中国药剂师干预减少骨科不合理用药的现状

doi:10.5246/jcps.2020.06.035

摘要/Abstract

摘要：

随着药学服务的需求不断增长, 医药保健的作用开始受到重视。在中国, 临床药学的培养和实践工作仍处于探索阶段。本综述旨在讨论药剂师主导的干预措施对减少骨科不适当药物使用的影响。结果显示临床药师可以协助骨科医生和护士在抗生素治疗、疼痛控制和抗凝治疗的各个环节合理使用药物。药师的临床干预措施大大减少用药错误和医疗费用, 但仍需长时间发展药学服务, 提高药师的专业素质和制定中国药师法。

关键词: 药学服务, 骨科, 抗生素, 抗凝血剂, 镇痛

Abstract:

As the demand for pharmaceutical services continues to grow, more and more attention has been paid to the pharmaceuticalcare effect. However, in China, the training pathways and practical work of clinical pharmacy are still in the exploratory stage. In the present review, we aimed to discuss the impact of pharmacist-led interventions in reducing inappropriate drug use in orthopaedics.Results showed clinical pharmacists can assist orthopaedists and nurses in the rational use of medication in all aspects of antibiotictherapy, pain control and anticoagulation therapy. The clinical interventions by pharmacists have greatly reduced medication errors and medical costs. However, there is still a long time to develop pharmacy service, improve the professional quality of pharmacists and enact the Chinese Pharmacist Law.

Key words: Pharmaceutical care, Orthopaedics, Antibiotic, Anticoagulant, Analgesia

中图分类号:

R951

Supporting:

谢程欣, 王维, 黄戈, 金鑫, 王成龙, 尹东. 中国药剂师干预减少骨科不合理用药的现状[J]. 中国药学(英文版), 2020, 29(6): 375-382.

Chengxin Xie, Wei Wang, Ge Huang, Xin Jin, Chenglong Wang, Dong Yin. Pharmacist-led interventions to reduce inappropriate drug use in the orthopaedics department in China[J]. Journal of Chinese Pharmaceutical Sciences, 2020, 29(6): 375-382.

参考文献

[1] Li, J.; Li, Z.P. Differences and similarities in clinical pharmacy practice in China and the United States: a narrative review. Eur. J. Hosp. Pharm. 2018, 25, 2-5.

[2] Xie, C.X.; Mu, X.P.; Hu, Z.M.; Wang, W.; Huang, W.W.; Huang, G.; Wang, C.L.; Yin, D. Impact of pharmaceutical care in the orthopaedic department. J. Clin. Pharm. Ther. 2019, 00, 1-7.

[3] Perlman, A.; Horwitz, E.; Hirsh-Raccah, B.; Aldouby-Bier, G.; Fisher Negev, T.; Hochberg-Klein, S.; Kalish, Y.; Muszkat, M. Clinical pharmacist led hospital-wide direct oral anticoagulant stewardship program. Isr. J. Health. Policy. Res. 2019, 8, 19.

[4] Yang, X.; Zhou, X.; Zhao, Y.; Chu, X. The working mode and effect of clinical pharmacists participating in medication reconciliation service in respiratory department. Chin. J. Med. 2018, 53, 1282-1286.

[5] Farris, K.B.; Carter, B.L.; Xu, Y.H.; Dawson, J.D.; Shelsky, C.; Weetman, D.B.; Kaboli, P.J.; James, P.A.; Christensen, A.J.; Brooks, J.M. Effect of a care transition intervention by pharmacists: an RCT. BMC. Health. Serv. Res. 2014, 14, 406.

[6] Thomas, R.; Huntley, A.L.; Mann, M.; Huws, D.; Elwyn, G.; Paranjothy, S.; Purdy, S. Pharmacist-led interventions to reduce unplanned admissions for older people: a systematic review and meta-analysis of randomised controlled trials. Age. Ageing. 2014, 43, 174-187.

[7] Renaudin, P.; Boyer, L.; Esteve, M.A.; Bertault-Peres, P.; Auquier, P.; Honore, S. Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis. Br. J. Clin. Pharmacol. 2016, 82, 1660-1673.

[8] Renaudin, P.; Coste, A.; Audurier, Y.; Berbis, J.; Canovas, F.; Jalabert, A.; Castet-Nicolas, A.; Mercier, G.; Villiet, M.; Dagneaux, L.; Breuker, C. Clinical, economic, and organizational impact of the clinical pharmacist in an orthopedic and trauma surgery department. J. Patient. Saf. 2018, 10, 25.

[9] Selcuk, A.; Sancar, M.; Okuyan, B.; Demirtunc, R.; Izzettin, F.V. The potential role of clinical pharmacists in elderly patients during hospital admission. Pharmazie. 2015, 70, 559-562.

[10] Cornu, P.; Steurbaut. S.; Leysen, T.; De Baere, E.; Ligneel, C.; Mets, T.; Dupont, A.G. Discrepancies in medication information for the primary care physician and the geriatric patient at discharge. Ann. Pharmacother. 2012, 46, 983-990.

[11] Tran, T.; Taylor, S.E.; Hardidge, A.; Mitri, E.; Aminian, P.; George, J.; Elliott, R.A. The prevalence and nature of medication errors and adverse events related to preadmission medications when patients are admitted to an orthopedic inpatient unit: an observational study. Ann. Pharmacother. 2019, 53, 252-260.

[12] Gjerde, A.M.; Aa, E.; Sund, J.K.; Stenumgard, P.; Johnsen, L.G. Medication reconciliation of patients with hip fracture by clinical pharmacists. Eur. J. Hosp. Pharm. 2016, 23, 166-170.

[13] Weiner, B.K.; Venarske, J.; Yu, M.N.; Mathis, K. Towards the reduction of medication errors in orthopedics and spinal surgery: outcomes using a pharmacist-led approach. Spine. 2008, 33, 104-107.

[14] Liu, Y.; Cui, X.; Liu, L. Medication reconciliation for elderly inpatients in orthopedics department by clinical pharmacists. Chin. J. Hosp. Pharm. 2016, 36, 766-770.

[15] Liu, G.Q.; Tang, Y.H. Review and analysis on 1982 inpatient medical orders in drum tower hospital group of Nanjing Yizheng hospital. Eval. Anal. Drug Use Hosp. China. 2016, 16, 115-117.

[16] Sun, B.; Shi, W.; Li, X.; Liu, G.; Fan, G. Practice of Clinical Pharmacists in the Drug Therapy of Orthopedics Ward. China. Pharmacist. 2018, 21, 875-878.

[17] Shang, D.W. Analysis of perioperative use of Antibacterials on 436 patients in the orthopedics Department of in Handan Central Hospital during the past 4 years. [master]. Hebei. Medical. University. 2017.

[18] Shen, X. The rationality of application of antibiotic prophylaxis in perioperative period in the department of orthopedics surgery. J. Traum. Surg. 2015, 17, 564-565.

[19] de With, K. Antibiotic stewardship: Measures for optimization of antibacterial therapy. Internist (Berl). 2015, 56, 1264-1270.

[20] Li, X.Y.; Chen, H.; Zhu, S.Y.; Liu, Y.; Yang, J.D.; Yuan, Z.; Yao, G.Q.; Qiu, F. Efficacy and feasibility of a collaborative multidisciplinary program for antibiotic prophylaxis in clean wound surgery. Int. J. Clin. Pharm. 2018, 40, 150-159.

[21] Hu, B.; Zhang, J.; Ha, L.; Zhang, C.; Li, X.; Ma, M. Clinical Evaluation of Prophylactic Application of Antibiotics in Hip Replacement in Orthopedics Department of Our Hospital during 2 Years. China Pharmacy. 2014, 25, 1275-1277.

[22] Cao, Y.; Zhang, M.; Fan, Y.; Luo, Z. Sharing of the Participation of Pain Professional Clinical Pharmacists in Pharmaceutical Monitoring of Orthopedic Analgesia. China Pharmacist. 2019, 22, 711-713.

[23] Bian, Y.Y.; Wang, L.C.; Qian, W.W.; Lin, J.; Jin, J.; Peng, H.M.; Weng, X.S. Role of parecoxib sodium in the multimodal analgesia after total knee arthroplasty: a randomized double-blinded controlled trial. Orthop. Surg. 2018, 10, 321-327.

[24] Zhu, N.N.; Xu, P.P.; Lei, T.T.; Sun, T.; Chan, S.W. Postoperative pain self-management behavior in patients who underwent total knee or hip arthroplasty. AORN J. 2017, 105, 355-364.

[25] Sun, Z.; Yan, K.; Yao, H.; Wang, J.L.; Tan, Y.G.; Wu, X.; Liang, L. Investigation on Practice of Pharmaceutical Care Provided by Clinical Pharmacists in Orthopedics Department. China Pharmacy. 2019, 30, 413-416.

[26] Schiek, S.; Hildebrand, C.; Ranft, D.; Dürrbeck, A.; Ghanem, M.; von Salis-Soglio, G.; Frontini, R.; Bertsche, T. A cohort study investigating medication management by pharmacists to prevent drug-related problems in pain therapy. Eur. J. Hosp. Pharm. 2015, 22, 156-160.

[27] Lovecchio, F.; Premkumar, A.; Stepan, J.G.; Albert, T.J. Fighting back: institutional strategies to combat the opioid epidemic: a systematic review. HSS. J. 2019, 15, 66-71.

[28] Smith, D.H.; Kuntz, J.L.; DeBar, L.L.; Mesa, J.; Yang, X.H.; Schneider, J.; Petrik, A.; Reese, K.; Thorsness, L.A.; Boardman, D.; Johnson, E.S. A randomized, pragmatic, pharmacist-led intervention reduced opioids following orthopedic surgery. Am. J. Manag. Care. 2018, 24, 515-521.

[29] Chen, M.; Li, H.; Long, E.; Chen, M. Role of Clinical Pharmacist in Rational Analgesics Use in Perioperative Period of Patients from Orthopedics Department. China Pharmacist. 2018, 21, 2145-2148.

[30] Meng, A.; Xie, H.; Yang, C.; Ge, W. Cost-effectiveness Analysis of two kinds of analgesic regimens in treatment of postoperative pain in orthopedics. China J. Pharm. Eco. 2017, 12, 19-22.

[31] Su, L.; Li, W.F.; Tan, Q.Q.; Zhang, L.J. Study on the relationship between analgesic effect and satisfaction of perioperative pain management in orthopedics. Strait Pharm. J. 2017, 29, 69-71.

[32] Wainwright, T.W.; Immins, T.; Middleton, R.G. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best. Pract. Res. Clin. Anaesthesiol. 2016, 30, 91-102.

[33] Tang, J.; Zhu, W.; Mei, X.L.; Zhang, Z.X. Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty. J. Orthop. Surg. Res. 2018, 13, 8.

[34] Cohen, A.T.; Tapson, V.F.; Bergmann, J.F.; Goldhaber, S.Z.; Kakkar, A.K.; Deslandes, B.; Huang, W.; Zayaruzny, M.; Emery, L.; Anderson, F.A. Jr, ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008, 371, 387-394.

[35] Traumatic, Orthopaedics, Group, OS, CMA. Expert consensus on screening and treatment of deep venous thrombosis in orthopaedic trauma patients. Chin. J. Orthop. Traum. 2013, 15.

[36] Kanchanabat, B.; Stapanavatr, W.; Meknavin, S.; Soorapanth, C.; Sumanasrethakul, C.; Kanchanasuttirak, P. Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis. Br. J. Surg. 2011, 98, 1356-1364.

[37] Song, J.; Ying, M.F.; Yu, Z.W.; Yu, L.Y. Trends and current status of oral anticoagulant use in hospitalized patients in China. Chin. Pharm. J. 2019, 54, 671-674.

[38] Han, F.; Li, Z.; Yang, W. Role of clinical pharmacists in anticoagulant treatment in orthopedic clinical pathways. Cent. South. Pharm. 2017, 15, 1164-1167.

[39] Guo, Y.; You, L.; Wang, J.; Zhang, Y. Analysis of anticoagulant drugs used in surgical inpatients in our hospital in 2013. China Pharmaceuticals. 2015, 24, 65-66.

[40] Heijboer, R.R.O.; Lubberts, B.; Guss, D.; Johnson, A.H.; Moon, D.K.; DiGiovanni, C.W. Venous thromboembolism and bleeding adverse events in lower leg, ankle, and foot orthopaedic surgery with and without anticoagulants. J. Bone. Joint. Surg. Am. 2019, 101, 539-546.

[41] Kim, S.; Ahn, H.; Shin, S.A.; Park, J.H.; Won, C.W. Trends of thromboprophylaxis and complications after major lower limb orthopaedic surgeries in Korea: National Health Insurance Claim Data. Thromb. Res. 2017, 155, 48-52.

[42] Zhou, L.; Wu, X.; Wu, T.; Bei, Y. Exploration and Reflection of Clinical Pharmacists Participating in Antico-agulant Therapy in the Department of Orthopedics. Pharm. Clin. Res. 2016, 24, 83-85.

[43] Fan, H.; Xiang, Q.; Ren, G.; Zhou, Y.; Cui, Y. Evaluation and systematic review of working mode of clinical pharmacists in China. Clin. Medication. J. 2016, 14, 23-29.

[44] Liu, G.L.; Chen, R. Status and role of clinical pharmacists under new medical reform. China Pharm. 2010, 21, 2785-2791.

[45] Chen, Z.H.; Cui, Y.M.; Zhou, Y.; Wang, Z.N.; Ke, Y. Peking university health science center model of clinical pharmacy education and clinical pharmacist services. Chin. Med. J. 2016, 129, 2890-2894.

[46] Rodríguez Vargas, B.; Delgado Silveira, E.; Iglesias Peinado, I.; Bermejo Vicedo, T. Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients. Int. J. Clin. Pharm. 2016, 38, 1164-1171.

[47] Tully, M.P. Prescribing errors in hospital practice. Br. J. Clin. Pharmacol. 2012, 74, 668-675.

[48] Zhou, L.N.; Rupa, A.P. Categorization and association analysis of risk factors for adverse drug events. Eur. J. Clin. Pharmacol. 2018, 74, 389-404.

[49] Komagamine, J.; Sugawara, K.; Kaminaga, M.; Tatsumi, S. Study protocol for a single-centre, prospective, non-blinded, randomised, 12-month, parallel-group superiority study to compare the efficacy of pharmacist intervention versus usual care for elderly patients hospitalised in orthopaedic wards. BMJ Open. 2018, 8, e021924.

[50] Buck, T.C.; Brandstrup, L.; Brandslund, I.; Kampmann, J.P. The effects of introducing a clinical pharmacist on orthopaedic wards in Denmark. Pharm. World. Sci. 2007, 29, 12-18.

[51] Graabaek, T.; Kjeldsen, L.J. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin. Pharmacol. Toxicol. 2013, 112, 359-373.

[52] Mo, J.; Huang, K.M.; Wang, X.M.; Sheng, X.Y.; Wang, Q.; Fang, X.Q.; Fan, S.W. The sensitivity of orthopaedic surgeons to the secondary prevention of fragility fractures. J. Bone. Joint. Surg. Am. 2018, 100, e153.

[53] Danila, M.I.; Outman, R.C.; Rahn, E.J.; Mudano, A.S.; Redden, D.T.; Li, P.; Allison, J.J.; Anderson, F.A.; Wyman, A.; Greenspan, S.L.; LaCroix, A.Z.; Nieves, J.W.; Silverman, S.L.; Siris, E.S.; Watts, N.B.; Miller, M.J.; Curtis, J.R.; Warriner, A.H.; Wright, N.C.; Saag, K.G. Evaluation of a multimodal, direct-to-patient educational intervention targeting barriers to osteoporosis care: a randomized clinical trial. J. Bone Miner. Res. 2018, 33, 763-772.

[54] Bos, J.M.; van den Bemt, P.M.; Kievit, W.; Pot, J.L.; Nagtegaal, J.E.; Wieringa, A.; van der Westerlaken, M.M.; van der Wilt, G.J.; de Smet, P.A.; Kramers, C. A multifaceted intervention to reduce drug-related complications in surgical patients. Br. J. Clin. Pharmacol. 2017, 83, 664-677.