Fuller Joanne M, Saini Bandana, Bosnic-Anticevich Sinthia, Garcia Cardenas Victoria, Benrimoj Shalom I, Armour Carol
The Graduate School of Health, University of Technology Sydney, Sydney, Australia; The Woolcock Institute of Medical Research, Sydney, Australia.
The Woolcock Institute of Medical Research, Sydney, Australia; Faculty of Pharmacy, University of Sydney, Sydney, Australia.
Res Social Adm Pharm. 2017 Sep-Oct;13(5):989-996. doi: 10.1016/j.sapharm.2017.05.019. Epub 2017 May 30.
Community pharmacists are well placed and evidence clearly demonstrates that they can be suitably trained to deliver professional services that improve the management of asthma patients in clinical, economic and humanistic terms. However the gap between this evidence and practice reality remains wide. In this study we measure the implementation process as well as the service benefits of an asthma service model.
Using an effectiveness-implementation hybrid design, a defined implementation process (progression from Exploration through Preparation and Testing to Operation stages) supporting an asthma service (promoting asthma control and inhaler technique) was tested in 17 community pharmacies across metropolitan Sydney.
Seven pharmacies reached the Operation stage of implementation. Eight pharmacies reached the Testing stage of implementation and two pharmacies did not progress beyond the Preparation stage of implementation. A total of 128 patients were enrolled in the asthma service with 110 patients remaining enrolled at the close of the study. Asthma control showed a positive trend throughout the service with the overall proportion of patients with 'poor' asthma control at baseline decreasing from 72% to 57% at study close. There was a statistically significant increase in the proportion of patients with correct inhaler technique from 12% at Baseline (Visit 1) to 33% at Visit 2 and 57% at study close.
Implementation of the asthma service varied across pharmacies. Different strategies specific to practice sites at different stages of the implementation model may result in greater uptake of professional services. The asthma service led to improved patient outcomes overall with a positive trend in asthma control and significant change in inhaler technique.
社区药剂师具备良好的条件，且有证据清楚表明，他们能够接受适当培训，以提供从临床、经济和人文角度改善哮喘患者管理的专业服务。然而，这一证据与实践现实之间的差距仍然很大。在本研究中，我们衡量了一种哮喘服务模式的实施过程以及服务效益。
采用有效性-实施混合设计，在悉尼大都市地区的17家社区药房对支持哮喘服务（促进哮喘控制和吸入器技术）的既定实施过程（从探索阶段逐步推进到准备、测试和运营阶段）进行了测试。
7家药房进入了实施的运营阶段。8家药房进入了实施的测试阶段，2家药房未超过实施的准备阶段。共有128名患者参加了哮喘服务，在研究结束时仍有110名患者参与。在整个服务过程中，哮喘控制呈现出积极趋势，基线时哮喘控制“不佳”的患者总体比例从72%降至研究结束时的57%。正确使用吸入器技术的患者比例从基线时（第1次就诊）的12%在第2次就诊时增至33%，在研究结束时增至57%，差异具有统计学意义。
哮喘服务在各药房的实施情况各不相同。针对实施模式不同阶段的实践场所采取不同策略，可能会使专业服务得到更多采用。哮喘服务总体上改善了患者的治疗效果，哮喘控制呈积极趋势，吸入器技术有显著变化。
