Results of a multicenter cluster-randomized controlled clinical trial testing the effectiveness of a bioinformatics-enabled pharmacist intervention in transplant recipients.

Autor:	Taber DJ; Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA. Electronic address: taberd@musc.edu., Ward RC; Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA., Buchanan CH; Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA., Axon RN; Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA., Milfred-LaForest S; Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA., Rife K; Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA., Felkner R; Department of Pharmacy Services, William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin, USA., Cooney D; Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA., Super N; Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA., McClelland S; Department of Pharmacy Services, Veterans Affairs Great Lakes Health Care System (VISN 12), Westchester, Illinois, USA., McKenna D; Department of Pharmacy Services, Portland Veterans Affairs Health Care System, Portland, Oregon, USA., Santa E; Department of Pharmacy Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA., Gebregziabher M; Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2023 Dec; Vol. 23 (12), pp. 1939-1948. Date of Electronic Publication: 2023 Aug 09.
DOI:	10.1016/j.ajt.2023.08.004
Abstrakt:	An ambulatory medication safety dashboard was developed to identify missing labs, concerning labs, drug interactions, nonadherence, and transitions in care. This system was tested in a 2-year, prospective, cluster-randomized, controlled multicenter study. Pharmacists at 5 intervention sites used the dashboard to address medication safety issues, compared with usual care provided at 5 control sites. A total of 2196 transplant events were included (1300 intervention vs 896 control). During the 2-year study, the intervention arm had a 11.3% (95% confidence interval, 7.1%-15.5%) absolute risk reduction of having ≥1 emergency department (ED) visit (44.2% vs 55.5%, respectively; P < .001, respectively) and a 12.3% (95% confidence interval, 8.2%-16.4%) absolute risk reduction of having ≥1 hospitalization (30.1% vs 42.4%, respectively; P < .001). In those with ≥1 event, the median ED visit rate (2 [interquartile range (IQR) 1, 5] vs 2 [IQR 1, 4]; P = .510) and hospitalization rate (2 [IQR 1, 3] vs 2 [IQR 1, 3]; P = .380) were similar. Treatment effect varied by comorbidity burden, previous ED visits or hospitalizations, and heart or lung recipients. A bioinformatics dashboard-enabled, pharmacist-led intervention reduced the risk of having at least one ED visit or hospitalization, predominantly demonstrated in lower risk patients. (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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