Emmerton L, Shaw J, Kheir N
School of Pharmacy, University of Otago, Dunedin, New Zealand.
J Clin Pharm Ther. 2003 Oct;28(5):395-402. doi: 10.1046/j.0269-4727.2003.00507.x.
Pharmaceutical care services became recognized in New Zealand in the mid-1990s, albeit with limited evidence of the acceptability and effectiveness of the model. An asthma-specific pharmaceutical care service was trialled in southern New Zealand, based on a 'problem-action-outcome' method, with pharmacists adopting a patient-centred, outcome-focused approach with multidisciplinary consultation.
To report on the implementation and outcomes of a specialist asthma service offered by community pharmacists.
Pharmacists in five pharmacies, servicing predominantly rural, established clientele, received training in the asthma service and research documentation. Ten patients per pharmacy were recruited in each year (years 1 and 2) of the study. The patients were entered into the study in cohorts of five per pharmacy twice yearly, with year 2 mirroring year 1. The phase-in design minimized the impact on the pharmacists. The patients acted as their own controls. All patients received individualized care and had approximately monthly consultations with the pharmacist, with clinical and quality of life (QoL) monitoring.
A total of 100 patients were recruited. On average, 4.3 medication-related problems were identified per patient; two-thirds of them were compliance-related. The most common interventions were revision of patients' asthma action plans, referral and medication counselling. Clinical outcomes included reduced bronchodilator use and improved symptom control in around two-thirds of patients. Asthma-specific QoL changes were more positive and correlated well with clinical indicators.
Further research is warranted to integrate this service into daily practice. Clinical outcomes were generally positive and supported by QoL indicators. Characteristics of New Zealand practice and this sample of pharmacies may limit the generalizability of these findings.
20世纪90年代中期，药学服务在新西兰得到认可，尽管该模式的可接受性和有效性的证据有限。基于“问题-行动-结果”方法，在新西兰南部试行一项针对哮喘的药学服务，药剂师采用以患者为中心、以结果为导向的方法并进行多学科会诊。
报告社区药剂师提供的专科哮喘服务的实施情况和结果。
五家主要服务农村固定客户群体的药店的药剂师接受了哮喘服务和研究文档方面的培训。在研究的每年（第1年和第2年），每家药店招募10名患者。患者每年分两批、每次每家药店5名进入研究，第2年情况与第1年相同。逐步引入设计将对药剂师的影响降至最低。患者自身作为对照。所有患者均接受个性化护理，大约每月与药剂师会诊一次，并进行临床和生活质量（QoL）监测。
共招募了100名患者。平均每名患者发现4.3个与药物相关的问题；其中三分之二与依从性有关。最常见的干预措施是修订患者的哮喘行动计划、转诊和药物咨询。临床结果包括约三分之二的患者支气管扩张剂使用减少和症状控制改善。哮喘特异性生活质量变化更为积极，且与临床指标相关性良好。
有必要进行进一步研究，以将这项服务纳入日常实践。临床结果总体呈阳性，并得到生活质量指标的支持。新西兰的实践特点和这些药店样本可能会限制这些结果的普遍性。
