斯洛文尼亚药物使用评估服务依从性的改善：一项随机对照试验。
Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial.
作者信息
Nabergoj Makovec Urška, Locatelli Igor, Kos Mitja
机构信息
Department of Social Pharmacy, University of Ljubljana, Faculty of Pharmacy, Askerceva cesta 7, 1000, Ljubljana, Slovenia.
出版信息
BMC Health Serv Res. 2021 Mar 22;21(1):266. doi: 10.1186/s12913-021-06223-8.
BACKGROUND
Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence.
METHODS
A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed.
RESULTS
Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16-2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05-1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = - 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed.
CONCLUSION
MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use.
TRIAL REGISTRATION
ClinicalTrials.gov - NCT04417400 ; 4th June 2020; retrospectively registered.
背景
基于现有的多项以患者为导向的活动，药物使用评估（MUR）服务于2015年在斯洛文尼亚实现标准化并正式采用。该服务旨在提供依从性支持，确保安全有效地使用药物。因此，本研究的目的是评估斯洛文尼亚MUR的益处，主要是对药物依从性的影响。
方法
在社区药房进行了一项随机对照试验，以比较MUR与标准护理。患者被随机分为试验组（患者在首次就诊时由认证的MUR提供者接受MUR）或对照组。研究的主要结局是通过电子©Morisky Widget MMAS-8软件在首次就诊（V1）和12周后（V2）评估的自我报告的多种药物依从性。对有意和无意的不依从进行了亚分析。MUR的影响定义为试验组和对照组在12周后©MMAS-8评分的相对差异。使用多元线性回归模型根据基线依从性（低、中、高）预测MUR的影响。还评估了几个次要结局（例如药物相关问题（DRP）的评估）。
结果
分析了153名（V1）和140名（V2）患者的数据。基线依从性低、中、高的患者分别为17.6%、48.4%和34.0%。在低依从性子群体中，试验组患者的总©MMAS-8评分比对照组患者增加了1.20分（95%CI = 0.16 - 2.25）（p = 0.025）。增加的0.84分（95%CI = 0.05 - 1.63）归因于有意不依从（p = 0.038），0.36分（95%CI = - 0.23 - 0.95）归因于无意不依从（p = 0.226）。此外，显示出有明显DRP的患者比例（p < 0.001）和对慢性药物使用的担忧（p = 0.029）在统计学上有显著下降。
结论
斯洛文尼亚的MUR服务提高了低药物依从性，并且在解决DRP和对慢性药物使用的担忧方面有效。
试验注册
ClinicalTrials.gov - NCT04417400；2020年6月4日；回顾性注册。
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