Samir Abdin Madjda, Grenier-Gosselin Lise, Guénette Line
Faculty of Pharmacy, Université Laval, Québec, QC, Canada.
CHU de Québec Research Centre, Population Health and Optimal Health Practices Research Unit, Hôpital du Saint-Sacrement, Québec, QC, Canada.
Int J Pharm Pract. 2020 Feb;28(1):75-83. doi: 10.1111/ijpp.12577. Epub 2019 Aug 29.
Recently, pharmacists have joined multidisciplinary healthcare teams within family medicine groups (FMG) in Quebec Province, Canada. This study assessed the impact of their interventions on the pharmacotherapy of patients with complex needs monitored in FMGs.
We performed a pre/post real-life intervention study among patients with complex needs referred to the FMG pharmacist in four FMGs in Quebec City. Pharmacists collected data at baseline, during follow-up and up to 6 months after the first encounter. They recorded all drug-related problems (DRPs) identified, interventions made and recommendations that were accepted by physicians. The researchers used the data collected to compare the medication regimen complexity index (MRCI) and medication adherence (using the proportion of days covered (PDC)) before and after the pharmacist's interventions. Descriptive statistics and paired sample t-tests were computed.
Sixty-four patients (median age: 74.5 years) were included; four patients were lost to follow-up. Pharmacists detected 300 DRPs (mean: 7.2 per patient) during the study period for which they made an intervention. The most common DRP was 'drug use without indication' (27%). The physicians accepted 263 (87.7%) of those interventions. The mean number of prescribed drugs per patient decreased from 13.8 (95% confidence interval (CI): 12.24 to 15.29) to 12.4 (95% CI: 10.92 to 13.90). The mean MRCI decreased from 47.18 to 41.74 (-5.44; 95% CI: 1.71 to 9.17), while the mean PDC increased from 84.4% to 90.0% (+5.6%; 95% CI: 2.7% to 8.4%).
Family medicine groups pharmacists can detect and resolve DRPs and can reduce medication regimen complexity and non-adherence to treatment in patients with complex needs monitored in FMGs.
最近，药剂师已加入加拿大魁北克省家庭医学组（FMG）的多学科医疗团队。本研究评估了他们的干预措施对FMG中监测的有复杂需求患者药物治疗的影响。
我们在魁北克市四个FMG中对转诊给FMG药剂师的有复杂需求患者进行了一项干预前后的实际干预研究。药剂师在基线、随访期间以及首次接触后长达6个月的时间收集数据。他们记录了所有识别出的药物相关问题（DRP）、采取的干预措施以及被医生接受的建议。研究人员利用收集到的数据比较药剂师干预前后的药物治疗方案复杂性指数（MRCI）和药物依从性（使用覆盖天数比例（PDC））。计算了描述性统计量和配对样本t检验。
纳入了64名患者（中位年龄：74.5岁）；4名患者失访。在研究期间，药剂师检测到300个DRP（平均每名患者7.2个），并针对这些问题进行了干预。最常见的DRP是“无适应证用药”（27%）。医生接受了其中263项（87.7%）干预措施。每名患者的平均处方药数量从13.8种（95%置信区间（CI）：12.24至15.29）降至12.4种（95%CI：10.92至13.90）。平均MRCI从47.18降至41.74（-5.44；95%CI：1.71至9.17），而平均PDC从84.4%增至90.0%（+5.6%；95%CI：2.7%至8.4%）。
家庭医学组药剂师能够检测并解决DRP，并可降低FMG中监测的有复杂需求患者的药物治疗方案复杂性和治疗不依从性。
