Division of General Internal Medicine, University of Washington, 329 NinthAve, Campus Box 359780, Seattle, WA 98104, USA.
BMC Health Serv Res. 2012 Nov 13;12:391. doi: 10.1186/1472-6963-12-391.
Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence.
This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey-Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression.
We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck.
Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.
尽管口服降糖药（OHA）是治疗 2 型糖尿病的重要手段，但 OHA 的依从性往往并不理想。药剂师作为患者为中心医疗之家的一部分，正越来越多地融入初级保健，可能对药物使用产生积极影响。我们研究了初级保健诊所中是否存在药剂师与更高的 OHA 依从性之间是否存在关联。
本回顾性队列研究分析了退伍军人事务部医疗保健系统内 196 个初级保健诊所的 280603 例糖尿病患者。药剂师的存在、药剂师全职等效人数（FTE）以及每个诊所对药房服务的看法是否存在瓶颈，均来自 2007 年退伍军人事务部临床实践组织调查-初级保健主任模块。使用从行政药房数据库中调整患者特征后的补充数据，构建患者使用 OHA 的药物占有比率（MPR）来衡量患者的依从性。通过线性回归分析了药房措施与诊所水平的 OHA 依从性之间的关联。
我们发现药剂师的存在与诊所水平的 OHA 依从性之间没有显著关联。但是，在认为药房服务存在瓶颈的诊所中，依从性较低。
无论 FTE 数量多少，药剂师的存在都与初级保健诊所的 OHA 药物依从性无关。为了确定如何最有效地利用这些资源来改善以患者为中心的结果，包括药物依从性，需要更仔细地检查药剂师在诊所中的作用。
