Wuyts Joke, Maesschalck Joris, De Wulf Isabelle, De Lepeleire Jan, Foulon Veerle
Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 O&N2 box 521, 3000, Leuven, Belgium.
Association of Pharmacists Belgium, Archimedesstraat 11, 1000, Brussels, Belgium.
Res Social Adm Pharm. 2020 Dec;16(12):1760-1767. doi: 10.1016/j.sapharm.2020.01.017. Epub 2020 Feb 5.
In the SIMENON study, medication use reviews were conducted for older polymedicated home-dwelling patients across 56 Belgian community pharmacies.
To evaluate the impact of the service on patient-reported outcome measures and patient-reported experience measures, and to evaluate the suitability of the chosen instruments.
A before-after design was used to measure the impact of the medication use review in a subset of patients, participating in the SIMENON study. Patients completed self-report questionnaires before and 3 and 12 weeks after the intervention by letter, phone or e-mail. Six outcomes were evaluated: medication-related quality of life, adherence, self-management, patient satisfaction, fall incidents and use of emergency healthcare services.
Questionnaires at baseline and endpoint were available for 83 patients (median age 77 years; median of 7 drugs) of 24 pharmacies. The Living with Medicines Questionnaire showed low medication burden at baseline (84.8/205) which increased to 85.7 three weeks later (n = 57; p = 0.219). Scores significantly reduced to 81.9 at twelve weeks (p = 0.031). The Probabilistic Medication Adherence Scale (n = 67) showed high median adherence scores at baseline (14/18) which remained unaltered (p = 0.974). The patient activation measure found low self-management in one third of the sample at baseline and endpoint (35.5% and 37.1% respectively; p = 0.243). The Patient Satisfaction with Pharmacist Services Questionnaire (n = 66) demonstrated high patient satisfaction. The number of patients with a hospitalization in the last three months decreased non-significantly from 14.8% to 11.1% in the post-measurement after 12 weeks (p = 0.227). No effect was observed on emergency room visits and falls.
The medication use review reduced medication burden but did not impact the patient's adherence and self-management. However, adherence scores were high, medication burden was low at baseline and the sample size was limited. The Living with Medicines instrument is a promising instrument for future research to assess medication-related quality of life in older polymedicated patients.
在SIMENON研究中，对比利时56家社区药房中使用多种药物的居家老年患者进行了用药评估。
评估该服务对患者报告的结局指标和患者报告的体验指标的影响，并评估所选工具的适用性。
采用前后设计来衡量用药评估对参与SIMENON研究的部分患者的影响。患者在干预前、干预后3周和12周通过信件、电话或电子邮件完成自我报告问卷。评估了六个结局：与药物相关的生活质量、依从性、自我管理、患者满意度、跌倒事件和紧急医疗服务的使用情况。
24家药房的83名患者（中位年龄77岁；中位用药7种）有基线和终点的问卷数据。《药物生活问卷》显示基线时药物负担较低（84.8/205），3周后增至85.7（n = 57；p = 0.219）。12周时得分显著降至81.9（p = 0.031）。《概率性药物依从性量表》（n = 67）显示基线时中位依从性得分较高（14/18），且保持不变（p = 0.974）。患者激活度测量发现，基线和终点时三分之一的样本自我管理能力较低（分别为35.5%和37.1%；p = 0.243）。《药剂师服务患者满意度问卷》（n = 66）显示患者满意度较高。在12周后的测量中，过去三个月内住院患者的比例从14.8%降至11.1%，但差异无统计学意义（p = 0.227）。未观察到对急诊就诊和跌倒的影响。
用药评估降低了药物负担，但未影响患者的依从性和自我管理。然而，依从性得分较高，基线时药物负担较低，且样本量有限。《药物生活》工具是未来研究中评估使用多种药物的老年患者与药物相关生活质量的一个有前景的工具。
