Slipp Marlene, Burnham Robert
Central Alberta Pain and Rehabilitation Institute (Slipp, Burnham), Lacombe, Alberta.
Can Pharm J (Ott). 2017 Feb 8;150(2):112-117. doi: 10.1177/1715163517690540. eCollection 2017 Mar-Apr.
The prevalence of chronic pain is high and increasing. Medication management is an important component of chronic pain management. There is a shortage of physicians who are available and comfortable providing this service. In Alberta, pharmacists have been granted an advanced scope of practice. Given this empowerment, their availability, training and skill set, pharmacists are well positioned to play an expanded role in the medication management of chronic pain sufferers.
To compare the effectiveness and cost of a physician-only vs a pharmacist-physician team model of medication management for chronic nonmalignant pain sufferers.
Data was analyzed for 89 patients who had received exclusively medication management at a rural Alberta multidisciplinary clinic. 56 were managed by a sole physician. 33 were managed by a team (pharmacist + physician). In the team model, the physician did the medical assessment, diagnosis, and established a treatment plan in consultation with the patient and pharmacist. The pharmacist then provided the ongoing follow-up including education, dose titration and side effect management and consulted with the physician as needed. Change in pain (Numerical Rating Scale) and disability (Pain Interference Questionnaire) over the course of treatment were recorded. The treatment duration and number of visits were used to calculate cost of care.
Both models of medication management resulted in significant and comparable improvements in pain, disability and patient perception of medication effectiveness. Patients in the physician-only group were seen more frequently and at a greater cost. The pharmacist-physician team approach was markedly more cost-effective, and patients expressed a high level of satisfaction with their medication management.
The pharmacist-physician team model of medication management results in significant reductions of pain and disability for chronic nonmalignant pain sufferers at a reduced cost and is well accepted by patients.
慢性疼痛的患病率很高且呈上升趋势。药物管理是慢性疼痛管理的重要组成部分。能够提供此项服务且对此感到得心应手的医生短缺。在艾伯塔省，药剂师已被授予更广泛的执业范围。鉴于这种授权、他们的可及性、培训和技能组合，药剂师在慢性疼痛患者的药物管理中很适合发挥更大的作用。
比较仅由医生进行药物管理与药剂师 - 医生团队模式对慢性非恶性疼痛患者进行药物管理的有效性和成本。
对在艾伯塔省农村多学科诊所仅接受药物管理的89名患者的数据进行了分析。56名患者由一名医生单独管理。33名患者由一个团队（药剂师 + 医生）管理。在团队模式中，医生进行医学评估、诊断，并与患者和药剂师协商制定治疗计划。然后药剂师提供持续随访，包括教育、剂量滴定和副作用管理，并根据需要与医生协商。记录治疗过程中疼痛（数字评分量表）和残疾（疼痛干扰问卷）的变化。治疗持续时间和就诊次数用于计算护理成本。
两种药物管理模式在疼痛、残疾和患者对药物有效性的感知方面均取得了显著且相当的改善。仅由医生管理的患者就诊更频繁，成本更高。药剂师 - 医生团队模式明显更具成本效益，患者对其药物管理表示高度满意。
药剂师 - 医生团队药物管理模式可显著减轻慢性非恶性疼痛患者的疼痛和残疾，降低成本，且患者接受度高。
