背景:哮喘和慢性阻塞性肺疾病患者依靠吸入治疗来降低疾病进展和恶化风险。如果出院时的吸入器治疗不符合当前指南和/或负担得起,则入院的患者恶化和再入院的风险增加。
目的:根据临床实践指南和保险范围,评估慢性吸入器方案对住院患者的适当性。
方法:一项子研究旨在分析单中心队列,务实,在大型学术医学中心进行的前瞻性随机对照试验。包括与药剂师一起接受药物服务并处方长效吸入器的患者。随机接受药剂师主导干预的参与者根据临床指南和患者保险评估吸入器的适当性。本子研究的目的是评估根据药剂师的审查确定为不合适的吸入器的数量。如果患者的任何吸入器与指南建议不一致或不在保险范围内,则认为患者的吸入器方案不适当。使用描述性统计来表征适当的吸入器使用。
结果:研究药剂师回顾了针对348例患者的552种独特的吸入器。总的来说,42%的吸入器是不合适的,影响50.3%的参与者。20%的吸入器基于保险是不合适的,根据指导方针,26%的人是不合适的,根据这两个标准,7%是不合适的。通过药房咨询对198名患者(57%)提出了建议,大多数建议使用吸入器(55%),其次是吸入器停药(38%)。
结论:由药剂师主导的对住院患者的慢性吸入治疗的回顾发现,在超过一半的患者中,有必要根据财务或临床指南改变治疗方式。需要增加处方吸入器的适当性的干预措施,以减少疾病进展和疾病恶化。
BACKGROUND: Patients with asthma and chronic obstructive pulmonary disease rely on inhaler therapy to reduce disease progression and exacerbation risk. Patients admitted to the hospital are at an increased risk for exacerbations and readmission if their inhaler therapy upon discharge is not aligned with current guidelines and/or affordable.
OBJECTIVE: Assess the appropriateness of the chronic inhaler regimen for patients admitted to the hospital based on clinical practice guidelines and insurance coverage.
METHODS: A sub-study was designed to analyze a cohort of a single-center, pragmatic, prospective randomized controlled trial at a large academic medical center. Patients admitted to a medicine service with a pharmacist and prescribed a long-acting inhaler were included. Participants randomized to a pharmacist-led intervention were assessed for inhaler appropriateness based on clinical guidelines and patient insurance. The objective of this sub-study is to assess the number of
inhalers identified as inappropriate based on the pharmacist\'s review. A patient was considered to have an inappropriate inhaler regimen if any of their
inhalers were inconsistent with guideline recommendations or not covered by insurance. Descriptive statistics were used to characterize appropriate inhaler use.
RESULTS: The study pharmacist reviewed 552 unique
inhalers for 348 patients. Overall, 42% of
inhalers were inappropriate, affecting 50.3% of participants. 20% of
inhalers were inappropriate based on insurance, 26% were inappropriate based on guidelines, and 7% were inappropriate based on both criteria. Recommendations were placed via a pharmacy consult for 198 patients (57%), most recommending an inhaler initiation (55%), followed by inhaler discontinuation (38%).
CONCLUSIONS: A pharmacist-led review of chronic inhaler therapy for patients admitted to the hospital identified the need for a change in therapy based on financial or clinical guidelines in over half of the patients reviewed. Interventions to increase the appropriateness of prescribed
inhalers are needed to reduce disease progression and disease exacerbation.