Kwint H F, Faber A, Gussekloo J, Bouvy M L
Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands; SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands.
J Clin Pharm Ther. 2014 Jun;39(3):248-52. doi: 10.1111/jcpt.12132. Epub 2014 Feb 13.
Little is known about the ability of community pharmacists who are inexperienced in medication review to identify drug-related problems (DRPs). The objective of our study was to investigate the completeness of DRPs in terms of number, type and clinical relevance identified by community pharmacists when performing home medication reviews (HMRs).
This is a cross-sectional study within the intervention arm of a randomized controlled trial among community-dwelling patients (≥65 years, ≥5 drugs) in ten Dutch community pharmacies. Community pharmacists, who were inexperienced in medication review, received 2-day training in medication review. These pharmacists interviewed patients at home about their medicines, identified potential DRPs and made recommendations in combination with medication and clinical records. Expert reviewers completed the number of potential DRPs and recommendations by reviewing all available information, including patient interview reports.
In 155 patients, community pharmacists identified a mean of 3·6 (SD 2·8) potential DRPs per patient and expert reviewers added 6·5 (SD 3·2) DRPs. Community pharmacists formulated 2·6 (SD 2·3) recommendations per patient and reviewers added 7·5 (SD 3·3) recommendations. Community pharmacists identified a higher proportion of clinically relevant DRPs compared with expert reviewers, as assessed by DRPs with high priority [OR = 1·8 (95% CI 1·4-2·2)], DRPs associated with recommendations for drug change [OR = 1·9 (95% CI 1·5-2·3)] and implemented recommendations for drug change [OR = 2·1 (95% CI 1·6-2·7)].
This study shows that the completeness of medication reviews by inexperienced community pharmacists with limited training could be improved, although they identified a higher proportion of potentially clinically relevant DRPs compared with expert reviewers. The results suggest that community pharmacists with limited experience in medication review may need more intensive post-graduate training.
对于缺乏用药评估经验的社区药剂师识别药物相关问题（DRP）的能力，我们了解甚少。本研究的目的是调查社区药剂师在进行家庭用药评估（HMR）时，在DRP的数量、类型和临床相关性方面识别的完整性。
这是一项在荷兰十家社区药房中针对社区居住患者（≥65岁，≥5种药物）进行的随机对照试验干预组内的横断面研究。缺乏用药评估经验的社区药剂师接受了为期两天的用药评估培训。这些药剂师在家中就患者的药物进行访谈，识别潜在的DRP，并结合用药和临床记录提出建议。专家评审员通过审查所有可用信息，包括患者访谈报告，完成潜在DRP和建议的数量统计。
在155名患者中，社区药剂师平均每名患者识别出3.6（标准差2.8）个潜在DRP，专家评审员补充了6.5（标准差3.2）个DRP。社区药剂师每名患者提出2.6（标准差2.3）条建议，评审员补充了7.5（标准差3.3）条建议。与专家评审员相比，社区药剂师识别出的具有临床相关性的DRP比例更高，这通过高优先级DRP[比值比（OR）=1.8（95%置信区间1.4 - 2.2）]、与药物变更建议相关的DRP[OR = 1.9（95%置信区间1.5 - 2.3）]以及实施的药物变更建议[OR = 2.1（95%置信区间1.6 - 2.7）]进行评估。
本研究表明，尽管与专家评审员相比，接受有限培训的缺乏经验的社区药剂师识别出的潜在临床相关DRP比例更高，但他们进行的用药评估的完整性仍可提高。结果表明，在用药评估方面经验有限的社区药剂师可能需要更强化的研究生培训。
