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药剂师在门诊管理流感样疾病或耳鼻喉疾病时,顺势疗法药物与对抗疗法药物联合使用的有效性。

Effectiveness of homeopathic medicine associated with allopathic medicine in the outpatient management of influenza-like illnesses or ear, nose, and throat disorders by pharmacists.

作者信息

Danno Karine, Cognet-Dementhon Brigitte, Thevenard Geneviève, Duru Gérard, Allaert François-André, Bordet Marie-France

机构信息

Laboratoires Boiron, 20, rue de la Liberation, F-69110 Sainte-Foy-les-Lyon, France.

出版信息

J Manag Care Pharm. 2013 Oct;19(8):631-41. doi: 10.18553/jmcp.2013.19.8.631.

Abstract

BACKGROUND

Pharmacists play an increasing role in advising on treatment for minor illnesses such as influenza-like illness (ILI) or ear, nose, and throat (ENT) disorders. However, the profile of patients consulting pharmacists with these illnesses, the types of over-the-counter (OTC) medicines recommended by pharmacists, and the effectiveness of these treatments have not been studied.

OBJECTIVES

To describe the sociodemographic and clinical characteristics of patients recommended allopathic and/or homeopathic medicines for ILI or ENT disorders by pharmacists in France and to investigate the effectiveness of these treatments.

METHODS: A prospective, observational, multicenter study was carried out in randomly selected pharmacies across the 8 IDREM medical regions of France. Pharmacies that agreed to participate recruited male or female patients who responded to the following inclusion criteria: age ≥ 12 years presenting with the first symptoms of an ILI or ENT disorder that were 
present for less than 36 hours prior to the pharmacy visit. All medicines recorded in the study were recommended by the pharmacists. The following data were recorded at inclusion and after 3 days of treatment: the intensity of 13 symptoms, global symptom score, and disease impact on daily activities and sleep. Two groups of patients were compared: those recommended allopathic medicine only (AT group) and those recommended homeopathic medicine with or without allopathic medicine (HAT group). The number and severity of symptoms, change in global symptom score, and disease impact on daily activities and sleep were compared in the 2 treatment groups after 3 days of treatment. Independent predictors of recommendations for homeopathic medicine were identified by multi-
factorial logistic regression analysis.

RESULTS

A total of 242 pharmacies out of 4,809 (5.0%) contacted agreed to participate in the study, and 133 (2.8%) included at least 1 patient; 573 patients were analyzed (mean age: 42.5 ± 16.2 years; 61.9% female). Of these, 428 received allopathic medicines only (74.7%; AT group), and 145 (25.3%) received homeopathic medicines (HAT group) alone (9/145, 1.6%) or associated with allopathy (136/145, 23.7%). At inclusion, HAT patients were significantly younger (39.6 ± 14.8 vs. 43.4 ± 16.1 years; P  less than  0.05), had a higher mean number of symptoms (5.2 ± 2.5 vs. 4.4 ± 2.5; P  less than  0.01), and more severe symptoms (mean global symptom score: 24.3 ± 5.5 vs. 22.3 ± 5.8; P = 0.0019) than AT patients. After 3 days, the improvement in symptoms and disease impact on daily activities and sleep was comparable in both groups of patients.

CONCLUSIONS

Patients recommended homeopathic medicine by pharmacists were younger and had more severe symptoms than those recommended allopathic medicine. After 3 days of treatment, clinical improvement was comparable in both treatment groups. Pharmacists have an important role to play in the effective management of ILI and ENT disorders.

摘要

背景

药剂师在为诸如流感样疾病(ILI)或耳鼻喉(ENT)疾病等轻症提供治疗建议方面发挥着越来越重要的作用。然而,就这些疾病咨询药剂师的患者特征、药剂师推荐的非处方(OTC)药物类型以及这些治疗方法的有效性尚未得到研究。

目的

描述在法国药剂师为ILI或ENT疾病推荐了对抗疗法和/或顺势疗法药物的患者的社会人口统计学和临床特征,并调查这些治疗方法的有效性。

方法

在法国8个IDREM医疗区域随机选择的药店中开展了一项前瞻性、观察性、多中心研究。同意参与的药店招募符合以下纳入标准的男性或女性患者:年龄≥12岁,在前往药店就诊前36小时内首次出现ILI或ENT疾病症状。研究中记录的所有药物均由药剂师推荐。在纳入时和治疗3天后记录以下数据:13种症状的严重程度、总体症状评分以及疾病对日常活动和睡眠的影响。比较两组患者:仅推荐对抗疗法药物的患者(AT组)和推荐了顺势疗法药物(无论是否联合对抗疗法)的患者(HAT组)。治疗3天后,比较两组患者症状的数量和严重程度、总体症状评分的变化以及疾病对日常活动和睡眠的影响。通过多因素逻辑回归分析确定推荐顺势疗法药物的独立预测因素。

结果

在联系的4809家药店中,共有242家(5.0%)同意参与研究,其中133家(2.8%)至少纳入了1名患者;共分析了573例患者(平均年龄:42.5±16.2岁;61.9%为女性)。其中,428例仅接受了对抗疗法药物(74.7%;AT组),145例(25.3%)接受了顺势疗法药物(HAT组),单独接受顺势疗法药物的有9例(1.6%),联合对抗疗法的有136例(23.7%)。纳入时,HAT组患者明显更年轻(39.6±14.8岁 vs. 43.4±16.1岁;P<0.05),平均症状数量更多(5.2±2.5个 vs. 4.4±2.5个;P<0.01),症状也更严重(平均总体症状评分:24.3±5.5 vs. 22.3±5.8;P = 0.0019)。3天后,两组患者症状的改善情况以及疾病对日常活动和睡眠的影响相当。

结论

药剂师推荐使用顺势疗法药物的患者比推荐使用对抗疗法药物的患者更年轻,症状也更严重。治疗3天后,两个治疗组的临床改善情况相当。药剂师在ILI和ENT疾病的有效管理中发挥着重要作用。

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