V. Silvari , E.K. Crowley , M. Carey , S. Robertson , S. McCarthy
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Inclusion criteria were primary research studies where the purpose of the study was any hospital ASP intervention applicable to optimising antithrombotic drug use, across all anticoagulation medications and in adult hospital inpatients.</p></div><div><h3>Results</h3><p>A total of 787 records were identified after duplicates were removed. Twenty-eight papers were included in this review. Twenty-four of these studies were single-centre studies; four of these studies were multi-centre studies. Eleven studies took a prospective approach, fifteen took a retrospective approach and two were quasi-experimental studies. Interventions implemented by either multidisciplinary ASP teams or pharmacist-led anticoagulation services included the provision of education to healthcare professionals and patients, undertaking medication reviews and implementing guidelines and protocols, and interventions to facilitate transitions of care. Clinical benefits to patients and cost savings were observed across many studies.</p></div><div><h3>Conclusion</h3><p>Implementing multidisciplinary ASP teams and pharmacist-led anticoagulation services is associated with an overall improvement in the safe use of anticoagulation among hospital patients. 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引用次数: 0
摘要
背景抗凝药物的使用非常复杂，容易出现影响患者安全的不当处方。本综述旨在根据抗凝论坛的抗凝管理核心要素，检索和综合有关抗凝管理计划（ASP）的临床和经济价值的现有研究。方法使用三个数据库（Cochrane 对照试验中央注册数据库 (CENTRAL)、Embase 和 PubMed）进行了全面的电子文献检索，检索时间从开始到 2023 年 1 月（含 2023 年 1 月）。纳入标准是研究目的是适用于优化抗血栓药物使用的任何医院 ASP 干预措施的主要研究，包括所有抗凝药物和成人住院患者。本综述共收录了 28 篇论文。其中 24 篇为单中心研究，4 篇为多中心研究。其中 11 项研究采用了前瞻性方法，15 项采用了回顾性方法，2 项为准实验研究。由多学科 ASP 团队或药剂师主导的抗凝服务所实施的干预措施包括：为医护人员和患者提供教育、进行用药审查、实施指南和协议，以及采取干预措施促进护理工作的过渡。结论实施多学科 ASP 团队和药剂师主导的抗凝服务与医院患者安全使用抗凝药物的整体改善相关。已确定的研究包含了 ASP 的一些核心要素，但仍有必要开展进一步的工作和研究，以规范 ASP 的采用和实施，并确保其在医护人员、医疗环境、医疗系统和政策制定者中得到优先考虑。
Value of hospital anticoagulation stewardship programme: A systematic review
Background
The use of anticoagulant medications is complex and prone to inappropriate prescribing that impacts patient safety. Anticoagulation stewardship is a growing field that requires more focus and attention.
Aim
This review aimed to retrieve and synthesise the available research studies on the clinical and economic value of Anticoagulation Stewardship Programmes (ASPs) in line with the Anticoagulation Forum Core Elements of Anticoagulation Stewardship.
Methods
A comprehensive electronic literature search was conducted using three databases (Cochrane Central Register of Controlled Trials (CENTRAL), Embase and PubMed) from inception up to and including January 2023. Inclusion criteria were primary research studies where the purpose of the study was any hospital ASP intervention applicable to optimising antithrombotic drug use, across all anticoagulation medications and in adult hospital inpatients.
Results
A total of 787 records were identified after duplicates were removed. Twenty-eight papers were included in this review. Twenty-four of these studies were single-centre studies; four of these studies were multi-centre studies. Eleven studies took a prospective approach, fifteen took a retrospective approach and two were quasi-experimental studies. Interventions implemented by either multidisciplinary ASP teams or pharmacist-led anticoagulation services included the provision of education to healthcare professionals and patients, undertaking medication reviews and implementing guidelines and protocols, and interventions to facilitate transitions of care. Clinical benefits to patients and cost savings were observed across many studies.
Conclusion
Implementing multidisciplinary ASP teams and pharmacist-led anticoagulation services is associated with an overall improvement in the safe use of anticoagulation among hospital patients. Studies identified incorporated some of the core elements of ASP, however further work and research are necessary to standardise the adoption and implementation of ASP and ensure that it is prioritised among healthcare professionals, in the healthcare setting, and among health systems and policy-makers.
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