McLean William, Gillis Jane, Waller Ron
Pharmaceutical Outcomes Research Unit, Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
Can Respir J. 2003 May-Jun;10(4):195-202. doi: 10.1155/2003/736042.
Despite advances in recent years, asthma morbidity and mortality have been noted to be on the increase in the past decade. The present study examined the failures and recommendations of past studies and introduced a new milieu for asthma care--the community pharmacy. The study incorporated a care protocol with the important ingredients of asthma education on medications, triggers, self-monitoring and an asthma plan, with pharmacists taking responsibility for outcomes, assessment of a patient's readiness to change and tailoring education to that readiness, compliance monitoring and physician consultation to achieve asthma prescribing guidelines.
Thirty-three pharmacists in British Columbia, specially trained and certified in asthma care, agreed to participate in a study in which experienced pharmacists would have asthma patients allocated to enhanced (pharmaceutical) care (EC) or usual care (UC). Pharmacists less experienced were clustered by geography and had their pharmacies randomized to two levels of care; each pharmacy then had patients randomized to EC versus control, UC versus control or EC versus UC depending on their pharmacy randomization. Six hundred thirty-one patients provided consent, of which 225 in EC or UC were analyzed for all outcomes. Patients were followed for one year.
Compared with patients in the UC group, the results of those in the EC group were as follows: symptom scores decreased by 50%; peak flow readings increased by 11%; days off work or school were reduced by approximately 0.6 days/month; use of inhaled beta-agonists was reduced by 50%; overall quality of life improved by 19%, and the specific domains of activity limitations, symptoms and emotional function also improved; initial knowledge scores doubled; emergency room visits decreased by 75%; and medical visits decreased by 75%. A patient satisfaction survey revealed that the population was extremely pleased with their pharmacy services. Cost analysis reinforces the EC model, which is more cost effective than UC in terms of most direct and indirect costs in asthma patients.
Specially trained community pharmacists in Canada, using a pharmaceutical care-based protocol, can produce impressive improvements in clinical, economic and humanistic outcome measures in asthma patients. The health care system needs to produce incentives for such care.
尽管近年来取得了进展，但在过去十年中，哮喘的发病率和死亡率一直在上升。本研究审视了以往研究的不足及建议，并引入了一种新的哮喘护理环境——社区药房。该研究纳入了一项护理方案，其中包含哮喘药物治疗教育、诱发因素、自我监测及哮喘计划等重要内容，药剂师负责治疗结果、评估患者改变的意愿并根据该意愿调整教育内容、监测依从性以及与医生协商以达到哮喘用药指南。
不列颠哥伦比亚省的33名经过哮喘护理专门培训并获得认证的药剂师同意参与一项研究，经验丰富的药剂师将把哮喘患者分配至强化（药物）护理（EC）组或常规护理（UC）组。经验较少的药剂师按地理位置分组，其所在药房被随机分配至两种护理级别；然后每个药房的患者根据药房的随机分组情况被随机分配至EC组与对照组、UC组与对照组或EC组与UC组。631名患者签署了知情同意书，其中225名接受EC或UC护理的患者的所有结果均被分析。对患者进行了为期一年的随访。
与UC组患者相比，EC组患者的结果如下：症状评分降低了50%；呼气峰流速读数增加了11%；误工或误学天数每月减少约0.6天；吸入型β受体激动剂的使用减少了50%；总体生活质量提高了19%，活动受限、症状及情绪功能等具体领域也有所改善；初始知识评分翻倍；急诊就诊次数减少了75%；医疗就诊次数减少了75%。一项患者满意度调查显示，患者对药房服务非常满意。成本分析支持了EC模式，就哮喘患者的大多数直接和间接成本而言，该模式比UC模式更具成本效益。
加拿大经过专门培训的社区药剂师采用基于药物治疗护理的方案，能够在哮喘患者的临床、经济和人文结局指标方面取得令人瞩目的改善。医疗保健系统需要为这种护理提供激励措施。
