Cawley Michael J, Warning William J
Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA.
Crozer-Keystone Center for Family Health, Springfield, PA, USA.
J Res Pharm Pract. 2018 Apr-Jun;7(2):88-94. doi: 10.4103/jrpp.JRPP_17_101.
This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center.
This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives.
Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; = 0.024 and 76.3 years vs. 54.6 years; < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity ( = -0.3593, = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines.
A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.
本研究旨在描述经过培训的药剂师在社区家庭健康中心进行高质量肺功能测试的影响。
这是一项回顾性队列研究，研究对象为2008年11月至2013年12月期间前来参加预定肺功能门诊预约的150名由医生转诊的患者。获得的信息包括疾病类型（阻塞性或限制性肺病患者）、根据吸烟史计算的肺龄下降情况、肺功能测试质量以及因肺功能测试结果而需要调整肺部药物治疗方案的患者百分比。采用Pearson相关性分析和描述性统计来实现研究目标。
药剂师进行的肺功能测试中有87%的测试符合质量指南。测试发现了可逆性气道疾病患者（39%）、慢性阻塞性肺病患者（21%）、限制性肺病患者（11%）以及混合性阻塞/限制性肺病患者（11%）。肺功能异常的患者比肺功能正常的患者有更长的吸烟包年史和更高的计算肺龄（分别为29.1包年对17包年；P = 0.024以及76.3岁对54.6岁；P < 0.001）。发现29.1的吸烟包年史与用力肺活量之间存在弱相关性（r = -0.3593，P = 0.018）。药剂师根据循证指南协助69%的患者调整了肺部药物治疗方案。
药剂师主导的肺功能测试服务与高质量测试结果相关，识别出了呼吸道疾病异常情况，并有助于根据循证指南调整肺部药物治疗方案。该服务未来的发展方向可能包括与医生签订合作医疗协议，以扩大药剂师的服务范围，将肺功能测试纳入其中。
