在社区药房环境中，自我报告患有 COPD 的个体的症状负担和呼吸药物依从性评估。
Assessment of symptom burden and adherence to respiratory medications in individuals self-reporting a diagnosis of COPD within a community pharmacy setting.
出版信息
J Am Pharm Assoc (2003). 2019 Jul-Aug;59(4):479-488.e1. doi: 10.1016/j.japh.2019.04.017. Epub 2019 May 22.
OBJECTIVES
Data on symptom burden or medication adherence in patients with chronic obstructive pulmonary disease (COPD) within a community pharmacy setting are limited. This study assessed symptom burden and adherence to respiratory medications in individuals reporting COPD, chronic bronchitis, or emphysema diagnoses visiting community pharmacies.
DESIGN
This cross-sectional study enrolled participants visiting 35 community pharmacies in Missouri (October 2016 to April 2017).
PARTICIPANTS
Eligible participants (aged 40 years or more with a self-reported history of COPD, prescription for at least 1 COPD maintenance medication during the previous 12 months, and able to complete an English questionnaire) were identified from pharmacy dispensing records.
MAIN OUTCOME MEASURES
Participants completed a questionnaire assessing demographics, clinical characteristics, health literacy, COPD Assessment Test (CAT) modified Medical Research Council (mMRC) dyspnea scale scores, and exacerbation history. Recent spirometry data were obtained, if available, from participants' physicians. COPD was classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016 criteria. Medication adherence was assessed as proportion of days covered (PDC) from dispensing records.
RESULTS
Of 682 participants (mean age 63.0 years; 57% female) with available pharmacy data, 251 (36.8%) had available spirometry data. Most participants had mMRC scores ≥ 2 (60.9%) and CAT scores ≥ 10 (90.2%); 57.2% reported at least 2 moderate or 1 or more severe exacerbations within the previous 12 months. GOLD classifications varied depending on the scale used (mMRC vs. CAT); more participants were classified as group C/D than group A/B, with the highest proportion classified as group D (higher symptom burden and exacerbation risk). Mean PDC was 0.46 ± 0.37; only 28.7% of participants were adherent (PDC ≥ 80%) to at least 1 COPD maintenance medication.
CONCLUSION
Individuals self-reporting a COPD diagnosis receiving respiratory medications from community pharmacies in Missouri have a high symptom burden and low medication adherence. Further research should determine reasons for low adherence and ways to reduce COPD symptoms.
目的
在社区药房环境中，有关慢性阻塞性肺疾病（COPD）患者症状负担或药物依从性的数据有限。本研究评估了在社区药房就诊的报告患有 COPD、慢性支气管炎或肺气肿的个体的症状负担和对呼吸药物的依从性。
设计
这项横断面研究纳入了 2016 年 10 月至 2017 年 4 月在密苏里州的 35 家社区药房就诊的参与者。
参与者
从药房配药记录中确定符合条件的参与者（年龄在 40 岁及以上，有 COPD 的自述病史，在过去 12 个月内至少有 1 种 COPD 维持药物的处方，并且能够完成英文问卷）。
主要观察指标
参与者完成了一份问卷，评估人口统计学、临床特征、健康素养、COPD 评估测试（CAT）改良的医学研究理事会（mMRC）呼吸困难量表评分和加重史。如果参与者的医生提供了最近的肺活量数据，则从医生处获得。根据全球慢性阻塞性肺疾病倡议（GOLD）2016 标准对 COPD 进行分类。药物依从性评估为从配药记录中获得的覆盖天数（PDC）比例。
结果
在 682 名有可用药房数据的参与者中（平均年龄 63.0 岁；57%为女性），有 251 名（36.8%）有可用的肺活量数据。大多数参与者的 mMRC 评分≥2（60.9%）和 CAT 评分≥10（90.2%）；57.2%报告在过去 12 个月内至少有 2 次中度或 1 次或更多次严重加重。GOLD 分类取决于使用的量表（mMRC 与 CAT）；使用 CAT 分类的参与者中，C/D 组比 A/B 组更多，比例最高的是 D 组（更高的症状负担和加重风险）。平均 PDC 为 0.46±0.37；只有 28.7%的参与者对至少 1 种 COPD 维持药物的依从性达到 80%（PDC≥80%）。
结论
在密苏里州的社区药房接受呼吸药物治疗的自我报告 COPD 诊断的个体，症状负担高，药物依从性低。进一步的研究应确定低依从性的原因和减少 COPD 症状的方法。
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