基于个体参与者数据Meta分析评价临床药师会诊在感染性疾病治疗中的效果研究

The Effectiveness of Clinical Pharmacist-Led Consultation Intervention in the Treatment of Infectious Diseases:Individual Participant Data Meta-Analysis

目的本研究旨在评估临床药师抗感染会诊的效果,探讨临床药师专业对会诊结局的影响。方法本研究连续纳入2017年4月至2019年12月的感染会诊患者,前瞻性收集患者的基线信息,开展多中心队列研究。以临床医师在治疗中是否采纳临床药师的建议作为暴露因素,以感染治疗有效率作为结局指标。统计分析基于个体参与者数据(individual participant data,IPD)Meta分析。结果共纳入来自12家三级医疗机构的2631例感染会诊患者,IPD Meta分析结果显示,在控制其他混杂因素的情况下,临床药师会诊干预能改善患者的预后[合并比值比(OR)=1.80,95%置信区间(CI):1.14~2.84,P=0.012],而感染和非感染专业临床药师的会诊效果相当(OR=0.87,95%CI:0.62~1.22,P=0.421)。结论临床药师会诊是一种能够优化感染性疾病治疗的干预措施,并且可实现服务的标准化。

OBJECTIVE The current study aims to evaluate the effectiveness of clinical pharmacist-led consultation(CPC)in the treatment of infectious diseases(ID)and the effect of pharmacist background on the outcome.METHODS We conducted a prospective and multicenter cohort study,including consecutive patients with ID between April 2017 and December 2019.Baseline characteristics including sex,age,liver and kidney function,comorbidity,infection severity were prospectively collected.The main exposure of interest was whether the attending physician adopted recommendations of the clinical pharmacist in the therapeutic scheme.The outcome was the infection effective response,assessed during day 3-7 after completing CPC.Two step individual participant data(IPD)meta-analysis were performed by inverse variance method.RESULTS A total of 2631 ID patients from 12 tertiary hospitals were included in the final analysis according to the predesigned inclusion and exclusion criteria.The IPD meta-analyses indicated that CPC intervention could improve the ID patient prognosis in the context of other confounders controlled[Pooled Odds ratio(OR)=1.80,95%Confidence Interval(CI):1.14-2.84],and the effectiveness of CPC served by ID and non-ID clinical pharmacists might be equivalent(Pooled OR=0.87,95%CI:0.62-1.22).CONCLUSION This study suggests that CPC is a promising pharmacist-led intervention to improve ID treatment,and it can achieve standardization among clinical pharmacists with different backgrounds by some measures.