Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
BENU Apotheek Zeist West, Zeist, The Netherlands.
NPJ Prim Care Respir Med. 2019 Jul 11;29(1):26. doi: 10.1038/s41533-019-0139-5.
Pharmaceutical care guidelines aim to provide recommendations for pharmaceutical care, reduce unwanted pharmacy practice variation and ultimately improve the quality of healthcare. This study evaluated community pharmacists' adherence to recommendations for the provision of care to asthma patients with first dispensing and follow-up refill encounters in The Netherlands. Data were pharmacists' self-assessment of adherence to guideline recommendations, independent observations of dispensing encounters and a nationwide questionnaire on pharmacists' views on the desirable (clinical) necessity of applying guideline recommendations to their patient population. The 21 pharmacists who performed self-assessment judged their adherence concerning inhalation instructions as high. The lowest scores were reported for recommendations to collect additional information on the type of lung disease and for asking patients' expectations, wishes and concerns. Sixty-eight dispensing encounters were observed. In 83% of the 35 first dispensing observations, inhalation instruction was provided. This percentage was lower (62%) at refill dispensings. During all encounters, pharmacy staff seldom explored patients' perceptions or responded to patients' expectations, wishes and concerns. One hundred and four pharmacists completed the feasibility questionnaire. Pharmacists judged that all patients should receive inhalation instruction at first dispensing. They regarded it necessary to check on patients' expectations, wishes and concerns regarding the treatment for only up to 70% of the patients. More efforts on guideline implementation are needed, especially on follow-up dispensings and on gaining relevant information from patients and other healthcare professionals. Pharmacists still have opportunities to grow in applying a patient-tailored approach and exploring patients' individual needs, rather than providing practical information.
药学服务指南旨在提供药学服务建议，减少不必要的药学实践差异，最终提高医疗保健质量。本研究评估了荷兰社区药师在首次配药和后续续配药时为哮喘患者提供护理的建议的依从性。数据来自药师对指南建议依从性的自我评估、配药时的独立观察以及全国范围内关于药师对将指南建议应用于其患者群体的理想（临床）必要性的看法的问卷调查。进行自我评估的 21 名药剂师认为他们在吸入指导方面的依从性很高。报告的最低分数是关于收集有关肺部疾病类型和询问患者期望、愿望和关注点的额外信息的建议。观察了 68 次配药。在 35 次首次配药观察中，83%的情况下提供了吸入指导。在续配药中，这一比例较低（62%）。在所有的配药过程中，药剂师很少探索患者的认知，也很少回应患者的期望、愿望和关注点。104 名药剂师完成了可行性问卷调查。药剂师认为所有患者在首次配药时都应该接受吸入指导。他们认为仅需要对多达 70%的患者检查他们对治疗的期望、愿望和关注点。需要进一步努力实施指南，特别是在后续配药以及从患者和其他医疗保健专业人员那里获取相关信息方面。药剂师仍然有机会在应用以患者为中心的方法和探索患者的个体需求方面取得进展，而不是提供实用信息。
