Tan Rachel, Kritikos Vicky, Cvetkovski Biljana, Rimmer Janet, Yan Kwok, Cheong Lynn, Bousquet Jean, Bosnic-Anticevich Sinthia
Woolcock Institute of Medical Research, Glebe, NSW, Australia; The University of Sydney, Camperdown, NSW, Australia.
Woolcock Institute of Medical Research, Glebe, NSW, Australia; The University of Sydney, Camperdown, NSW, Australia.
Res Social Adm Pharm. 2020 Sep 1. doi: 10.1016/j.sapharm.2020.08.009.
Allergic Rhinitis (AR) is a highly burdened chronic respiratory disease, which affects about 40% of the world's population. Research shows that only 15% of people with AR, in the community pharmacy setting are using optimal AR medication. There is a clear need to better implement AR management guidelines so that more effective medication selection and an evidence-based approach to the management of AR is implemented.
This paper describes the methods that will be used to develop, implement, evaluate and refine an evidence-based, guideline informed allergic rhinitis clinical management pathway, Allergic Rhinitis Clinical Management Pathway (AR-CMaP) for community pharmacy.
AR-CMaP was developed based on the latest AR management guidelines for pharmacy and empirical evidence associated with patient self-management behaviours in community pharmacy, utilising the Promoting Action on Research Implementation in Health Services implementation framework (Phase 1). AR-CMaP was then implemented in six pharmacies in the Australian Capital Territory (ACT), Australia (Phase 2). The impact of AR-CMaP on AR management in the pharmacy (AR medication management and pharmacy practice) will be evaluated in a pre-post intervention study design (Phase 3). Phase 4 will involve the refinement of AR-CMaP to ensure its generalisability and scalability; readiness for large-scale dissemination across different pharmacy locations (e.g. rural, remote, metropolitan) and different pharmacy business models.
There is an urgent need to develop a translational AR clinical pathway, to address the wide-spread challenge of suboptimal AR management and burden of AR on individuals and society. This protocol paper describes the methods underpinning the development, implementation, evaluation and refinement of an evidence-based AR clinical pathway for community pharmacy setting, which is in line with current clinical evidence and feasible for effective implementation into the community pharmacy setting.
变应性鼻炎（AR）是一种负担沉重的慢性呼吸道疾病，影响着全球约40%的人口。研究表明，在社区药房环境中，只有15%的AR患者正在使用最佳的AR药物。显然有必要更好地实施AR管理指南，以便实施更有效的药物选择和基于证据的AR管理方法。
本文描述了将用于开发、实施、评估和完善基于证据、指南指导的社区药房变应性鼻炎临床管理路径——变应性鼻炎临床管理路径（AR-CMaP）的方法。
AR-CMaP是根据最新的药房AR管理指南以及与社区药房患者自我管理行为相关的经验证据，利用卫生服务研究实施促进行动实施框架（第1阶段）制定的。然后在澳大利亚首都地区（ACT）的六家药房实施AR-CMaP（第2阶段）。将在干预前后研究设计中评估AR-CMaP对药房AR管理（AR药物管理和药房实践）的影响（第3阶段）。第4阶段将涉及完善AR-CMaP，以确保其通用性和可扩展性；准备好在不同药房地点（如农村、偏远、大都市）和不同药房商业模式中进行大规模传播。
迫切需要制定一个转化性的AR临床路径，以应对AR管理欠佳这一广泛存在的挑战以及AR对个人和社会造成的负担。本方案文件描述了为社区药房环境开发、实施、评估和完善基于证据的AR临床路径的方法，该方法符合当前临床证据，并且在社区药房环境中有效实施是可行的。
