University of Iowa College of Pharmacy, 115 S. Grand Ave., S515 PHAR, Iowa City, IA 52242.
J Manag Care Spec Pharm. 2014 Jul;20(7):734-40. doi: 10.18553/jmcp.2014.20.7.734.
Medication nonadherence is a common problem, resulting in significant human and economic cost, which can be a challenge to identify and resolve in practice. Adherence tools have been developed to assist health care providers with managing medication nonadherence; however, there is a need to develop a literature base for using adherence tools effectively.
To (a) describe the experiences and perspectives of pharmacists and student pharmacists using the Adherence Estimator (AE) and Drug Adherence Work-up (DRAW) tools and (b) describe medication nonadherence issues identified via use of the AE and DRAW tools in community pharmacies and outpatient clinics.
A practice-based study involving 6 primary care clinics and 4 community pharmacies in Iowa and Michigan was conducted. Each adherence tool was administered approximately 20 times by pharmacists or student pharmacists to patients at each site, using a crossover design with randomization to the initial tool. Sites determined how to incorporate tools into workflow and how to select patients. Data from completed tools were analyzed descriptively. Data from an online survey completed by tool administrators about their experiences and suggestions were analyzed thematically.
Sites submitted 209 AE and 179 DRAW tools. Half of patients with a completed AE had at least 1 medication of medium or high risk of nonadherence, and 19% had at least 1 medication of high risk. For DRAW, 82% of patients reported at least 1 yes answer for reasons for nonadherence, and 58% reported 2. On average, the AE tool took 6.9 minutes, and the DRAW tool took 9.3 minutes. Forty-four surveys were submitted (20 community and 24 clinic). Two themes emerged from the open-ended responses: tool benefits and translating tools into practice. While the tools were useful for identifying specific reasons for nonadherence and promoting dialogue, they required additional time and effort from both patients and pharmacists. Health literacy, patient reluctance to discuss nonadherence, AE scaling, and DRAW length were voiced as concerns.
Both tools were useful for uncovering specific reasons for medication nonadherence in 5-10 minute encounters, but barriers exist to incorporating such tools into busy workflows.
药物依从性差是一个常见的问题，导致了巨大的人力和经济成本，这在实践中可能是一个挑战，难以识别和解决。已经开发了一些依从性工具来帮助医疗保健提供者管理药物依从性问题；然而，需要为有效地使用这些依从性工具建立一个文献基础。
（a）描述药剂师和实习药剂师使用依从性估计器（AE）和药物依从性评估（DRAW）工具的经验和观点，以及（b）描述通过在社区药房和门诊诊所使用 AE 和 DRAW 工具发现的药物依从性问题。
在爱荷华州和密歇根州的 6 个初级保健诊所和 4 家社区药房进行了一项基于实践的研究。每个依从性工具由药剂师或实习药剂师在每个地点大约使用 20 次，采用随机交叉设计，初始工具随机分配。各地点决定如何将工具纳入工作流程以及如何选择患者。使用描述性分析对完成的工具中的数据进行分析。对工具管理员完成的在线调查中关于他们的经验和建议的文本数据进行了主题分析。
各地点共提交了 209 份 AE 和 179 份 DRAW 工具。完成 AE 的患者中，有一半至少有一种药物存在中或高度的不依从风险，19%的患者至少有一种药物存在高度不依从风险。对于 DRAW，82%的患者报告至少有一个与不依从有关的“是”的答案，58%的患者报告有两个。平均而言，AE 工具需要 6.9 分钟，而 DRAW 工具需要 9.3 分钟。共提交了 44 份调查（20 份社区调查和 24 份诊所调查）。从开放式回答中出现了两个主题：工具的好处和将工具转化为实践。虽然这些工具对于发现药物不依从的具体原因和促进对话很有用，但它们需要患者和药剂师投入额外的时间和精力。健康素养、患者不愿讨论不依从、AE 量表和 DRAW 长度被认为是问题所在。
这两种工具都可以在 5-10 分钟的就诊中，发现药物不依从的具体原因，但是在将这些工具纳入繁忙的工作流程中存在障碍。
