Twigg Michael J, Wright David J
School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK.
Integr Pharm Res Pract. 2017 Feb 7;6:53-59. doi: 10.2147/IPRP.S105279. eCollection 2017.
COPD is a leading cause of morbidity and mortality across the world and is responsible for a disproportionate use of health care resources. It is a progressive condition that is largely caused by smoking. Identification of early stage COPD provides an opportunity for interventions, such as smoking cessation, which prevent its progression. Once diagnosed, ongoing support services potentially provide an opportunity to assist the patient in managing their condition and working more closely with the rest of the primary care team. While there are a number of robust studies which have demonstrated the role which pharmacists could undertake to identify and prevent disease progression, adoption of such services is currently limited. As a service that would seem to be appropriate for adoption in all societies where smoking is prevalent, we have performed a review of reported approaches that have been used when setting up and evaluating such services, and therefore aim to inform researchers and policy makers in other countries on how best to proceed. Implementation science has been used to further contextualize the findings of the review in terms of components that are likely to enhance the likelihood of implementation. With reference to screening services, we have made clear recommendations as to the identification of patients, structure and smoking cessation elements of the program. Further work needs to be undertaken by policy makers to determine the approaches that can be used to motivate pharmacists to provide this service. In terms of ongoing support services, there is some evidence to suggest that these would be effective and cost-effective to the health service in which they are implemented. However, the capability, opportunity and motivation of pharmacists to provide these, more complex, services need to be the focus for researchers before implementation by policy makers.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因之一，且医疗资源使用比例失调。它是一种主要由吸烟导致的渐进性疾病。早期COPD的识别为干预措施提供了机会，如戒烟，以防止其病情进展。一旦确诊，持续的支持服务有可能为帮助患者管理病情并与初级保健团队的其他成员更紧密合作提供机会。虽然有许多有力研究表明药剂师在识别和预防疾病进展方面可发挥的作用，但此类服务的采用目前有限。作为一项似乎适用于所有吸烟盛行社会的服务，我们对设立和评估此类服务时所采用的报告方法进行了综述，旨在为其他国家的研究人员和政策制定者提供最佳实施方法的信息。实施科学已被用于根据可能提高实施可能性的组成部分，进一步将综述结果置于具体情境中。关于筛查服务，我们已就项目中患者的识别、结构和戒烟要素提出了明确建议。政策制定者需要开展进一步工作，以确定可用于激励药剂师提供此项服务的方法。就持续支持服务而言，有证据表明这些服务对实施它们的医疗服务而言是有效且具有成本效益的。然而，在政策制定者实施之前，药剂师提供这些更复杂服务的能力、机会和动力需要成为研究人员关注的焦点。
