影响社区药剂师主导的药物审查服务提供的因素：来自安大略省药物审查年度服务的证据
Factors affecting the delivery of community pharmacist-led medication reviews: evidence from the MedsCheck annual service in Ontario.
作者信息
Pechlivanoglou Petros, Abrahamyan Lusine, MacKeigan Linda, Consiglio Giulia P, Dolovich Lisa, Li Ping, Cadarette Suzanne M, Rac Valeria E, Shin Jonghyun, Krahn Murray
机构信息
Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.
The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay st, Toronto, M5G0A4, ON, Canada.
出版信息
BMC Health Serv Res. 2016 Nov 21;16(1):666. doi: 10.1186/s12913-016-1888-2.
BACKGROUND
Medication reviews have become part of pharmacy practice across developed countries. This study aimed to identify factors affecting the likelihood of eligible Ontario seniors receiving a pharmacy-led medication review called MedsCheck annual (MCA).
METHODS
We designed a cohort study using a random sample of pharmacy claims for MCA-eligible Ontario seniors using linked administrative data from April 2012 to March 2013. Guided by a conceptual framework, we constructed a generalized-estimating-equations model to estimate the effect of patient, pharmacy and community factors on the likelihood of receiving MCA.
RESULTS
Of the 2,878,958 eligible claim-dates, 65,605 included an MCA. Compared to eligible individuals who did not receive an MCA, recipients were more likely to have a prior MCA (OR = 3.03), receive a new medication on the claim-date (OR = 1.78), be hypertensive (OR = 1.18) or have a recent hospitalization (OR = 1.07). MCA recipients had fewer medications (e.g., OR = 0.44 for ≥12 medications versus 0-4 medications), and were less likely to receive an MCA in a rural (OR = 0.74) or high-volume pharmacy (OR = 0.65).
CONCLUSIONS
The most important determinant of receiving an MCA was having had a prior MCA. Overall, MCA recipients were healthier, younger, urban-dwelling, and taking fewer medications than non-recipients. Policies regarding current and future medication review programs may need to evolve to ensure that those at greatest need receive timely and comprehensive medication reviews.
背景
药物审查已成为发达国家药学实践的一部分。本研究旨在确定影响安大略省符合条件的老年人接受名为年度药物检查（MCA）的由药剂师主导的药物审查可能性的因素。
方法
我们使用2012年4月至2013年3月的关联行政数据，对安大略省符合MCA条件的老年人的药房报销申请进行随机抽样，设计了一项队列研究。在一个概念框架的指导下，我们构建了一个广义估计方程模型，以估计患者、药房和社区因素对接受MCA可能性的影响。
结果
在2,878,958个符合条件的报销日期中，65,605个包含MCA。与未接受MCA的符合条件个体相比，接受者更有可能之前接受过MCA（比值比[OR]=3.03），在报销日期接受新药物治疗（OR=1.78），患有高血压（OR=1.18）或近期住院（OR=1.07）。接受MCA的患者用药较少（例如，≥12种药物与0 - 4种药物相比，OR=0.44），并且在农村地区（OR=0.74）或大容量药房接受MCA的可能性较小（OR=0.65）。
结论
接受MCA的最重要决定因素是之前接受过MCA。总体而言，与未接受者相比，接受MCA的人更健康、更年轻、居住在城市且用药较少。当前和未来药物审查项目的政策可能需要改进，以确保最需要的人能够及时获得全面的药物审查。
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