Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Ann Palliat Med. 2021 Feb;10(2):2008-2017. doi: 10.21037/apm-20-1458. Epub 2020 Dec 22.
To evaluate the characteristics of drug-related problems (DRPs) in cancer pain patients, and to identify the impact of pharmacists' intervention in cancer pain associated DRPs.
In this investigative, single-arm intervention study, clinical pharmacists identified DRPs in cancer pain patients and provided interventions based on medication information, direct patient-pharmacist interview, and ward rounds with multi-disciplinary team (MDT). Types and causes of DRPs, interventions, acceptance and outcome were sorted based on Pharmaceutical Care Network Europe (PCNE) DRP classification V9.0, which includes 3 primary domains for problems, 9 for causes, 5 for interventions, 3 for acceptance, and 4 for DRPs status.
Totally, 42 cancer pain patients were enrolled, and 47 DRPs in 33 (78.6%) patients were identified by clinical pharmacists. The major type of DRPs was treatment effectiveness (30; 63.8%) and treatment safety (17; 36.2%). For the "treatment effectiveness" category, the "effect of drug treatment not optimal" was dominant category (27/30; 90%). A total of 66 DRP causes were identified, and most of DRPs were caused by "drug selection" (27; 40.9%) and "dose selection" (16; 24.2%). Within the "drug selection" category, "no or incomplete drug treatment in spite of existing indication" was dominant category (25/27; 92.6%). According to DRPs, 159 interventions were provided by clinical pharmacists and 99.4% of interventions were accepted by prescribers or patients. Finally, 44 (93.6%) DRPs were solved.
In cancer pain patients, insufficient pain control mainly caused by inappropriate selection and dosage of analgesics. Clinical pharmacists' interventions dramatically ameliorate these problems and bring about positive effects in cancer pain pharmacotherapy.
评估癌症疼痛患者药物相关问题（DRPs）的特征，并确定药师干预对癌症疼痛相关 DRPs 的影响。
在这项调查性、单臂干预研究中，临床药师根据药物信息、直接患者-药师访谈以及多学科团队（MDT）查房，确定癌症疼痛患者的 DRP，并提供干预措施。根据欧洲药学保健网络（PCNE）DRP 分类 V9.0 对 DRP 的类型和原因、干预措施、接受度和结果进行分类，该分类包括 3 个问题主要领域、9 个原因、5 个干预措施、3 个接受度和 4 个 DRP 状态。
共纳入 42 例癌症疼痛患者，临床药师共发现 33 例（78.6%）患者的 47 个 DRP。DRP 的主要类型为治疗效果（30 个；63.8%）和治疗安全性（17 个；36.2%）。在“治疗效果”类别中，“药物治疗效果不理想”是主要类别（27/30；90%）。共发现 66 个 DRP 原因，大多数 DRP 是由“药物选择”（27 个；40.9%）和“剂量选择”（16 个；24.2%）引起的。在“药物选择”类别中，“尽管存在适应证，但未进行或不完全进行药物治疗”是主要类别（25/27；92.6%）。根据 DRP，临床药师提供了 159 项干预措施，99.4%的干预措施得到了处方者或患者的接受。最后，44 个（93.6%）DRP 得到解决。
在癌症疼痛患者中，主要由镇痛药物选择和剂量不当引起的疼痛控制不足。临床药师的干预措施显著改善了这些问题，并在癌症疼痛治疗中带来了积极的效果。
