Dillon Paul, Smith Susan M, Gallagher Paul, Cousins Gráinne
School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland.
Department of General Practice and HRB Centre for Primary Care Research, RCSI, St. Stephen's Green, Dublin 2, Ireland.
Int J Pharm Pract. 2019 Feb;27(1):45-54. doi: 10.1111/ijpp.12463. Epub 2018 Jun 13.
Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence.
An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice.
There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice.
Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring.
社区药房是监测药物依从性的理想场所，然而，由药剂师主导的干预措施存在障碍。让未来的药剂师承担更多职责可能会克服此类障碍。我们的目标是确定影响药房实习生进行依从性监测的药物监测态度和背景因素，以为药物依从性教育活动提供信息。
对爱尔兰共和国所有药房实习生（N = 123）进行了一项在线析因调查，这些实习生于2016年5月完成了高级社区药房实践学习，以评估他们对药物监测的态度，并确定在重复配药期间影响老年高血压患者依从性监测的受访者特征和背景因素。使用药物监测态度量表（MMAM）来评估实习生的态度，并进行析因 vignette 分析以确定影响提供依从性建议行为意图的因素。
共完成了121份在线调查。一半的实习生表示，他们在与患者讨论依从性时感到不舒服且有对抗性。在析因 vignette 分析中，较高的药物监测态度导致提供依从性建议的可能性更高；诸如药房所有权类型（非连锁商店）等实践学习特征以及包括患者治疗时间较长和时间压力等背景因素对药房实习生提供依从性建议的可能性有显著负面影响。
在假设情景中，药物监测态度和背景因素影响了提供依从性建议的反应。确保药学专业学生接受关于依从性模式和解决不依从问题的适当技能的教育，并参与结构化计划以促进实践学习期间的患者互动，可能会改善药物监测态度和依从性监测。
