Salter Sandra M, Delfante Brock, de Klerk Sarah, Sanfilippo Frank M, Clifford Rhonda M
Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
BMJ Open. 2014 Jul 9;4(7):e005648. doi: 10.1136/bmjopen-2014-005648.
To evaluate how community pharmacists manage patients with anaphylaxis.
A randomised, cross-sectional, simulated patient study of community pharmacist practice.
300 metropolitan pharmacies located in Perth Australia, randomised to three groups of 100 pharmacies. Each group corresponded to a different epinephrine autoinjector: original EpiPen, new-look EpiPen or Anapen.
300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen).
Primary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis).
Simulated patients approached pharmacists, using a standardised scenario, for assistance with epinephrine autoinjector use and advice about the use of antihistamines in anaphylaxis. Scores for each outcome were obtained based on the number of predefined statements addressed by the pharmacist during the consultation (maximum score=5 for preparedness and 8 for engagement).
The mean anaphylaxis preparedness score was 2.39 points (SD 1.17). Scores for new-look EpiPen were significantly higher than for original EpiPen and Anapen (2.75 vs 2.38 points, p=0.027; 2.75 vs 2.03 points, p<0.001, respectively). Overall, 17.3% of pharmacists correctly demonstrated the epinephrine autoinjector. The mean anaphylaxis engagement score was 3.11 points (SD 1.73). Scores for new-look EpiPen were similar to original EpiPen and Anapen (3.11 vs 3.32 points; 3.11 vs 2.90 points, both p=0.42). Engagement was associated with preparedness. For each additional engagement point, preparedness increased by 7% (0.357 points; 95% CI 0.291 to 0.424; p<0.001).
Pharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis action plans. Pharmacists who had a more comprehensive discussion about anaphylaxis with patients, were more prepared for anaphylaxis emergencies. Future research should evaluate the nature and significance of errors in pharmacists' autoinjector technique.
评估社区药剂师如何管理过敏反应患者。
一项关于社区药剂师实践的随机、横断面模拟患者研究。
位于澳大利亚珀斯的300家都市药房，随机分为三组，每组100家药房。每组对应一种不同的肾上腺素自动注射器：原装EpiPen、新版EpiPen或Anapen。
访问了300家药房，最终分析纳入了271次模拟患者就诊（88次使用原装EpiPen，92次使用新版EpiPen，91次使用Anapen）。
主要指标为过敏反应准备情况（治疗急性过敏反应的准备程度）。次要指标为过敏反应参与度（与患者就其过敏反应进行讨论的意愿）。
模拟患者采用标准化场景向药剂师寻求肾上腺素自动注射器使用方面的帮助以及关于过敏反应中使用抗组胺药的建议。根据药剂师在咨询过程中涉及的预定义陈述数量获得每个观察指标的得分（准备情况最高分为5分，参与度最高分为8分）。
过敏反应准备情况的平均得分为2.39分（标准差1.17）。新版EpiPen的得分显著高于原装EpiPen和Anapen（分别为2.75分对2.38分，p = 0.027；2.75分对2.03分，p < 0.001）。总体而言，17.3%的药剂师正确演示了肾上腺素自动注射器的使用方法。过敏反应参与度的平均得分为3.11分（标准差1.73）。新版EpiPen的得分与原装EpiPen和Anapen相似（分别为3.11分对3.32分；3.11分对2.90分，p均为0.42）。参与度与准备情况相关。参与度每增加1分，准备情况提高7%（0.357分；95%置信区间0.291至0.424；p < 0.001）。
药剂师对过敏反应症状和急救知识有一定了解，但肾上腺素自动注射器使用技术较差，且很少讨论过敏反应行动计划。与患者就过敏反应进行更全面讨论的药剂师，对过敏反应紧急情况的准备更充分。未来研究应评估药剂师自动注射器使用技术错误的性质和意义。
