Kharjul Mangesh, Braund Rhiannon, Green James
School of Pharmacy, University of Otago, Dunedin, New Zealand.
Int J Clin Pharm. 2018 Apr;40(2):354-359. doi: 10.1007/s11096-018-0606-z. Epub 2018 Feb 21.
Background Adherence to treatment is important to achieve target outcomes, particularly for those with type 2 diabetes. Pharmacists are well placed to enhance adherence, however evidence of the impact on clinical outcomes is not well known. Objective To determine the impact of an adherence support service on adherence scores and subsequent clinical biomarkers (HbA1c). Setting Community pharmacies providing a Medicines Use Review (MUR) Service in a New Zealand locality. Methods Records of patients receiving MURs between 2007 and 2012 were obtained from a single locality. Data extraction included: individual characteristics, the adherence score assigned at every consultation, pathology records. Patients receiving oral hypoglycaemic medications (n = 86) were included in the final analysis using generalised estimating equations to explore change in HbA1c over time, and whether this was related to the adherence score. Main Outcome Measures (a) change in adherence scores and (b) association between adherence sores and HbA1c. Results A total of 350 records were obtained, of those, 115 of 350 people had follow up MUR visit/s and could be analysed for changes in adherence. Most people (110/115) showed sustained or improved adherence scores with follow up visits. For those receiving oral hypoglycaemic medications (n = 86); where poor adherence scores were recorded, their HbA1c levels were higher and continued to increase by ~ 0.1% (1 mmol/mol) every 10 weeks, B = 0.11, p = 0.009. Conversely, those with high adherence scores showed an overall decrease in HbA1c levels. Conclusion MURs may positively influence medication adherence. This improved adherence shows a measurable decline in HbA1c levels.
坚持治疗对于实现目标疗效很重要，尤其是对于2型糖尿病患者。药剂师在提高治疗依从性方面具有优势，然而，其对临床疗效影响的证据尚不明确。目的：确定一项依从性支持服务对依从性评分及后续临床生物标志物（糖化血红蛋白）的影响。地点：新西兰某地区提供用药回顾（MUR）服务的社区药房。方法：从一个地区获取2007年至2012年间接受MUR服务患者的记录。数据提取包括：个体特征、每次咨询时分配的依从性评分、病理记录。使用广义估计方程对接受口服降糖药治疗的患者（n = 86）进行最终分析，以探讨糖化血红蛋白随时间的变化，以及这是否与依从性评分相关。主要观察指标：（a）依从性评分的变化；（b）依从性评分与糖化血红蛋白之间的关联。结果：共获得350份记录，其中350人中有115人接受了后续MUR随访，可分析依从性变化。大多数人（110/115）随访时依从性评分持续或有所提高。对于接受口服降糖药治疗的患者（n = 86），依从性评分较低者，糖化血红蛋白水平较高，且每10周持续升高约0.1%（1 mmol/mol），B = 0.11，p = 0.009。相反，依从性评分高者糖化血红蛋白水平总体下降。结论：用药回顾可能对药物依从性产生积极影响。依从性提高表明糖化血红蛋白水平有可测量的下降。
