Wright David, Twigg Michael, Barton Garry, Thornley Tracey, Kerr Clare
School of Pharmacy, University of East Anglia, Norwich, UK.
Int J Pharm Pract. 2015 Feb;23(1):36-43. doi: 10.1111/ijpp.12165. Epub 2014 Nov 20.
Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition that can be effectively managed by smoking-cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management, and COPD is one area where they are ideally located to provide a comprehensive service. This study aims to evaluate the effect of a community pharmacy-based COPD service on patient outcomes.
Patients in one UK location were recruited over a 10-week period to receive a community pharmacy-based COPD support service consisting of signposting to or provision of smoking-cessation service, therapy optimisation and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data were collected over a 6-month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and National Health Service (NHS) resource utilisation were measured.
Three hundred six patients accessed the service. Data to enable comparison before and after intervention was available for 137 patients. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine general practitioner (GP) visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and accident and emergency visits and hospital admissions).
Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective.
慢性阻塞性肺疾病（COPD）是一种渐进性慢性病，可通过戒烟、优化处方治疗以及提供预防胸部感染导致住院的治疗来有效管理。英国政府的议程是让社区药剂师参与慢性病管理，而COPD是他们最适合提供全面服务的领域之一。本研究旨在评估基于社区药房的COPD服务对患者结局的影响。
在英国一个地区，在10周内招募患者接受基于社区药房的COPD支持服务，包括指向戒烟服务或提供戒烟服务、治疗优化以及建议获取包含类固醇和抗生素的急救包以预防因胸部感染导致的住院。在6个月内收集所有招募患者的数据。测量适当的临床结局、患者报告的药物依从性、生活质量和国民医疗服务体系（NHS）资源利用情况。
306名患者使用了该服务。有137名患者可获得干预前后进行比较的数据。发现患者报告的依从性、急救包的使用、生活质量有显著改善，且常规全科医生（GP）就诊次数减少。估计干预成本因其他NHS服务（GP、急诊就诊和住院）使用的减少而得到抵消。
结果表明该服务改善了患者的服药行为，且具有成本效益。
