Use of a drug-related problem oriented medical record in the medication review of critically ill patients – Randomized clinical trial

IF 3.7 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Research in Social & Administrative Pharmacy Pub Date : 2025-01-23 DOI:10.1016/j.sapharm.2025.01.010

Tâmara Natasha Gonzaga de Andrade Santos , Givalda Mendonça da Cruz Macieira , Rafaella de Oliveira Santos Silva , Giselle de Carvalho Brito , Sabrina Joany Felizardo Neves , Mônica Thaís Ferreira Nascimento , Fernando de Castro Araújo Neto , Alessandra Rezende Mesquita , Divaldo Pereira de Lyra , Alfredo Dias de Oliveira Filho

{"title":"Use of a drug-related problem oriented medical record in the medication review of critically ill patients – Randomized clinical trial","authors":"Tâmara Natasha Gonzaga de Andrade Santos , Givalda Mendonça da Cruz Macieira , Rafaella de Oliveira Santos Silva , Giselle de Carvalho Brito , Sabrina Joany Felizardo Neves , Mônica Thaís Ferreira Nascimento , Fernando de Castro Araújo Neto , Alessandra Rezende Mesquita , Divaldo Pereira de Lyra , Alfredo Dias de Oliveira Filho","doi":"10.1016/j.sapharm.2025.01.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The identification and reduction of drug-related problems (DRPs) through DRP-oriented medical records during the hospitalization of critically impatients can optimize health indicators, such as length of hospital stay.</div></div><div><h3>Objective</h3><div>To determine the effect of medical records focused on drug-related problems on the duration of stay for patients in intensive care units.</div></div><div><h3>Method</h3><div>A randomized controlled clinical trial was conducted with patients assigned to intervention or the usual care groups involving clinical pharmacists. This trial occurred between March 2018 and March 2019 and was completed in two intensive care units within two hospitals in Brazil. Exploratory secondary outcomes included the mortality rate and reductions in Sequential Organ Failure Assessment (SOFA) and Δ SOFA scores.</div></div><div><h3>Results</h3><div>A total of 150 patients participated—54.6 % were women, most being white (77.3 %). Further, the main diagnosis was Acute Coronary Syndrome (22.6 %), followed by Congestive Heart Failure (12.6 %) and Heart Failure (10 %). A significant difference was observed in the length of stay between the intervention group and the control group, respectively 7.08 days (±4.38) and 10.7 days (±6.32). Among the secondary outcomes, a significant difference was observed in the mortality rates between the two groups: (6.58 %) in the intervention group and 25.68 % in the control group. Regarding Δ SOFA, the intervention group exhibited a reduction of 4.63 in the SOFA score during hospitalization. The control group showed an increase of 1.88 in the score during the same period.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the use of Diagnoses - Adverse Clinical Findings - Medications (DAM), a medical record model aimed at resolving drug-related problems, reduced the length of hospital stay and mortality rates among patients. Furthermore, this model proved to be more effective than the usual care provided by clinical pharmacists.</div></div>","PeriodicalId":48126,"journal":{"name":"Research in Social & Administrative Pharmacy","volume":"21 4","pages":"Pages 268-276"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research in Social & Administrative Pharmacy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1551741125000105","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The identification and reduction of drug-related problems (DRPs) through DRP-oriented medical records during the hospitalization of critically impatients can optimize health indicators, such as length of hospital stay.

Objective

To determine the effect of medical records focused on drug-related problems on the duration of stay for patients in intensive care units.

Method

A randomized controlled clinical trial was conducted with patients assigned to intervention or the usual care groups involving clinical pharmacists. This trial occurred between March 2018 and March 2019 and was completed in two intensive care units within two hospitals in Brazil. Exploratory secondary outcomes included the mortality rate and reductions in Sequential Organ Failure Assessment (SOFA) and Δ SOFA scores.

Results

A total of 150 patients participated—54.6 % were women, most being white (77.3 %). Further, the main diagnosis was Acute Coronary Syndrome (22.6 %), followed by Congestive Heart Failure (12.6 %) and Heart Failure (10 %). A significant difference was observed in the length of stay between the intervention group and the control group, respectively 7.08 days (±4.38) and 10.7 days (±6.32). Among the secondary outcomes, a significant difference was observed in the mortality rates between the two groups: (6.58 %) in the intervention group and 25.68 % in the control group. Regarding Δ SOFA, the intervention group exhibited a reduction of 4.63 in the SOFA score during hospitalization. The control group showed an increase of 1.88 in the score during the same period.

Conclusion

This study demonstrated that the use of Diagnoses - Adverse Clinical Findings - Medications (DAM), a medical record model aimed at resolving drug-related problems, reduced the length of hospital stay and mortality rates among patients. Furthermore, this model proved to be more effective than the usual care provided by clinical pharmacists.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Research in Social & Administrative Pharmacy PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.20

自引率

10.30%

发文量

225

审稿时长

47 days

期刊介绍： Research in Social and Administrative Pharmacy (RSAP) is a quarterly publication featuring original scientific reports and comprehensive review articles in the social and administrative pharmaceutical sciences. Topics of interest include outcomes evaluation of products, programs, or services; pharmacoepidemiology; medication adherence; direct-to-consumer advertising of prescription medications; disease state management; health systems reform; drug marketing; medication distribution systems such as e-prescribing; web-based pharmaceutical/medical services; drug commerce and re-importation; and health professions workforce issues.