目标:对有特殊医疗保健需求和医疗复杂性的儿童和青少年的护理协调(CYSHCN-CMC),尤其是药物管理,对提供者来说很难,父母/照顾者,和病人。本报告描述了在儿科长期护理机构(pLTCF)中创建临床药物治疗实践,应用标准操作程序指导全面用药管理(CMM),并建立合作实践协议(CPA)以指导药物治疗。
方法:在前瞻性病例系列中,在9个月的时间内,将102例以CYSHCN-CMC为特征的患者纳入pLTCF质量改善项目。
结果:药剂师确定,阻止,或解决了1355个药物治疗问题(DTP),平均每位患者进行13次干预。患者平均有9.5种复杂的慢性疾病,中位住院时间为2815天(7.7年)。由于药剂师评估和建议而停用的最常见药物包括苯海拉明,沙丁胺醇,磷酸钠灌肠,异丙托溴铵,还有甲氧氯普胺.每位患者的平均药物数量从23减少到20。对244种干预措施的药物经济学分析显示,每月可节省$44,304(每位患者每月$434)的直接费用,每月可避免$48,835(每位患者每月$479)。避免了28次急诊就诊/入院以及61次诊所和紧急护理就诊。再入院率降低了44%。药剂师的建议有98%的接受率。
结论:使用CPA在CYSHCN-CMC中进行CMM降低了药物负担,已解决,并预防不良事件,降低医疗保健相关成本,降低了医院再入院率,并与pLTCF提供者合作得到了广泛接受和实施。
OBJECTIVE: Care coordination for children and youth with special health care needs and medical complexity (CYSHCN-CMC), especially medication management, is difficult for providers, parents/caregivers, and -patients. This report describes the creation of a clinical pharmacotherapy practice in a pediatric long-term care facility (pLTCF), application of standard operating procedures to guide comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy.
METHODS: In a prospective
case series, 102 patients characterized as CYSHCN-CMC were included in this pLTCF quality improvement project during a 9-month period.
RESULTS: Pharmacists identified, prevented, or resolved 1355 drug therapy problems (DTP) with an average of 13 interventions per patient. The patients averaged 9.5 complex chronic medical conditions with a -median length of stay of 2815 days (7.7 years). The most common medications discontinued due to pharmacist assessment and recommendation included diphenhydramine, albuterol, sodium phosphate enema, ipratropium, and metoclopramide. The average number of medications per patient was reduced from 23 to 20. A pharmacoeconomic analysis of 244 of the interventions revealed a monthly direct cost savings of $44,304 ($434 per patient per month) and monthly cost avoidance of $48,835 ($479 per patient per month). Twenty-eight ED visits/admissions and 61 clinic and urgent care visits were avoided. Hospital -readmissions were reduced by 44%. Pharmacist recommendations had a 98% acceptance rate.
CONCLUSIONS: Use of a CPA to conduct CMM in CYSHCN-CMC decreased medication burden, resolved, and prevented adverse events, reduced health care-related costs, reduced hospital readmissions and was well-accepted and implemented collaboratively with pLTCF providers.