School of Pharmacy, University of East Anglia, Norwich, Norfolk, NR4 7TJ, United Kingdom.
School of Pharmacy, University of East Anglia, Norwich, Norfolk, NR4 7TJ, United Kingdom.
Res Social Adm Pharm. 2020 Apr;16(4):560-567. doi: 10.1016/j.sapharm.2019.07.015. Epub 2019 Jul 27.
Medication compliance aids (MCAs) to support adherence lack evidence for cost-effectiveness yet a 2001 survey in England estimated 100,000 patients receiving an MCA whilst living in their home.
(s): To obtain a contemporary estimate of MCA provision by community pharmacies in England and describe factors influencing pharmacist decision-making regarding MCA initiation.
A stratified random sample of two community pharmacies per county (n = 40) in England were surveyed by telephone and a more detailed postal survey sent to participants expressing an interest. Data were collected to determine magnitude of MCA provision and, professional and administrative factors influencing initiation were reported as percentage (95% confidence interval) respondents reporting a factor.
An estimated 273,529 MCAs are filled by community pharmacies in England with a median (IQR) of 20(10, 50) MCAs per pharmacy per month provided for patients living in their home. Practitioners' judgement of appropriateness for MCA initiation was reported by 51.3 ± 11% as the primary factor influencing decision-making relative to 16.3 ± 8% and 20 ± 8.8% reporting patient's and carer's opinion respectively. Some form of assessment tool was reported by 13 ± 7.3% respondents. Postal survey respondents (n = 31) indicated that decision-making regarding MCA initiation was often or always affected by suitability of medication for dispensing in an MCA by 58% ± 17% of respondents; 74.2% ± 15.4% and 53.3% ± 17.9% of respondents' decision-making was never or rarely affected by the risk of adverse events and reduced patient autonomy arising from an MCA respectively.
Provision of MCAs by pharmacies in England has more than doubled in the past decade. Beyond considering the practicalities of whether an MCA is suitable for a patient, there is limited evidence of pharmacists considering patient choice or risk of adverse events arising from sudden increased adherence prior to initiation.
支持依从性的药物依从性辅助工具（MCAs）缺乏成本效益的证据，但 2001 年在英格兰进行的一项调查估计，有 10 万名在家中接受 MCA 的患者。
（s）：获得英格兰社区药房提供 MCA 的当代估计，并描述影响药剂师启动 MCA 决策的因素。
通过电话对英格兰每个县的两家社区药房（n=40）进行分层随机抽样调查，并向表示有兴趣的参与者发送更详细的邮寄调查。收集数据以确定 MCA 提供的规模，并报告影响启动的专业和行政因素，以报告因素的受访者百分比（95%置信区间）表示。
估计英格兰社区药房提供了 273529 个 MCA，中位数（IQR）为每个药房每月为在家中居住的患者提供 20（10，50）个 MCA。启动 MCA 的适当性的从业者判断被报告为影响决策的主要因素，相对而言，分别为 16.3±8%和 20±8.8%，报告患者和照顾者的意见。13±7.3%的受访者报告了某种形式的评估工具。邮政调查受访者（n=31）表示，MCA 启动的决策通常或总是受到 MCA 中药物给药适用性的影响，58%±17%的受访者；分别有 74.2%±15.4%和 53.3%±17.9%的受访者的决策受到不良反应风险和 MCA 导致的患者自主权降低的影响。
英格兰药房提供 MCA 的数量在过去十年中增加了一倍多。除了考虑 MCA 是否适合患者的实际情况外，几乎没有证据表明药剂师在启动之前考虑患者的选择或因突然增加依从性而产生的不良反应风险。
