A prospective intervention study to identify drug-related emergency department visits comparing a standard care group and a pharmaceutical care group.

IF 3.1 4区 医学 Q1 EMERGENCY MEDICINE
European Journal of Emergency Medicine Pub Date : 2024-02-01 Epub Date: 2023-08-25 DOI:10.1097/MEJ.0000000000001070
Benjamin J Hellinger, André Gries, Susanne Schiek, Yvonne Remane, Thilo Bertsche
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引用次数: 0

Abstract

Background and importance: Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions.

Objective: The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support.

Design/setting/participants: This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related.

Outcome measures and analysis: The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated.

Main results: A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25-Q75) 63.5-83.5] and took 7 [(Q25-Q75) 5-8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25-Q75) 66-83] and number of drugs taken was 9 [(Q25-Q75) 5.25-11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35-5.38). An intervention on the patient's pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group.

Conclusion: In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.

一项前瞻性干预研究,旨在对标准护理组和药物护理组进行比较,以确定与药物有关的急诊就诊情况。
背景和重要性:药物不良反应是一个沉重的负担。这些药物不良反应可能会导致患者住院治疗,但在急诊科(ED)往往无法正确识别。临床药剂师虽然没有被常规使用,但可以帮助识别药物不良反应:主要目的:与没有额外支持的标准组相比,在有临床药师加入急诊科团队的制药组中检查急诊科就诊的药物关联性:这项前瞻性干预研究在德国莱比锡一家三级甲等大学医院的急诊室进行。研究对象包括年龄≥50 岁的患者。从 2020 年 3 月 1 日至 2020 年 5 月 31 日,患者被纳入标准组。2021 年 3 月 1 日至 2021 年 5 月 31 日,药物组患者入组。临床药剂师为急诊室团队提供支持,为患者提供详细的用药史和药物分析。两组患者均需评估其急诊就诊是否与药物有关:结果测量和分析:比较两组患者在急诊室就诊时发现的与药物相关的次数。主要结果:标准组共有 798 名患者,药物组共有 827 名患者。在标准组中,因药物引起急诊就诊的患者的中位年龄为 77 岁[(Q25-Q75)63.5-83.5],服用 7 种[(Q25-Q75)5-8]药物。药物组的中位年龄为 78 岁[(Q25-Q75) 66-83],服药次数为 9 次[(Q25-Q75) 5.25-11]。标准组中有 31 例(3.9%)与药物有关的急诊就诊,而药物组中则有 104 例(12.6%)(OR 3.56;95% CI 2.35-5.38)。在标准组中,16 例与药物相关的急诊就诊中对患者的药物治疗进行了干预,而在药物组中则有 77 例:结论:在这项研究中,临床药剂师的加入有助于提高对与药物相关的急诊就诊的识别率。与标准护理组相比,药剂组的停药率和剂量减少率明显更高。
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来源期刊
CiteScore
3.60
自引率
27.30%
发文量
180
审稿时长
6-12 weeks
期刊介绍: The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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