การบริบาลทางเภสัชกรรมแบบเชิงรุกบนหอผู้ป่วย ในผู้ป่วยโรคหืดและปอดอุดกั้นเรื้อรัง

บทคัดย่อ

Previous studies reported that pharmaceutical care in out-patients can reduce the incidence of hospitalization due to asthma or chronic obstructive pulmonary disease (COPD) exacerbation, but some of them were still admitted to the hospital with exacerbation. The aims of this study were to investigate drug related problems (DRPs), the impact of proactive pharmaceutical care in in-patients to prevent readmission within 28 days after discharge, and the factors association with readmission and readmission costs. It was conducted in patients with asthma or COPD diagnosis who admitted at Warinchamrab hospital. They were classified into 2 groups (146 patients each); the experimental group received the proactive pharmaceutical care from October 2020 to March 2021 and the control group received usual care from October 2019 to March 2020. DRPs and costs were analyzed by descriptive statistics. The impact of proactive pharmaceutical care to prevent readmission was analyzed by multiple logistic regression. The results indicated that 279 DRPs were identified in the experimental group whereas 8 DRPs were founded in the control group. The most commonly found DRP in the experimental group was non-adherence (40.5%); 98.3% of the DRPs interventions were accepted by physician; 49.6% of patients with DRPs needed pharmaceutical care at ward more than one visit, and 3.2% was referred to primary care team. Proactive pharmaceutical care in the experimental group decreased odds of readmission compared with the control group (OR=0.22, 95%CI 0.06-0.91, p=0.036). Readmission costs in the experimental group less than the control group (21,063 baht and 106,877 baht, respectively). Providing proactive pharmaceutical care on ward in asthma/COPD patients reduced overall hospital readmission and costs. Proactive pharmaceutical care should be continued for long term study and increase the efficacy of patient care service with the primary care unit.