge care gaps for patients on LAIs by providing community-based services in addition to traditional clinic-based care.
摘要：
精神分裂症患者经常会出现洞察力差和思想混乱等症状，这限制了他们始终如一地寻求和接受护理的能力。在农村环境中，系统性因素，包括有限的资源和运输，进一步加剧了获得医疗保健的困难。长效注射抗精神病药（LAIs）可以提高药物依从性并减少复发的住院。药剂师有机会提供个性化护理和改善医疗保健。试点服务在门诊护理诊所和家庭护理环境中进行。药剂师每周对LAIs的患者进行检查，与非粘附患者的协调护理，并在以患者为中心的医疗中心（PCMH）提供随访预约。对于无法接触到的患者，外展药剂师在家访时提供精神病评估和LAI药物管理。在过去的一年中，有10名LAI处方患者被选中进行审查。审查的期限为开始服务前后90天。药剂师干预导致4名以前失去随访的患者恢复了护理。LAI填充所覆盖的天数百分比从平均26%增加到67%(P=.06)。与心理健康事件相关的急诊室就诊总数从11次减少到2次（P=0.03）。超过1年未进行代谢实验室监测的4名患者接受了实验室监测。PCMH药房服务，包括外展药剂师的家访，除了传统的诊所护理外，还可以通过提供基于社区的服务来改善LAI患者的获取和弥合护理差距。
