评价三级社区医院药师主导的华法林咨询服务与医师管理的有效性

IF 1.3 Q4 PHARMACOLOGY & PHARMACY
Erik Wasowski, Anne Harris, Taylor Elias
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引用次数: 0

摘要

背景:华法林的使用是复杂的狭窄的治疗窗口,需要密切监测,以防止严重的不良事件。文献表明,药剂师主导的华法林管理改善了患者的预后,缩短了住院时间。本研究评估了最近在克利夫兰诊所卫生系统内的3家医院实施的药剂师驱动的华法林咨询服务的影响。方法:这是一项回顾性的多中心研究,纳入了2023年6月1日至2024年7月31日期间在克利夫兰诊所医院接受至少3剂华法林治疗的64名成年患者。排除标准包括入院时国际标准化比率(INR)升高、阿加曲班使用、活动性癌症或两家管理机构均责令华法林。结果:两组间主要转归,超治疗INR值率无显著差异(P = 0.84)。此外,亚治疗性INR率、24小时内INR≥0.7、出院时治疗性INR、大出血等次要结局无显著差异。然而,药剂师订购初始起始剂量的可能性是医生的两倍。结论:总的来说,在比较药剂师和医生使用华法林的结果时,没有发现显著差异。未来需要更大样本量的研究来探索给药方案的潜在差异及其对显著INR升高率的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating the Effectiveness of a Pharmacist-Driven Warfarin Consult Service Versus Physician Management in a Tertiary Community Hospital.

Background: The use of warfarin is complicated by a narrow therapeutic window, requiring close monitoring to prevent serious adverse events. Literature has shown that pharmacist-led warfarin management improves patient outcomes and decreases hospitalization length of stay. This study assessed the impact of the recently implemented pharmacist-driven warfarin consult service at 3 hospitals within the Cleveland Clinic Health System. Methods: This was a retrospective, multi-centered study which included 64 adult patients admitted to Cleveland Clinic Hospitals between June 1, 2023, and July 31, 2024 who received at least 3 doses of warfarin. Exclusion criteria included an elevated international normalized ratio (INR) upon admission, argatroban use, active cancer, or warfarin ordered by both managing services. Results: The primary outcome, rate of supratherapeutic INR values, did not significantly differ between groups (P = .84). In addition, the secondary outcomes including rate of subtherapeutic INRs, INR ≥0.7 within 24 hours, therapeutic INR at discharge, and major bleeding showed no significant difference. However, pharmacists were twice as likely to order an initial starting dose of <5 mg compared to physicians (62.5% vs 31.3%). In addition, physician-managed patients were observed more frequently for the INR ≥0.7 within 24 hours (11 vs 4 events). Conclusion: Overall, there was not a significant difference found in patient outcomes when comparing pharmacist versus physician warfarin management. Future studies with a larger sample size are needed to explore the potential differences in dosing regimens and its effect on the rate of significant INR elevations.

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来源期刊
Journal of Pharmacy Technology
Journal of Pharmacy Technology PHARMACOLOGY & PHARMACY-
CiteScore
1.50
自引率
0.00%
发文量
49
期刊介绍: For both pharmacists and technicians, jPT provides valuable information for those interested in the entire body of pharmacy practice. jPT covers new drugs, products, and equipment; therapeutic trends; organizational, legal, and educational activities; drug distribution and administration; and includes continuing education articles.
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