Iihara Naomi, Ohara Eri, Nishio Takayuki, Muguruma Hiroshi, Matsuoka Eitoku, Houchi Hitoshi, Kirino Yutaka
Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University.
Department of Pharmacy, Sanuki City Hospital.
Yakugaku Zasshi. 2017;137(9):1161-1167. doi: 10.1248/yakushi.17-00086.
Some patients do not inform healthcare professionals of adverse drug reactions (ADRs) because they fear termination of aggressive medication therapies. Preferences for aggressive medication therapies may differ between patients and pharmacists. The goal of this study was to estimate whether pharmacists were able to accurately assess patient preference for aggressive medication therapies with potentially stronger ADRs. A cross-sectional study was conducted of hospitalized patients (35 to 74 years of age) receiving oral medications for a chronic disease or systemic chemotherapy at three hospitals in Japan. We estimated the extent of agreement between patient responses and pharmacist predictions using a scenario-based investigation (1) to examine the choice between an aggressive medication therapy and the standard therapy, and (2) to assess increased life expectancy as a result of aggressive medication therapy. The extent of agreement was estimated using the kappa statistic. Of 113 patients, 43 (38.1%) chose the aggressive medication therapy. Pharmacists correctly predicted the choice of 25 (58.1%) of these patients [kappa 0.32 (95% confidence interval 0.15-0.50)]. Of 111 patients, 42 (37.8%) expected one additional life expectancy year. However, pharmacists predicted that as many as 36 (85.7%) of these patients would require more years of added life expectancy before choosing an aggressive medication therapy [kappa 0.24 (0.08-0.40)]. Agreement between patients and pharmacists on the choice of aggressive medication therapy was generally poor. Pharmacists should make an effort to identify patients who might prefer more aggressive medication therapies with potentially stronger ADRs in order to minimize ADR risk.
一些患者不向医疗保健专业人员告知药物不良反应（ADR），因为他们担心积极的药物治疗会终止。患者和药剂师对积极药物治疗的偏好可能不同。本研究的目的是评估药剂师是否能够准确评估患者对可能有更强ADR的积极药物治疗的偏好。在日本的三家医院对35至74岁接受口服药物治疗慢性病或全身化疗的住院患者进行了一项横断面研究。我们使用基于情景的调查估计了患者反应与药剂师预测之间的一致程度，（1）检查积极药物治疗和标准治疗之间的选择，以及（2）评估积极药物治疗导致的预期寿命增加。使用kappa统计量估计一致程度。在113名患者中，43名（38.1%）选择了积极药物治疗。药剂师正确预测了其中25名（58.1%）患者的选择[kappa 0.32（95%置信区间0.15 - 0.50）]。在111名患者中，42名（37.8%）预期多活一年。然而，药剂师预测，这些患者中多达36名（85.7%）在选择积极药物治疗之前需要多活更多年[kappa 0.24（0.08 - 0.40）]。患者和药剂师在积极药物治疗选择上的一致性普遍较差。药剂师应努力识别可能更喜欢有更强ADR风险的更积极药物治疗的患者，以尽量降低ADR风险。
