School of Pharmacy, University of Otago, Dunedin, New Zealand; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Res Social Adm Pharm. 2014 Jan-Feb;10(1):185-94. doi: 10.1016/j.sapharm.2013.04.008. Epub 2013 May 17.
In New Zealand, pharmacists are funded to provide adherence support to their patients via a service called "Medicines Use Review" (MUR). The service is based on the assumption that the medication regimen is clinically appropriate and therefore does not include a clinical review. However, whether or not pharmacists make clinical recommendations to patients during MUR is unclear.
To identify the types of drug-related problems (DRPs) and interventions provided during MUR in order to understand whether clinical interventions occur.
A single district health board that funds MUR services was identified. The MUR providers that conducted MURs during the period (from 2007 - December 2011) were invited to participate. All MUR consultation records were reviewed and the data extracted were categorized according to the DRP Classification Scheme v6.2 by Pharmaceutical Care Network Europe (PCNE). DRPs that did not fit into the criteria were documented separately.
Consultation records for 353 individual patients were obtained from five MUR providers. Of these patients, 56.4% were female and the median age was 73 years. A total of 886 DRPs were identified and resulted in a total of 844 interventions. During this period, 2718 medications were prescribed to these MUR patients. The most frequent DRPs identified were problems with "health literacy" and "non-adherence" to medications. However 18.1% (n = 160) of the DRPs were perceived as a clinical review that went beyond the practice of MUR. The most common intervention was "patient counselling" (20%), "compliance packaging provided" (16%) and "recommendation to change medication" (11%).
In this study, pharmacists perhaps based on ethical, legal and moral obligations provided clinical interventions that exceeded those expected and funded in a MUR. Since MUR detected a low number of clinical DRPs when compared to clinical medication review services conducted previously, a funding system that only supports MUR might not provide the important clinical support required by patients. Patients who receive only MUR may potentially be missing out on optimal care.
在新西兰，药剂师通过一项名为“用药审查”（MUR）的服务获得资金，为患者提供用药依从性支持。该服务基于药物治疗方案在临床层面是合理的这一假设，因此不包括临床审查。然而，药剂师在 MUR 期间是否向患者提出临床建议尚不清楚。
确定在 MUR 中提供的药物相关问题（DRP）的类型和干预措施，以了解是否存在临床干预。
确定了一个为 MUR 服务提供资金的单一地区卫生局。邀请在此期间（2007 年至 2011 年 12 月）进行 MUR 的 MUR 提供者参与。审查了所有 MUR 咨询记录，并根据欧洲药学保健网络（PCNE）的 DRP 分类方案 v6.2 对数据进行了分类。不符合标准的 DRP 单独记录。
从五名 MUR 提供者处获得了 353 名个体患者的咨询记录。其中 56.4%为女性，中位年龄为 73 岁。共确定了 886 个 DRP，并导致 844 项干预措施。在此期间，这些 MUR 患者共开具了 2718 种药物。最常见的 DRP 是“健康素养”和“药物不依从”问题。然而，18.1%（n=160）的 DRP 被认为是超出 MUR 实践的临床审查。最常见的干预措施是“患者咨询”（20%）、“提供合规包装”（16%）和“建议改变药物”（11%）。
在这项研究中，药剂师可能基于伦理、法律和道德义务，提供了超出 MUR 预期和资助范围的临床干预措施。由于与之前进行的临床药物审查服务相比，MUR 检测到的临床 DRP 数量较少，因此仅支持 MUR 的资金系统可能无法为患者提供所需的重要临床支持。仅接受 MUR 的患者可能会错过最佳治疗。
