Hackerson Meghan L, Luder Heidi R, Beck Andrew F, Wedig Joseph M, Heaton Pamela C, Frede Stacey M
J Am Pharm Assoc (2003). 2018 Jul-Aug;58(4S):S101-S108.e1. doi: 10.1016/j.japh.2018.04.012. Epub 2018 May 2.
To decrease nonadherence rates through the design and implementation of a collaborative prescription management program involving a community pharmacy and a large pediatric primary care center.
Kroger and Cincinnati Children's Pediatric Primary Care Center collaborated to identify and address patients' barriers to filling new prescriptions. After filling new medications for clinic patients, pharmacists telephoned patients to inform them that their prescription was ready and to reinforce the importance of initiating the therapy. Pharmacists followed up with families to address barriers when prescriptions remained at the pharmacy after 48 hours. Pharmacists communicated with prescribers if prescriptions were not filled, allowing the clinic staff to follow up.
The primary outcome of this prospective pilot study with a comparison group was primary nonadherence (PNA), defined as the proportion of patients who did not pick up prescriptions or a reasonable alternative within 30 days after the pharmacy received the prescription. Secondary outcomes were the impact on secondary nonadherence and identification of adherence barriers.
Fifty-nine patients were enrolled from November 2016 to April 2017. Characteristics between the intervention group and a standard-care group were similar. The majority of prescribed medications were for acute conditions, the average patient age was 4.9 years, and 86% of patients were covered by Medicaid. Intervention patients had significantly less PNA compared with the standard-care group (14.0% vs. 53.3%, respectively; P < 0.001). Intervention patients had significantly greater secondary adherence rates compared with standard-care patients (38.8% vs. 7%; P < 0.001). Common barriers likely resulting in PNA included lack of time, lack of urgency, transportation challenges, and cost.
Increased communication between the primary care provider and the community pharmacy, coupled with targeted patient-specific interventions before the initial fill of medications, resulted in significant reductions in PNA.
通过设计并实施一项涉及社区药房和大型儿科初级保健中心的协作处方管理计划，降低不依从率。
克罗格公司与辛辛那提儿童医院儿科初级保健中心合作，以识别并解决患者在新处方取药方面的障碍。为门诊患者配好新药物后，药剂师会打电话通知患者处方已备好，并强调开始治疗的重要性。如果处方在48小时后仍留在药房，药剂师会跟进家庭以解决障碍。如果处方未配好，药剂师会与开处方者沟通，以便诊所工作人员进行跟进。
这项设有对照组的前瞻性试点研究的主要结果是初次不依从（PNA），定义为药房收到处方后30天内未取走处方或合理替代药物的患者比例。次要结果是对二次不依从的影响以及对依从性障碍的识别。
2016年11月至2017年4月共招募了59名患者。干预组和标准治疗组之间的特征相似。大多数处方药物用于治疗急性病症，患者平均年龄为4.9岁，86%的患者参加了医疗补助计划。与标准治疗组相比，干预组的PNA显著更低（分别为14.0%和53.3%；P<0.001）。与标准治疗组患者相比，干预组患者的二次依从率显著更高（38.8%和7%；P<0.001）。可能导致PNA的常见障碍包括时间不足、缺乏紧迫感、交通困难和费用问题。
初级保健提供者与社区药房之间加强沟通，再加上在首次配药前针对患者的特定干预措施，可显著降低PNA。
