Holle Lisa M, Levine Joel, Buckley Thomas, White C Michael, White Cedric, Hadfield Matthew J
J Am Pharm Assoc (2003). 2020 Jul-Aug;60(4):e109-e116. doi: 10.1016/j.japh.2020.02.014. Epub 2020 Mar 18.
To assess the novel approach of using the community pharmacist as the primary health care team member to facilitate colorectal cancer (CRC) risk counseling and screening in socioeconomically disadvantaged populations.
A collaborative effort between the UConn Health Colon Cancer Prevention Program and UConn School of Pharmacy in conjunction with large independent chain pharmacies (medium to medium-high volume) located in metropolitan areas of Connecticut, including Hartford, Bridgeport, New Haven, and Stamford. Pharmacies located in hospitals, across the street from a large physician practice, or within the community.
The study involved 2 phases. The first phase involved education and training for community pharmacists regarding counseling approaches for patients on the topic of CRC. The second phase of the study involved patient recruitment and counseling with subsequent fecal immunohistochemical testing (FIT).
A community pharmacist provided face-to-face counseling on CRC risk factor reduction and provided CRC screening to patients who were without insurance or underinsured. No CRC screening or education program existed beforehand.
A target sample size of 60 participants was needed with a type 1 error rate of 5% and a power of 80%. Exploration of variables using multivariate logistic regression model included any variable with a univariate P < 0.2. Multivariate P values < 0.05 were considered independent predictors.
After approaching 312 consumers, 16 of them consented to the study. The majority of participants (88%) were African American or Latino, and 69% were currently unemployed. Eight participants agreed to complete FIT, and 88% of participants completed FIT correctly. Only 1 positive FIT result was observed, but a subsequent colonoscopy was negative. Of the 12 questions that assessed baseline CRC knowledge in the initial survey, 16 participants answered an average of 2.6 (range, 0-6, SD, 1.6) questions incorrectly. Only 4 participants completed the follow-up survey of CRC knowledge and program satisfaction; thus, exploration of variables was not conducted. Patients indicated high satisfaction with the program of education and FIT dispensing.
This study faced difficulty in recruiting pharmacists to participate, with the main reason being lack of compensation and disruption to workflow. Patient participation in the trial was also low because of a lack of time or interest in participation. Of the patients who did participate, the level of satisfaction in having the pharmacist speak to them about CRC screening was high. This service is an excellent example of how the pharmacist can provide a more accessible, convenient, and responsive approach to patients' needs while improving health equity. Future studies that employ a revenue model to build the infrastructure and capacity necessary to offer this service efficiently and consistently are needed.
评估将社区药剂师作为初级卫生保健团队成员，以促进社会经济弱势人群进行结直肠癌（CRC）风险咨询和筛查的新方法。
康涅狄格大学健康结肠癌预防项目与康涅狄格大学药学院合作，联合位于康涅狄格州大都市地区（包括哈特福德、布里奇波特、纽黑文和斯坦福德）的大型独立连锁药店（中等到中高流量）。药店位于医院内、大型医生诊所对面的街道上或社区内。
该研究包括两个阶段。第一阶段涉及对社区药剂师进行关于CRC主题患者咨询方法的教育和培训。研究的第二阶段涉及患者招募和咨询，随后进行粪便免疫组化检测（FIT）。
社区药剂师就降低CRC风险因素提供面对面咨询，并为没有保险或保险不足的患者提供CRC筛查。此前不存在CRC筛查或教育项目。
需要60名参与者的目标样本量，I型错误率为5%，检验效能为80%。使用多变量逻辑回归模型对变量进行探索，包括任何单变量P<0.2的变量。多变量P值<0.05被视为独立预测因素。
在接触312名消费者后，其中16人同意参与研究。大多数参与者（88%）是非裔美国人或拉丁裔，69%目前失业。8名参与者同意完成FIT，88%的参与者正确完成了FIT。仅观察到1个FIT阳性结果，但随后的结肠镜检查结果为阴性。在初始调查中评估基线CRC知识的12个问题中，16名参与者平均答错2.6个问题（范围为0 - 6，标准差为1.6）。只有4名参与者完成了CRC知识和项目满意度的后续调查；因此，未进行变量探索。患者对教育和FIT发放项目表示高度满意。
本研究在招募药剂师参与方面面临困难，主要原因是缺乏报酬和工作流程受到干扰。由于缺乏时间或参与兴趣，患者参与试验的比例也很低。在参与的患者中，药剂师与他们谈论CRC筛查的满意度很高。这项服务是一个很好的例子，说明药剂师如何在改善健康公平性的同时，为患者需求提供更易获得、方便且响应迅速的方法。未来需要开展采用收益模式来建立高效且持续提供此项服务所需基础设施和能力的研究。
