■围手术期舞台是一个独特而具有挑战性的环境,需要协调复杂的过程和整个护理团队的参与。药剂师的实践范围已经发展到以患者为中心,并扩展到包括围手术期在内的各种环境。
■要进行批判性评估,合成,并提供了药剂师主导的干预措施对围手术期临床重要结局的特征和影响的现有证据。
■系统评价和荟萃分析。
■我们搜索了PubMed,Embase,和CINAHL从指数开始到2023年9月。纳入的研究比较了药剂师主导的干预措施对临床重要结果的有效性(例如,住院时间,再入院)与围手术期常规护理相比。两名独立审稿人使用DEPICT-2(药剂师干预表征工具的描述性要素)提取数据,并使用CroweCriticalAssessment(CCAT)进行质量评估。使用随机效应模型以95%置信区间(CI)估计总体效应[二分的比值比(OR)和连续数据的标准平均差(SMD)]。
■25项研究符合资格,20(80%)的研究设计不受控制。在围手术期,大多数干预措施是多成分且连续的。干预部分包括临床药学服务(如药物管理/优化、药物和解,出院咨询)和医疗保健专业人员的教育。虽然一些研究对干预的发展和过程进行了较小的描述,只有一项研究报告了干预发展的理论基础。汇总分析显示,与常规护理相比,药剂师护理对住院时间(11项研究;SMD-0.09;95%CI-0.49至-0.15)和全因再入院(8项研究;OR0.60;95%CI0.39-0.91)具有显着影响。大多数纳入的研究(n=21;84%)质量中等。
■药剂师主导的干预措施可有效改善围手术期的临床重要结局;然而,大多数研究质量中等。研究缺乏利用理论来发展干预措施;因此,目前尚不清楚基于理论的干预措施是否比没有理论因素的干预措施更有效。未来的研究应优先考虑开发和评估针对整个外科护理途径的多方面理论知情的药剂师干预措施。
药剂师活动对围手术期临床结果的影响为什么要进行这项研究?手术前后的时间会给患者的健康带来重大风险。虽然程序的技术方面很重要,应将其与提供最佳医疗保健质量相结合,以增加获得预期临床结果的可能性.药剂师是有效的医疗团队成员,他们有可能改善围手术期患者的预后。因此,探索临床药师在这些环境中的作用和影响势在必行。到目前为止,没有关于药剂师在围手术期的作用和有效性的文献综述。研究人员做了什么?我们旨在总结和评估关于围手术期药师活动对临床结局的影响和特点的证据质量。检查了三个图书馆数据库,以确定符合纳入条件的研究。两位作者提取了数据并评估了纳入研究的质量。统计分析用于观察药剂师干预对不同终点的成功。研究人员发现了什么?共包括25项研究。大多数药剂师活动包括多个组成部分(例如药物管理和教育其他医疗保健提供者),并且跨越了整个围手术期。对纳入研究的分析表明,药剂师的活动减少了住院时间,并减少了患者出院后返回医院的次数。大多数研究没有讨论发展药剂师活动所采用的方法。发现是什么意思?许多药剂师活动类型被证明可以成功减少住院时间和再入院发作。未来研究的新方向应该从结构和过程方面研究药剂师主导的干预措施的发展,以确保这些干预措施的可重复性。
UNASSIGNED: The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists\' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings.
UNASSIGNED: To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings.
UNASSIGNED: A systematic review and meta-analysis.
UNASSIGNED: We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of
pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs).
UNASSIGNED: Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of
pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality.
UNASSIGNED: Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.
The impact of pharmacist activities on clinical outcomes in perioperative settings Why was the study done? The time around the surgery imposes significant risks to patient’s health. While technical aspects of a procedure are important, it should be combined with the provision of optimal healthcare quality to increase the likelihood of desired clinical outcomes. Pharmacists are effective healthcare team members who have the potential to improve patient’s outcomes in the perioperative settings. It is hence imperative to explore the roles and impact of clinical pharmacists in these settings. Thus far, there is no synthesis of literature regarding the
pharmacist roles and effectiveness in the perioperative setting. What did the researchers do? We aimed to summarize and appraise the quality of evidence on the characteristics and impact of pharmacist activities on clinical outcomes in the perioperative settings. Three library databases were examined to identify studies eligible for inclusion. Two authors extracted data and assessed the quality of included studies. Statistical analysis was used to look at the success of the pharmacist interventions on different endpoints. What did the researchers find? A total of 25 studies were included. Most pharmacist activities consisted of multiple components (such as medication management and educating other healthcare providers) and spanned the whole perioperative journey. The analysis of included studies showed that pharmacist activities reduced the elapsed time in hospital and the number of times a patient winds up going back to a hospital after discharge. Most studies did not discuss the methods adopted to develop
pharmacist activities. What do the findings mean? A number of pharmacist activity types were shown to be successful in reducing the duration of hospitalization and readmission episodes. New directions for future research should investigate the development of
pharmacist-led interventions in terms of structure and processes to ensure the reproducibility of these interventions.