Marvanova Marketa, Henkel Paul Jacob
J Am Pharm Assoc (2003). 2017 Sep-Oct;57(5):596-600.e1. doi: 10.1016/j.japh.2017.05.011. Epub 2017 Jul 18.
This pilot study examined community pharmacists' knowledge to provide care and services for persons with Alzheimer disease (AD) and area income-based disparities in knowledge and availability of cognitive enhancers.
A cross-sectional telephone survey of pharmacies (n = 137) in high- and low-income areas in Chicago was conducted on pharmacists' degree, experience, and continuing education, as well as knowledge of AD disease and treatment expectations, adverse effects (AEs) of donepezil, and self-care recommendations for insomnia. Pharmacies were selected from highest- and lowest-income zip code areas, defined using household area median incomes from the 2008-2012 American Community Survey 5-Year Estimates. In-stock availability of select cognitive enhancers was obtained. Chi-square, Fisher exact test, and simple and multiple logistic regression analyses were performed with the use of Stata 10.1.
Odds were 70% lower that pharmacists in low-income areas would say there was nothing to reverse the course of AD (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13-0.70) and 7 times greater that they would recommend a medication to reverse the course of AD (OR 7.04, 95% CI 2.19-22.62) compared with pharmacists in high-income areas. Odds were more than 50% lower that pharmacists in low-income areas would name at least 1 adverse effect for donepezil (OR 0.42, 95% CI 0.19-0.92) compared with peers in high-income areas. Pharmacies in low-income areas had lower odds of having 4 of the 5 surveyed formulations of cognitive enhancers in stock.
It is concerning that 20%-30% of pharmacists recommended a medication to "reverse" the course of AD, about one-half of pharmacists could not mention a single adverse effect of donepezil, and more than one-fourth of pharmacists made an inappropriate self-care sleep aid recommendation for a person with AD who was using rivastigmine patch. Although overall results regarding pharmacists' knowledge were poor, performance was significantly poorer in low-income areas. As our AD population increases, we need to strengthen pharmacists' knowledge on and competencies important for pharmacy-related AD care.
本试点研究调查了社区药剂师为阿尔茨海默病（AD）患者提供护理和服务的知识水平，以及基于地区收入的认知增强剂知识和可及性方面的差异。
对芝加哥高收入和低收入地区的药房（n = 137）进行横断面电话调查，内容包括药剂师的学位、经验和继续教育，以及对AD疾病的了解、治疗期望、多奈哌齐的不良反应（AE）和失眠的自我护理建议。药房从2008 - 2012年美国社区调查5年估计的最高和最低收入邮政编码地区中选取。获取了选定认知增强剂的库存情况。使用Stata 10.1进行卡方检验、Fisher精确检验以及简单和多元逻辑回归分析。
与高收入地区的药剂师相比，低收入地区的药剂师表示没有办法逆转AD病程的可能性低70%（优势比[OR] 0.30，95%置信区间[CI] 0.13 - 0.70），而他们推荐药物逆转AD病程的可能性高7倍（OR 7.04，95% CI 2.19 - 22.62）。与高收入地区的同行相比，低收入地区的药剂师说出多奈哌齐至少一种不良反应的可能性低50%以上（OR 0.42，95% CI 0.19 - 0.92）。低收入地区的药房库存5种被调查认知增强剂制剂中4种的可能性较低。
令人担忧的是，20% - 30%的药剂师推荐药物“逆转”AD病程，约一半的药剂师说不出多奈哌齐的任何一种不良反应，超过四分之一的药剂师为正在使用卡巴拉汀贴片的AD患者给出了不恰当的自我护理助眠建议。尽管药剂师知识的总体结果较差，但低收入地区的表现明显更差。随着我们AD患者群体的增加，我们需要加强药剂师对与药房相关的AD护理重要的知识和能力。
