Watson M C, Bond C M, Grimshaw J M, Mollison J, Ludbrook A, Walker A E
Department of General Practice and Primary Care, University of Aberdeen, Westburn Road, Aberdeen AB25 2AY, Scotland, UK.
Fam Pract. 2002 Oct;19(5):529-36. doi: 10.1093/fampra/19.5.529.
Community pharmacists have increasing involvement in the self-management of minor illness as a result of the availability of a wider range of over-the-counter (OTC) medicines. We undertook a randomized controlled trial (RCT) to assess the effectiveness and efficiency of educational strategies to implement evidence-based guidelines for the sale of OTC anti-fungals in the community pharmacy setting.
The aim of the study was to compare the effectiveness and efficiency of two guideline dissemination strategies in community pharmacy settings.
A 2 x 2 factorial, cluster RCT was conducted with 60 community pharmacies in the Grampian region of Scotland. The interventions included dissemination of an evidence-based guideline for OTC management of vulvovaginal candidiasis (thrush) by postal dissemination (control), educational outreach visit or attendance at a continuing professional education session. Pre- and post-intervention simulated patient visits were made to participating pharmacies. The simulated patients completed assessment forms following each visit. The primary outcome was the appropriateness (based upon the guidelines) of sale or no sale of OTC anti-fungals.
There were no significant differences in the proportion of appropriate outcomes following educational outreach [odds ratio (OR) = 1.1; 95% confidence interval (CI) 0.52 to 2.45] or continuing professional education (OR = 0.88; 95% CI 0.41 to 1.91).
Neither strategy was effective in improving the appropriateness of OTC management of vulvovaginal candidiasis by community pharmacy staff. Further research is needed to identify barriers to guideline implementation and evidence-based practice in this setting.
由于可获得种类更多的非处方药（OTC），社区药剂师在小病自我管理方面的参与度日益提高。我们开展了一项随机对照试验（RCT），以评估在社区药房环境中实施基于证据的非处方抗真菌药销售指南的教育策略的有效性和效率。
本研究的目的是比较两种指南传播策略在社区药房环境中的有效性和效率。
在苏格兰格兰扁地区的60家社区药房进行了一项2×2析因整群随机对照试验。干预措施包括通过邮寄传播（对照）、教育外展访问或参加继续职业教育课程来传播基于证据的外阴阴道念珠菌病（鹅口疮）非处方管理指南。在干预前后对参与的药房进行模拟患者访视。模拟患者在每次访视后填写评估表。主要结局是根据指南确定非处方抗真菌药销售或不销售的适宜性。
教育外展访视（优势比[OR]=1.1；95%置信区间[CI]0.52至2.45）或继续职业教育（OR=0.88；95%CI0.41至1.91）后适宜结局的比例无显著差异。
两种策略均未有效提高社区药房工作人员对外阴阴道念珠菌病非处方管理的适宜性。需要进一步研究以确定该环境中指南实施和循证实践的障碍。
