药物治疗对慢性阻塞性肺疾病（COPD）患者用药依从性和住院的影响：一项随机对照研究。
Effect of pharmaceutical care on medication adherence and hospital admission in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled study.
机构信息
1 Pharmacy Department of First Affiliated Hospital, 2 Guangzhou Institute of Respiratory Disease of First Affiliated Hospital, 3 Pharmacology Department of Pharmaceutical College, Guangzhou Medical University, Guangzhou 510182, China.
出版信息
J Thorac Dis. 2014 Jun;6(6):656-62. doi: 10.3978/j.issn.2072-1439.2014.06.20.
BACKGROUND
Poor adherence leads to a high rate of exacerbation and poor health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). However, few strategies are acceptable and effective in improving medication adherence. We investigated whether pharmaceutical care by clinical pharmacists could reinforce medication adherence to reduce exacerbation and improve HRQoL.
METHODS
A randomized controlled study was carried out at The First Affiliated Hospital of Guangzhou Medical University from February 2012 to January 2014. Non-adherence patients were randomly assigned to receive pharmaceutical care or to usual care. The pharmaceutical care consisted of individualized education and a series of telephone counseling for 6 months provided by clinical pharmacists. Medication adherence was measured by pill counts plus direct interview at 1- and 6-month pharmaceutical care and one-year follow-up. Severe exacerbations were defined as events that led to hospitalization for acute COPD attack. An interview was conducted to investigate hospital admissions and evaluate severe exacerbations at one-year follow-up. HRQoL was measured by St George's Respiratory Questionnaire at 6 months.
RESULTS
At 6-month pharmaceutical care and one-year follow-up, the pharmaceutical care group exhibited higher medication adherence than the usual care group (73.4±11.1 vs. 55.7±11.9, P=0.016 and 54.4±12.5 vs. 66.5±8.6, P=0.039, respectively). There are 60 acute exacerbations resulted in a hospital admission in the usual group while 37 ones in the pharmaceutical care group during one-year follow-up (P=0.01). Hospital admissions due to acute exacerbation in the pharmaceutical care group were 56.3% less than the usual care group (P=0.01). There was a significant difference in the symptoms and impact subscales respectively at 6-month pharmaceutical care between two groups (P=0.032, P=0.018).
CONCLUSIONS
Individualized pharmaceutical care improved medication adherence, reduced hospitalization and elevated HRQoL in patients with COPD.
背景
在慢性阻塞性肺疾病（COPD）患者中，药物依从性差会导致高频率恶化和较差的健康相关生活质量（HRQoL）。然而，改善药物依从性的策略很少是可接受且有效的。我们研究了临床药师提供的药物治疗是否可以增强药物依从性，以减少恶化并改善 HRQoL。
方法
一项随机对照研究于 2012 年 2 月至 2014 年 1 月在广州医科大学第一附属医院进行。非依从性患者被随机分配接受药物治疗或常规护理。药物治疗包括由临床药师提供的个体化教育和为期 6 个月的一系列电话咨询。通过在药物治疗的 1 个月和 6 个月以及 1 年随访时进行药物计数和直接访谈来衡量药物依从性。严重恶化被定义为导致因急性 COPD 发作住院的事件。在 1 年随访时进行访谈以调查住院情况并评估严重恶化。在 6 个月时通过圣乔治呼吸问卷测量 HRQoL。
结果
在药物治疗的 6 个月和 1 年随访时，药物治疗组的药物依从性高于常规护理组（分别为 73.4±11.1 与 55.7±11.9，P=0.016 和 54.4±12.5 与 66.5±8.6，P=0.039）。在 1 年随访期间，常规组中有 60 例急性恶化导致住院，而药物治疗组中有 37 例（P=0.01）。药物治疗组因急性恶化导致的住院率比常规护理组低 56.3%（P=0.01）。在药物治疗的 6 个月时，两组在症状和影响亚量表方面有显著差异（P=0.032，P=0.018）。
结论
个体化药物治疗改善了 COPD 患者的药物依从性，减少了住院治疗，并提高了 HRQoL。
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