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Impact of designated pharmacists’ interventions on physicians’ acceptance of the Knowledge-based Renal Dosage Adjustment System

Title
Impact of designated pharmacists’ interventions on physicians’ acceptance of the Knowledge-based Renal Dosage Adjustment System
Authors
최경숙
Issue Date
2018
Department/Major
대학원 생명·약학부약학전공
Publisher
이화여자대학교 대학원
Degree
Doctor
Advisors
이정연

곽혜선
Abstract
Objectives The purpose of this study was to verify whether designated pharmacist interventions were associated with physicians’ acceptance of the Knowledge-based Renal Dosage Adjustment system (K-RDS) for hospitalized patients with reduced renal function. Methods This retrospective study compared physicians’ acceptance of the K-RDS with and without designated pharmacists. Patients who were ≥ 20 years of age, estimated glomerular filtration rate (eGFR) under 50 ml/min on medications that required dose adjustments were enrolled from April to June 2017. We analyzed the number of dosing alerts of the K-RDS from the Healthcare Information System of a tertiary teaching hospital. The factors associated with the physicians’ acceptance rate were analyzed using a multivariate logistic regression method. Results There were 9,168 dosing alerts from 668,414 orders (1.4%). After the application of exclusion criteria, 2,341 alerts remained. Alerts related to ranitidine and famotidine were the most frequent. A total of 1,363 prescription interventions were made, and 491 (36.0%) interventions were performed by designated pharmacists. The physician acceptance rate was 54.4% in the designated pharmacist group and 47.0% in the control group (p=0.0233). The presence of designated pharmacists 1.353 (95% confidence interval [CI] 1.035-1.768, p=0.0272), female 0.758 (95% CI 0.638-0.900, p=0.0016), medical department 0.659 (95% CI 0.469-0.926, p<0.0001), eGFR ≤40-<50 ml/min 1.538 (95% CI 1.176-2.013 if <10 ml/min, p<0.0001), eGFR ≤40-<50 ml/min 1.519 (95% CI 1.176-2.013 if ≤10-<40 ml/min, p<0.0001), and medication category 6.058-43.992 (95% CI 1.648~215.008 depending on the medication category, p<0.0001) were significant factors affecting the physicians’ acceptance. Conclusions This study suggests that pharmacists’ interventions have a positive effect on improving physicians’ acceptance of the K-RDS which benefits patient care. In addition to the presence of designated pharmacists, impaired renal function, male and medication category also positively affected the physicians’ acceptance of alerts by the K-RDS. Keywords Knowledge-based Renal Dosage System, physicians’ acceptance, designated pharmacist intervention;본 연구는 병동담당약사의 중재가 신기능이 감소된 입원환자에게 적용되는 Knowledge-based Renal Dosage Adjustment system (K-RDS) 가이드라인에 대한 처방의의 수용율과 관련이 있는지 확인하고자 하였다. 2017년 4월부터 6월까지 연구병원에 입원한 20세 이상 성인 중 glomerular filtration rate가 50 ml/min 미만이면서, 신기능에 따라 용량조절이 필요한 약품을 처방 받은 입원환자를 중재대상으로 하였다. 3차 상급종합병원의 의료정보시스템의 Knowledge-based Renal Dosage Adjustment system (K-RDS)의 경고를 추출하여 병동담당약사의 유무에 따른 처방의의 수용율을 후향적으로 비교하였다. 연구기간 중 전체 668,414처방 중 9,168건의 경고가 발생하였으며, 이중 20세 미만 환자에 대한 처방, 신기능 예측을 위한 자료 부재, 퇴원 처방을 제외한 2,341건의 경고를 분석하였다. 총 처방에 대한 경고는 1.4% 이었으며, ranitidine 및 famotidine이 가장 빈번하게 경고를 발생한 약물이었다. 병동담당약사군의 평균 연령은 73.4±11.5세 였으며, 대조군의 평균 연령은 73.4±11.0세였다. 연구대상 중 65세 이상의 고령환자가 82.3% 이었다. 연구기간 중 총 1,603건의 처방 중재가 있었으며 이 중 31.5%인 430건이 병동담당약사에 의해 중재되었다. 약사의 처방 중재는 의약품 정보 제공, 과용량, 투여 간격의 순으로 빈도가 높았다. 처방의의 K-RDS에 대한 순응율은 병동담당약사군에서 54.4% 이었으며, 대조군에서 47.0% 이었다, 다변량 로지스틱 회귀분석 결과 병동담당약사의 유무 1.353(95% CI 1.035-1.768, p=0.0272), 여성 0.758(95% CI 0.638-0.900, p=0.0016), 내과계 입원 병동 0.659(95% CI 0.469-0.926, p<0.0001), eGFR ≤40-<50 ml/min 1.538(95% CI 1.176-2.013 if <10 ml/min, p<0.0001), eGFR ≤40-<50 ml/min 1.519 (95% CI 1.176-2.013 if ≤10-<40 ml/min, p<0.0001), 약물군 6.058-43.992 (95% CI 1.648~215.008 depending on the medication category, p<0.0001)등 이 처방의의 순응도에 유의하게 영향을 주는 요인으로 확인되었다. 본 연구를 통하여 병동담당약사의 처방 중재가 (K-RDS) 가이드라인에 대한 처방의의 수용율을 향상시킬 수 있음을 확인하였다.
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