以中小型医院预防感染的额外报销为指标,评估医院药剂师的活动。

IF 1.2 Q4 PHARMACOLOGY & PHARMACY
Yuichi Tasaka, Takeshi Uchikura, Shiro Hatakeyama, Daisuke Kikuchi, Masami Tsuchiya, Ryohkan Funakoshi, Taku Obara
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引用次数: 0

摘要

背景:日本医院通过获得 1 类或 2 类感染预防额外报销(ARIP),建立了 2018 至 2021 财年的医疗服务体系。然而,与医院药剂师实践相关的 ARIP 申请结果研究却很少:本研究利用日本医院药剂师协会于 2020 年对医院药剂部门的状况进行的年度问卷调查数据,以获得 ARIP 为指标,评估了拥有 100-299 张病床的医院药剂师所开展的活动。在调查项目中,本研究使用了与医院功能、床位数、药剂师人数、医院是否纳入诊断程序组合(DPC)系统、平均住院日和工作性质相关的项目进行分析。当相关系数的绝对值在 0-0.2 范围内时,每位药剂师的床位数与药剂师服务的实施情况或平均住院时间之间的关系被认为是不相关的;而当相关系数的绝对值分别在 0.2-0.4、0.4-0.7 或 0.7-1 范围内时,这种关系被认为是弱、中或强相关的:共收到 3612 家医院的回复(回复率:43.6%)。其中,210 家符合 ARIP 1 标准且拥有 100-299 张病床的医院和 245 家符合 ARIP 2 标准且拥有 100-299 张病床的医院被纳入我们的分析范围。药剂师人数存在明显差异,ARIP 1 医院的药剂师人数更多。在药剂师服务方面,我们观察到了明显的差异,ARIP 1 医院在入院前病人的药物管理和指导、注射药物的无菌药物处理和治疗药物监测方面的频率更高。在拥有 ARIP 1(173 家医院)和 ARIP 2(105 家医院)的 DPC 医院中,每名药剂师的平均床位数分别为 21.7 张和 24.7 张,平均住院时间分别为 14.3 天和 15.4 天。此外,在 ARIP 1(R = -0.207)和 ARIP 2(R = -0.279)的 DPC 医院中,"相当好 "或 "经常 "的药剂师服务数量与每位药剂师的床位数之间存在微弱的负相关。此外,在 ARIP 2 医院中,每位药剂师的平均床位数与平均住院时间之间存在微弱的相关性(R = 0.322):我们的研究结果表明,在拥有 ARIP 1 或 2 的 100-299 张床位的 DPC 医院中,每位药剂师的床位数越少,药剂师的服务就越好。促进医院药剂师服务的积极努力以及减少每位药剂师的床位数可能会缩短住院时间,尤其是在以 ARIP 获取作为指标的 ARIP 2 中小型医院。这些发现可能有助于在未来加快医院药剂师参与感染控制的步伐。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of hospital pharmacists' activities using additional reimbursement for infection prevention as an indicator in small and medium-sized hospitals.

Background: Hospitals in Japan established the healthcare delivery system from FY 2018 to 2021 by acquiring an additional reimbursement for infection prevention (ARIP) of category 1 or 2. However, research on outcomes of ARIP applications related to the practice of hospital pharmacists is scarce.

Methods: This study assessed the activities performed by hospital pharmacists in hospitals with 100 to 299 beds, using ARIP acquirement as an indicator, using data from an annual questionnaire survey conducted in 2020 by the Japanese Society of Hospital Pharmacists on the status of hospital pharmacy departments. Out of the survey items, this study used those related to hospital functions, number of beds, number of pharmacists, whether the hospital is included in the diagnosis procedure combination (DPC) system, average length of stay, and nature of work being performed in the analysis. The relationship between the number of beds per pharmacist and state of implementation of pharmacist services or the average length of hospital stay was considered uncorrelated when the absolute value of the correlation coefficient was within 0-0.2, whereas the relationship was considered to have a weak, moderate, or strong correlation when the absolute value ranged at 0.2-0.4, 0.4-0.7, or 0.7-1, respectively.

Results: Responses were received from 3612 (recovery rate: 43.6%) hospitals. Of these, 210 hospitals meeting the criteria for ARIP 1 with 100-299 beds, and 245 hospitals meeting the criteria for ARIP 2 with 100-299 beds, were included in our analysis. There was a significant difference in the number of pharmacists, with a larger number in ARIP 1 hospitals. For the pharmacist services, significant differences were observed, with a more frequency in ARIP 1 hospitals in pharmaceutical management and guidance to pre-hospitalization patients, sterile drug processing of injection drugs and therapeutic drug monitoring. In DPC hospitals with ARIP 1 (173 hospitals) and 2 (105 hospitals), the average number of beds per pharmacist was 21.7 and 24.7, respectively, while the average length of stay was 14.3 and 15.4 d, respectively. Additionally, a weak negative correlation was observed between the number of pharmacist services with "Fairly well" or "Often" and the number of beds per pharmacist for both ARIP 1 (R = -0.207) and ARIP 2 (R = -0.279) DPC hospitals. Furthermore, a weak correlation (R = 0.322) between the average number of beds per pharmacist and the average length of hospital stay was observed for ARIP 2 hospitals.

Conclusions: Our results suggest that lower beds per pharmacist might lead to improved pharmacist services in 100-299 beds DPC hospitals with ARIP 1 or 2. The promotion of proactive efforts in hospital pharmacist services and fewer beds per pharmacist may relate to shorter hospital stays especially in small and medium-sized hospitals with ARIP 2 when ARIP acquisition was used as an indicator. These findings may help to accelerate the involvement of hospital pharmacists in infection control in the future.

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