A stepped wedge randomised controlled trial assessing the efficacy and patient acceptability of virtual clinical pharmacy in rural and remote Australian hospitals

Abstract Background Despite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS). Methods A stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level. Results Compared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p

摘要 背景
尽管药物治疗是最常见的医疗干预手段，且药物相关不良事件在医院中频发，但澳大利亚许多农村及偏远医院受限于资源匮乏，未设置驻院药学服务。本研究针对农村及偏远医疗机构，推行了虚拟临床药学服务（Virtual Clinical Pharmacy Service, VCPS），由2名资深农村全科医院药剂师分别负责4家医院，旨在评估该服务是否能提升医疗机构对《国家安全与优质卫生服务标准（National Safety and Quality Health Service Standards, NSQHS）》的依从性。
方法 本研究采用阶梯楔式随机对照试验设计，以每月1家的进度在8家医院逐步推行远程医疗药学服务。主要结局指标为患者入院及出院时的药物重整完成率。次要评价指标涵盖：其他NSQHS标准的依从性（包括最佳药物病史记录、药物重整及静脉血栓栓塞风险评估）、患者结局指标（含48小时内复诊、28天内再入院及住院时长），以及潜在药物相关伤害的检出情况（包括药剂师识别的药物相关问题、报告的用药错误及跌倒事件）。研究邀请患者填写患者报告体验问卷。数据从电子病历中采集，采用混合logistic回归模型分析以评估VCPS的干预效果；抗菌药物使用情况、跌倒事件及用药错误在机构层面开展分析，其余数据则在患者层面进行分析。
结果 相较于对照组（n=535），干预组患者（n=527）完成入院药物重整的概率显著更高（优势比（Odds Ratio, OR）=11.16，95%置信区间（Confidence Interval, CI）=5.59~22.30，p<