Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
Association of Belgian Pharmacies (APB), Brussels, Belgium.
J Eval Clin Pract. 2021 Dec;27(6):1343-1352. doi: 10.1111/jep.13567. Epub 2021 Mar 24.
RATIONALE, AIMS AND OBJECTIVES: The rise in chronic diseases urges for an identification of interventions that improve adherence. However, no golden standard exists for evaluating adherence in polymedicated patients. The objectives were to investigate the impact of a pharmacist-led medication use review (MUR) service on adherence implementation rates for chronic medication, and to evaluate the appropriateness of two adherence calculation approaches in this regard.
Before-after study (SIMENON study) including ambulatory, aged, polymedicated patients. Refill data were used to calculate the proportion of days covered (PDC) per medication before and after the MUR. Adherence was assessed for chronic, solid, oral medication using a prescription-based and interval-based approach, and the performance of both approaches was compared.
Adherence was evaluated for 1483 medications from 316 patients. The median baseline PDC per medication was 0.95 (prescription-based method) and 0.91 (interval-based approach). Pearson correlation between both approaches was 0.616 (P < .0001). The prescription-based approach found less medication below the adherence threshold of 0.80 (319 medications; 21.5% vs 481 medications; 32.4%). Using the prescription-based approach, the proportion of non-adherent patients at baseline was 61.7% (195/316 patients), of which 54.9% (107/195 patients) was only non-adherent for one medication. Median PDC scores increased significantly from 0.95 to 0.99 and 0.91 to 0.99 with the prescription-based and interval-based approach respectively (both P < .0001). Only considering the 319 medications with baseline PDC scores <0.8 using the prescription-based approach, the median PDC scores significantly increased from 0.67 to 0.84 (P < .0001), with a median score improvement of 18.3%.
Although baseline adherence was high in this population of polymedicated aged patients, both calculation methods showed the MUR significantly improved adherence. The prescription-based approach was considered the most appropriate method. Based on these findings and literature evidence, it is recommended to implement the MUR service in Belgium and target non-adherent patients for maximal effect.
背景、目的和目标：慢性病发病率的上升促使人们寻找能够提高患者服药依从性的干预措施。然而，目前还没有评估多种药物治疗患者服药依从性的金标准。本研究旨在调查药剂师主导的药物使用审查（MUR）服务对改善慢性药物治疗依从性的影响，并评估两种依从性计算方法在此方面的适用性。
这项前后对照研究（SIMENON 研究）纳入了门诊、年龄较大、合并用药的患者。在 MUR 前后，使用 refill 数据计算每种药物的用药天数比例（PDC）。采用基于处方和基于时间间隔的方法，对慢性固体口服药物的依从性进行评估，并比较两种方法的性能。
共纳入 316 名患者的 1483 种药物进行评估。每种药物的基线 PDC 中位数分别为基于处方的方法 0.95 和基于时间间隔的方法 0.91。两种方法之间的 Pearson 相关性为 0.616（P < 0.0001）。基于处方的方法发现有 319 种药物（21.5%）低于 0.80 的依从性阈值，而基于时间间隔的方法发现有 481 种药物（32.4%）低于该阈值。使用基于处方的方法，基线时非依从性患者的比例为 61.7%（195/316 名患者），其中 54.9%（107/195 名患者）仅有一种药物不依从。PDC 评分中位数分别从 0.95 和 0.91 显著增加到 0.99 和 0.99，采用基于处方和基于时间间隔的方法，差异均有统计学意义（均 P < 0.0001）。仅考虑基线 PDC 评分<0.8 的 319 种药物，基于处方的方法中 PDC 评分中位数从 0.67 显著增加到 0.84（P < 0.0001），平均提高 18.3%。
尽管在接受多种药物治疗的老年患者中，基线依从性较高，但两种计算方法均显示 MUR 显著提高了依从性。基于处方的方法被认为是最适用的方法。基于这些发现和文献证据，建议在比利时实施 MUR 服务，并针对不依从的患者进行干预，以获得最大效果。
