Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.
Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal, Centre Intégré de Santé et de Services Sociaux de Laval, Quebec, Canada.
Res Social Adm Pharm. 2019 Feb;15(2):145-153. doi: 10.1016/j.sapharm.2018.04.004. Epub 2018 Apr 6.
Drug-related problems (DRPs) are highly prevalent in chronic kidney disease (CKD) patients. Community pharmacists are ideally positioned to manage these DRPs. However, little is known about the factors influencing their interventions with CKD patients.
Using the theory of planned behavior (TPB), this qualitative study sought to: (1) explore the behavioral beliefs (perceived advantages and disadvantages), normative beliefs (perceived expectations of significant others) and control beliefs (perceived barriers and facilitators) influencing community pharmacists' interventions related to identifying and managing DRPs in CKD; and (2) compare these beliefs among three DRPs prevalent in CKD patients.
Community pharmacists in Quebec, Canada participated in face-to-face individual semi-structured interviews. The topic guide was based on the TPB. Three vignettes were presented to stimulate community pharmacists' thoughts about their interventions regarding: (1) the use of an inappropriate over-the-counter laxative; (2) prescriptions of anti-inflammatory medications; and (3) non-adherence to antihypertensive medication. Integral transcripts of audio recordings were analyzed using thematic analysis. The findings on each of the three DRPs were systematically compared.
Fifteen community pharmacists participated in the study. All expressed a positive attitude toward DRP management, mentioning advantages such as gaining the patient's loyalty as a client and avoiding CKD complications. Participants mentioned that patients and physicians generally approve their interventions, but the dynamics of these relationships may vary depending on the DRP. Common barriers in the management of the three DRPs were the pharmacists' limited time and heavy workloads. The pharmacists felt that the main disadvantage is that these interventions interrupt the workflow in the pharmacy.
Community pharmacists hold positive views of their interventions in CKD. However, enhancing community pharmacists' involvement in CKD care may require measures to facilitate pharmacists' proactivity, inter-professional collaboration and a work organization adapted to clinical activities.
药物相关问题（DRPs）在慢性肾脏病（CKD）患者中非常普遍。社区药剂师是管理这些 DRPs 的理想人选。然而，对于影响他们对 CKD 患者干预的因素知之甚少。
本研究使用计划行为理论（TPB），旨在：（1）探讨影响社区药剂师干预 CKD 患者识别和管理 DRPs 的行为信念（感知优势和劣势）、规范信念（感知重要他人的期望）和控制信念（感知障碍和促进因素）；（2）比较三种在 CKD 患者中常见的 DRPs 之间的这些信念。
加拿大魁北克省的社区药剂师参加了面对面的个人半结构化访谈。主题指南基于 TPB。呈现了三个案例来激发社区药剂师对以下方面的干预措施的思考：（1）使用不适当的非处方轻泻剂；（2）开具抗炎药物；（3）不遵守抗高血压药物治疗。使用主题分析对音频记录的完整转录本进行分析。对三种 DRP 中的每一种的发现进行了系统比较。
15 名社区药剂师参加了研究。所有人都对 DRP 管理持积极态度，提到了一些优势，例如赢得患者作为客户的忠诚度并避免 CKD 并发症。参与者提到，患者和医生通常都认可他们的干预措施，但这些关系的动态可能因 DRP 而异。在管理三种 DRP 时的共同障碍是药剂师有限的时间和繁重的工作量。药剂师认为，主要的缺点是这些干预措施会中断药店的工作流程。
社区药剂师对其在 CKD 中的干预措施持有积极的看法。然而，要增强社区药剂师对 CKD 护理的参与，可能需要采取措施促进药剂师的积极性、跨专业合作以及适应临床活动的工作组织。
