Application and effectiveness evaluation of resident clinical pharmacist-led medication therapy management model in geriatric cardiology departments
- VernacularTitle:驻科药师主导的药物治疗管理模式在老年心血管内科的应用与效果评价
- Author:
Jingwen GUO
1
;
Wen TIAN
2
;
Bochang ZHANG
3
;
Lishuang CHANG
4
;
Shuang CAI
1
Author Information
1. Dept. of Pharmacy，the First Affiliated Hospital of China Medical University，Shenyang 110001，China
2. Geriatric Medical Center，the First Affiliated Hospital of China Medical University，Shenyang 110001，China
3. College of Intelligent Medicine，China Medical University，Shenyang 110001，China
4. College of Clinical Pharmacy，Shenyang Pharmaceutical University，Shenyang 110001，China
- Publication Type:Journal Article
- Keywords:
clinical pharmacy;
medication therapy management;
resident pharmaceutical service model;
intravenous infusion
- From:
China Pharmacy
2025;36(21):2718-2722
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To investigate the effectiveness of resident clinical pharmacist-led medication therapy management （MTM） model in geriatric cardiology departments， and provide reference for optimizing resident pharmaceutical services. METHODS A retrospective cohort study was conducted， incorporating data from inpatients admitted to the Department of Cardiovascular Medicine in the Geriatric Medical Center of our hospital during March to August 2023 （conventional group， n＝ 903） and the same period in 2024 （MTM group， n＝963）. The conventional group received only standard pharmaceutical services （including prospective prescription review and retrospective order evaluation）， while the MTM group received additional resident clinical pharmacist-led interventions-such as medication reconciliation， personalized therapeutic drug monitoring （TDM）， standardized intravenous infusion management， and a four-stage closed-loop monitoring process-based on conventional care. The effectiveness of the MTM model was evaluated by comparing the primary outcome measures （e.g.， intravenous infusion rate， TDM target attainment rate） and secondary outcome measures [e.g.， incidence of drug-drug interactions （DDIs）， incidence of grade 3 or higher acute kidney injury， average length of hospital stay， cholesterol， and medication cost per capita] between the two groups. RESULTS Compared with the conventional group， in terms of primary outcome indexes： both the overall intravenous infusion rate and the use rate of acid-suppressive injection were significantly lowered in the MTM group （P＜0.05）； serum concentration target attainment rates for digoxin and vancomycin were increased significantly （P＜0.05）. For secondary outcome indexes， the MTM group exhibited significant decreases in the work incidence of grade 3 or higher acute kidney injury， the incidence of DDIs， the rate of patients leaving the hospital against medical advice， alanine amino-transferase， aspartate transferase and the per capita total medication cost （P＜0.05）. Additionally， there was a notable increase in the creatinine， estimated glomerular filtration rate and a significant shortening of the per capita length of hospital stay （P＜0.05）. CONCLUSIONS The resident clinical pharmacist-led MTM model can significantly optimize medication therapy processes， enhance medication safety and cost-effectiveness， thus playing a positive role in promoting rational drug use and improving patient outcomes.
