Crealey Grainne E, Sturgess Ian K, McElnay James C, Hughes Carmel M
Clinical and Practice Research Group, The School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland.
Pharmacoeconomics. 2003;21(7):455-65. doi: 10.2165/00019053-200321070-00001.
Pharmaceutical care is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. It describes the process through which a pharmacist collaborates with a patient and with healthcare professionals in designing, implementing and monitoring a therapeutic plan that will produce specific, desirable therapeutic outcomes for the patient. The elderly are a patient population who could particularly benefit from pharmaceutical care provision as they are at greater risk of experiencing significant drug-related problems such as inappropriate prescribing, noncompliance with prescribed medication and adverse drug reactions/interactions leading to a decrease in health-related quality of life. The extent of economic benefit of pharmaceutical care reported in the literature is variable and its generalisability is suspect due to the lack of trials which have utilised a robust research design. The few studies which have undertaken a rigourous economic evaluation have used a range of data collection methods that is reflective of the difficulty of capturing essential data. Furthermore, even in well-designed studies, the generalisability of economic evaluations to other countries is questionable because of unique national data collection systems and an inability to pool international data because of disparities between different healthcare systems. The use of a suitable measure for health-related quality of life is also problematic in a very diverse and heterogeneous population such as the elderly and, therefore, adds to the difficulties of inclusion of such measures in economic analyses of pharmaceutical care programmes. A more standardised approach to data collection is required to facilitate economic analyses as an essential element in the evaluation of any pharmaceutical care programme for the elderly. Suggestions on such approaches, together with a critical appraisal of studies performed to date, are the focus of this review.
药学服务被定义为负责提供药物治疗，目的是实现明确的结果，从而提高患者的生活质量。它描述了药剂师与患者以及医疗保健专业人员合作设计、实施和监测治疗计划的过程，该计划将为患者产生特定的、理想的治疗结果。老年人是一个特别能从药学服务中受益的患者群体，因为他们面临重大药物相关问题的风险更高，例如处方不当、不遵医嘱服药以及药物不良反应/相互作用，这些都会导致与健康相关的生活质量下降。文献中报道的药学服务的经济效益程度各不相同，而且由于缺乏采用稳健研究设计的试验，其普遍性也受到质疑。少数进行了严格经济评估的研究使用了一系列数据收集方法，这反映了获取基本数据的难度。此外，即使在设计良好的研究中，由于独特的国家数据收集系统以及不同医疗保健系统之间存在差异而无法汇总国际数据，经济评估在其他国家的普遍性也值得怀疑。在老年人这样非常多样化和异质的人群中，使用合适的与健康相关的生活质量衡量标准也存在问题，因此，这增加了在药学服务项目经济分析中纳入此类衡量标准的难度。需要一种更标准化的数据收集方法来促进经济分析，作为评估任何老年人药学服务项目的一个基本要素。关于此类方法的建议，以及对迄今为止所进行研究的批判性评价，是本综述的重点。
