Wongpakaran R, Suansanae T, Tan-Khum T, Kraivichian C, Ongarjsakulman R, Suthisisang C
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
J Clin Pharm Ther. 2017 Jun;42(3):329-336. doi: 10.1111/jcpt.12518. Epub 2017 Mar 20.
Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient's function and quality of life. Due to the complicated neurobiological aetiology of autism spectrum disorder (ASD), a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population. We evaluate the impact of providing specialty psychiatry (PS) pharmacist intervention in identifying and resolving drug-related problems (DRPs) among children with ASD associated with disruptive behaviours.
An eight-week-long, prospective, randomized open-label study was conducted. Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included. They were randomly assigned to an intervention or a control group. Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist, while those in control group were cared by a hospital pharmacist. The primary outcome was the number of patients who resolved of at least one DRP by the end of the study. The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability (ABC-I) scores between the two groups.
Twenty-five patients were randomly assigned to either an intervention or control group. At week 8, the total number of patients who resolved of at least one DRP was 13 (52%) in the intervention group and 4 (16%) in the control group, respectively (P=.016). Improper drug selection, medication non-adherence and subtherapeutic dosage were the most common DRPs. Mean ABC-I scores improved in the intervention group more than in the control group (9.8±5.6 vs 17.7±7.9; P<.001).
To the best of our knowledge, this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD. The reduction in common DRPs mostly resulted from the PS pharmacist interventions, including selection of antipsychotic agent, adjustment of dosage based on ABC-I scores and provision of individualized drug counselling. Reducing DRPs led to the improvement of any disruptive behaviour. In addition, multidisciplinary team should develop drug therapy protocols to promote the role of pharmacists in this setting.
迄今为止，心理药物治疗一直专注于改善破坏性行为，以提高患者的功能和生活质量。由于自闭症谱系障碍（ASD）复杂的神经生物学病因，传统的药剂师干预可能不足以启动对这一弱势群体的最佳护理。我们评估提供专科精神病学（PS）药剂师干预对识别和解决与破坏性行为相关的ASD儿童药物相关问题（DRP）的影响。
进行了一项为期八周的前瞻性随机开放标签研究。纳入年龄在2.5至12岁之间、患有ASD且表现出破坏性行为的儿童。他们被随机分配到干预组或对照组。干预组患者接受PS药剂师提供的药剂师干预，而对照组患者由医院药剂师护理。主要结局是在研究结束时解决至少一个DRP的患者数量。次要结局是比较两组之间的平均异常行为检查表-易怒（ABC-I）评分。
25名患者被随机分配到干预组或对照组。在第8周时，干预组中解决至少一个DRP的患者总数为13名（52%），对照组为4名（16%）（P = 0.016）。药物选择不当、用药依从性差和治疗剂量不足是最常见的DRP。干预组的平均ABC-I评分改善程度大于对照组（9.8±5.6对17.7±7.9；P < 0.001）。
据我们所知，这是第一项证明PS药剂师干预是解决ASD患者DRP的有效策略的研究。常见DRP的减少主要源于PS药剂师的干预，包括抗精神病药物的选择、根据ABC-I评分调整剂量以及提供个性化的药物咨询。减少DRP导致任何破坏性行为得到改善。此外，多学科团队应制定药物治疗方案，以促进药剂师在这种情况下的作用。
