藥師藉由資訊檢核系統設置以提升心衰竭用藥品質

Improving Heart Failure Medication Prescription Quality by Pharmacist Through Inspection System

心臟衰竭（heart failure, HF）依照病人左心室射出率，分為射出分率降低（HF with reduced ejection fraction, HFrEF）、射出分率正常（HF with preserved ejection fraction, HFpEF）以及射出分率輕度降低（HF with mildly reduced ejection fraction, HFmrEF）三類型。關於HFrEF的治療，2016年歐洲心衰竭治療指引提出數種「指引導向藥物治療」（guideline-directed medical therapy, GDMT），其中包含renin–angiotensin system inhibitor（RASi）、β-blocker及mineralocorticoid receptor antagonists（MRA）。本院為高雄醫學大學附設中和紀念醫院，過去並無收集HFrEF GDMT藥品開立率相關資料，自2020年12月開始進行心衰竭疾病別認證收案後，才開始以人工方式收集數據，但此方法既無法擴大族群至所有HFrEF病人，且耗費相當多的人力成本。為能促進HFrEF病人的照護品質，本次專案目標設定為建立心衰竭用藥提示系統，利用系統來達到1.提醒醫師開立GDMT藥品2.分析本院GDMT藥品開立率3.分析藥品未開立理由。系統於2021年3月建置完成，且後續不斷進行系統優化，優化內容包含，1.調整系統未用藥理由選項2.比照2021年8月新發布的歐洲心衰竭治療指引，新增sodium-glucose cotransporter-2 inhibitors（SGLT-2inhibitor）藥品檢核功能3.系統檢核結果匯人雲端病歷4.新增常規報表查詢系統5.報表新增GDMT雲端藥歷資料。分析2022年9月至2022年12月檢核結果，RASi、β-blocker、MRA、SGLT-2 inhibitor開立率皆有逐漸上升趨勢，2022年12月住院期問RASi開立率為88.9%、β-blocker為88.9%、MRA為55.6%、SGLT-2 inhibitor為72.2%；出院帶藥RASi為88.9%、β-blocker為88.9%、MRA為61.1%、SGLT-2 inhibitor為66.7%，成效良好。近年來，跨團隊照護為各醫療機構重點發展方向，本專案經由臨床藥師發起，與心臟科醫師、個案管理師、資訊工程師共同完成心衰竭用藥提示系統，促進本院心衰竭照護品質，讓病人得到更好的醫療照護。

Heart failure (HF) is divided into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction (HFmrEF). Regarding the treatment of HFrEF, the 2016 European heart failure treatment guideline suggested several guideline-directed medical therapy (GDMT), including renin–angiotensin system inhibitor (RASi), 3-blocker and mineralocorticoid receptor antagonists (MRA). In the past, Kaohsiung Medical University Chung-Ho Memorial Hospital did not collect the prescription rate of HFrEF GDMT drugs. Since December 2020, we began to collect data after the heart failure disease-specific care certification was prepared. However, collecting data manually cannot expand the population to all HFrEF patients and consume considerable labor costs. To improve the quality of care for HFrEF patients, the goal of this project is to establish an inspection system for heart failure medication, using the system to achieve 1. Remind doctors to prescribe GDMT medication 2. Analyze the prescription rate of GDMT medication in our hospital 3. Analyze the unprescribed reasons. The system was completed in March 2021, and the system will continue to be optimized in the future. The optimization content includes 1. Adjust the system's unprescribed reason options 2. Following the latest European heart failure treatment guideline in August 2021, we added sodium-glucose cotransporter-2 inhibitor (SGLT-2 inhibitor) into the inspection system 3. System inspection results are imported into cloud medical records 4. Created a data export system 5. Added GDMT medication from PharmaCloud to the data export system. Analyzing the inspection results from September 2022 to December 2022, the prescription rates of RASi, 3-blocker, MRA, and SGLT-2 inhibitor all had a gradual upward trend. In December 2022, the prescription rate of RASi during hospitalization was 88.9%, 3-blocker 88.9%, MRA 55.6%, SGLT-2 inhibitor 72.2%; The prescription rate of RASi on discharge medication was 88.9%, 3-blocker 88.9%, MRA 61.1%, SGLT-2 inhibitor 66.7%. In recent years, cross-team care has become a key development direction in various medical institutions. This project was initiated by clinical pharmacists who worked with cardiologists, case managers, and computer engineers to complete the heart failure medication inspection system to improve the quality of heart failure care in our hospital and wish patients can get better medical care.