Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Headache. 2013 Oct;53(9):1451-63. doi: 10.1111/head.12163. Epub 2013 Jun 28.
To describe practice behavior and understanding among pharmacy personnel, both pharmacists and non-pharmacist staff, in the management of mild and moderate migraines.
Migraine is recognized as a prevalent and chronic neurological disorder. In developing countries, such as Thailand, community pharmacies are a widely used source of health care for various illnesses including migraine. However, the quality of migraine management and knowledge among pharmacy personnel is unclear.
Cross-sectional study. The sample comprised 142 randomly selected community pharmacies in a city in the south of Thailand. Simulated clients visited the pharmacies twice, at least 1 month apart, to ask for the treatment of mild and moderate migraines. After the encounters, question asking, drug dispensing, and advice giving by pharmacy staff were recorded. Subsequently, the providers in 135 pharmacies participated in the interview to evaluate their knowledge in migraine management.
The majority of pharmacy personnel were less likely to ask questions in cases of mild migraine when compared with moderate attack (mean score [full score = 12] 1.8 ± 1.6 vs 2.6 ± 1.5, respectively, P < 0.001). Mean difference of question asking between mild and moderate migraines was -0.8 (95% confidence interval -1.1 to -0.5, P < 0.001). Approximately 33% and 54% of the providers appropriately dispensed non-steroidal anti-inflammatory drugs for mild attack and ergotamine for moderate migraine, respectively, P < 0.001. Prophylactic medications (eg, atenolol, propranolol, flunarizine) were inappropriately recommended, particularly in moderate attack (28.2% vs 17.6% in mild migraine, P = 0.018). Less than 30% of providers advised the patients on the maximum limit of dose or discontinuity of medications when recovered. Compared with non-pharmacists, pharmacists tended to ask more questions, give more advice, and dispense less appropriately; however, there were no significant differences. The results from the interview showed that most pharmacy personnel had inadequate knowledge on migraine management. Pharmacists had better knowledge on question asking (mild migraine 5.1 ± 2.1 vs 3.1 ± 1.3, respectively, P < .001; moderate disorder 6.5 ± 3.1 vs 3.9 ± 2.1, respectively, P < .001) and tended to have more knowledge on advice giving but poorer drug dispensing in moderate migraine according to the guidelines, relative to non-pharmacists (20.5% vs 40.3%, P = .014).
A large number of community pharmacists and non-pharmacist staff had inappropriate practice behavior and understanding. Continuing education and interventions are important to improve the practice and knowledge of pharmacy personnel, particularly the pharmacists.
描述药剂师和非药剂师药剂人员在管理轻度和中度偏头痛方面的实践行为和理解。
偏头痛被认为是一种普遍且慢性的神经系统疾病。在泰国等发展中国家，社区药店是治疗各种疾病（包括偏头痛）的常用医疗来源。然而，药剂人员在偏头痛管理和知识方面的质量尚不清楚。
横断面研究。该样本包括泰国南部一个城市的 142 家随机选择的社区药店。模拟客户至少相隔 1 个月两次访问药店，以寻求轻度和中度偏头痛的治疗。接触后，记录药剂人员的询问、药物配给和建议。随后，135 家药店的提供者参加了访谈，以评估他们在偏头痛管理方面的知识。
与中度偏头痛发作相比，大多数药剂人员在轻度偏头痛发作时不太可能询问问题（平均得分[满分=12]分别为 1.8±1.6 与 2.6±1.5，P<0.001）。轻度和中度偏头痛之间询问问题的平均差异为-0.8（95%置信区间-1.1 至-0.5，P<0.001）。大约 33%和 54%的提供者分别为轻度偏头痛发作和中度偏头痛发作适当开出非甾体抗炎药和麦角胺，P<0.001。预防性药物（如阿替洛尔、普萘洛尔、氟桂利嗪）被不适当地推荐，特别是在中度偏头痛发作时（轻度偏头痛发作时为 28.2%，中度偏头痛发作时为 17.6%，P=0.018）。不到 30%的提供者在患者康复时告知他们药物的最大剂量限制或中断。与非药剂师相比，药剂师倾向于多问问题、多提建议、少配药；然而，没有显著差异。访谈结果表明，大多数药剂人员在偏头痛管理方面知识不足。药剂师在询问问题方面的知识更好（轻度偏头痛发作时为 5.1±2.1，中度偏头痛发作时为 3.1±1.3，分别为 P<0.001；中度障碍时为 6.5±3.1，中度偏头痛发作时为 3.9±2.1，分别为 P<0.001），并且根据指南，与非药剂师相比，他们在中度偏头痛发作时的建议和药物配给方面的知识更丰富，但相对较差（20.5%比 40.3%，P=0.014）。
大量社区药剂师和非药剂师药剂人员的实践行为和理解存在不当之处。继续教育和干预措施对于提高药剂人员的实践和知识水平非常重要，特别是药剂师。
