University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
J Manag Care Spec Pharm. 2014 Aug;20(8):786-92. doi: 10.18553/jmcp.2014.20.8.786.
Community pharmacies provide a promising platform for monitoring and improving therapy adherence and providing pharmaceutical care. Structured methods and appropriate software are important tools to increase pharmacist effectiveness and improve health outcomes. In 2006, the Medication Monitoring and Optimization (MeMO) program was introduced in several community pharmacies in the Netherlands. MeMO facilitates targeted and continuous patient-centered pharmaceutical care around chronic medication, such as for osteoporosis, cardiovascular disease, and asthma/chronic obstructive pulmonary disease (COPD).
To describe the MeMO program and summarize findings from publications on its effectiveness, patient satisfaction, and cost-effectiveness.
In the first part of this article, the MeMO program is extensively described. In the second part, a review of the evidence of effectiveness, cost-effectiveness, and patient satisfaction of the MeMO program is provided. Evidence is based on 5 previously published articles.
The MeMO program starts with structured counseling sessions with patients at the initiation and follow-up of chronic therapies. This process is followed by a continuous phase in which patients' therapy adherence is monitored on a monthly basis, using standardized search algorithms in the pharmacy database. When the algorithm detects a patient's discontinuation of therapy, tailored interventions are used to improve adherence and optimize pharmacotherapy. For osteoporosis patients, treatment discontinuation with bisphosphonates after 1 year dropped from 31.7% to 16.1% (P less than 0.001). This program was shown to be cost-effective in patients initiating osteoporotic therapy. Future scenarios with lower drug prices (e.g., from generic prescribing) result in cost savings for the MeMO program. For lipid-lowering drugs, the MeMO program has been shown to lower therapy discontinuation after 1 year from 25.9% to 13.6% (P less than 0.001). By extrapolating these results to patients' lifetimes, the intervention was estimated to be cost-effective, with gains for primary prevention of cardiovascular events, and even cost saving in secondary prevention. Results from the ongoing MeMO asthma/COPD program are promising, showing marked improvements in therapy control and quality of life for asthma and COPD patients. Almost all patients participating in MeMO programs are satisfied with the pharmacy team and have gained knowledge of the effectiveness and administration of their medications and the importance of therapy adherence.
The MeMO program is an effective and structured method to improve patients' adherence to chronic medication in the field of osteoporosis, lipid-lowering drugs, and asthma/COPD and is well received by patients. By targeting the program toward nonadherent and high-risk patients, the program showed favorable cost-effectiveness.
社区药店为监测和改善治疗依从性并提供药学服务提供了一个有前景的平台。结构化方法和适当的软件是提高药剂师效率和改善健康结果的重要工具。2006 年，荷兰的几家社区药店引入了药物监测和优化（MeMO）计划。MeMO 围绕慢性药物（如骨质疏松症、心血管疾病和哮喘/慢性阻塞性肺疾病（COPD））促进有针对性的、持续的以患者为中心的药物护理。
描述 MeMO 计划，并总结关于其有效性、患者满意度和成本效益的出版物的发现。
本文的第一部分详细描述了 MeMO 计划。第二部分提供了关于 MeMO 计划的有效性、成本效益和患者满意度的证据综述。证据基于之前发表的 5 篇文章。
MeMO 计划从慢性治疗开始和随访时与患者进行结构化咨询开始。然后进入一个连续阶段，每月使用药店数据库中的标准化搜索算法监测患者的治疗依从性。当算法检测到患者停止治疗时，会使用定制的干预措施来提高依从性并优化药物治疗。对于骨质疏松症患者，使用双膦酸盐治疗 1 年后的停药率从 31.7%降至 16.1%（P<0.001）。该计划在开始骨质疏松症治疗的患者中显示出成本效益。未来的情况，如药物价格降低（例如，从通用处方），则为 MeMO 计划节省成本。对于降脂药物，MeMO 计划显示 1 年后的停药率从 25.9%降至 13.6%（P<0.001）。通过将这些结果外推到患者的一生中，该干预措施被估计为具有成本效益，为心血管事件的一级预防带来收益，甚至在二级预防中节省成本。正在进行的 MeMO 哮喘/COPD 计划的结果很有希望，显示出哮喘和 COPD 患者的治疗控制和生活质量显著改善。参与 MeMO 计划的几乎所有患者都对药店团队满意，并获得了有关其药物疗效和管理以及治疗依从性重要性的知识。
MeMO 计划是一种有效的结构化方法，可以改善骨质疏松症、降脂药物和哮喘/COPD 领域患者对慢性药物的依从性，并且深受患者欢迎。通过将该计划针对非依从性和高风险患者，该计划显示出有利的成本效益。
