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南非开普敦一家初级保健诊所中,药剂师主导的糖尿病俱乐部患者药物治疗管理:回顾性和前瞻性审计。

Pharmacist-led medication therapy management of diabetes club patients at a primary healthcare clinic in Cape Town, South Africa: A retrospective and prospective audit.

机构信息

School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa.

出版信息

S Afr Med J. 2022 May 31;112(6):437-445.


DOI:
PMID:36217874
Abstract

Diabetes mellitus (DM) is a complex chronic condition and remains a public health concern worldwide. In South Africa (SA), many patients with DM access public sector primary healthcare clinics, and those who are considered to be stable are referred to the club system, which is managed by a multidisciplinary team. Patients who have DM are often diagnosed with concurrent medical conditions, resulting in multiple medication therapies that lead to medication therapy problems (MTPs). Prescriber adherence to standard treatment guidelines (STGs) is aimed at improving glycaemic control to minimise complications and decrease healthcare costs. The pharmacist's role in medication therapy management (MTM) for DM is underutilised in public sector healthcare facilities. Objectives. To evaluate the implementation of a pharmacist-led MTM intervention to optimise the management of stable patients with type 2 DM attending a diabetes club at a Cape Town community day centre. Methods. An evaluation study design using a case study approach was conducted over 8 months from November 2016 to June 2017. A retrospective and prospective audit was conducted from patient folders of stable patients who attended the club. Quantitative data were extracted from the folders. A trained pharmacist audited baseline (pre-intervention) data. Prescribing staff were notified of therapeutic discrepancies through written pharmacist's pharmacotherapeutic recommendations (intervention). Pharmacist-led interventions audited prescriber adherence to SA STGs and the Essential Medicines List, and prescriber responses to the pharmacist's recommendations (post-intervention) were recorded as accepted, partially accepted or rejected. Estimated costs were calculated for rational and irrational prescribing of aspirin during the MTM process. Results. Of 104 patient folders audited, most were for females (n=70; 67.3%). A total of 453 MTPs were identified, averaging four interventions per folder reviewed. The most common MTPs identified were the absence of basic clinical data: body mass index not documented (22.5%) in the folder, no medical indication noted (19.2%), and laboratory tests not requested (18.3%) by clinicians. Prescriber acceptance of the pharmacist's recommendations was found to be low (26.8%), suggestive of clinical inertia. Aspirin was found to be irrationally prescribed to patients with DM (15.4%). Conclusion. Pharmacists can identify, resolve and prevent MTPs and rationalise appropriate medication therapy in patients with DM. Prescriber uptake of pharmacists' pharmacotherapeutic recommendations seems overlooked. Pharmacist-led workshops to advocate for rational prescribing are needed to mitigate MTPs among stable patients with type 2 DM at public sector healthcare facilities.

摘要

糖尿病(DM)是一种复杂的慢性疾病,仍然是全球公共卫生关注的问题。在南非(SA),许多 DM 患者在公立医院初级保健诊所就诊,那些被认为稳定的患者被转诊到俱乐部系统,该系统由多学科团队管理。患有 DM 的患者通常被诊断出患有同时存在的医疗状况,导致多种药物治疗,从而导致药物治疗问题(MTPs)。开处方者遵守标准治疗指南(STGs)旨在改善血糖控制,以最大程度地减少并发症并降低医疗保健成本。药剂师在 DM 药物治疗管理(MTM)中的作用在公立医院医疗设施中未得到充分利用。目的。评估由药剂师主导的 MTM 干预措施在优化在开普敦社区日中心的糖尿病俱乐部就诊的稳定 2 型 DM 患者管理中的实施情况。方法。从 2016 年 11 月至 2017 年 6 月进行了为期 8 个月的评估研究设计,采用案例研究方法。对参加俱乐部的稳定患者的病历夹进行了回顾性和前瞻性审核。从病历夹中提取定量数据。一名经过培训的药剂师审核了基线(干预前)数据。通过书面药剂师的药物治疗建议通知治疗人员发现治疗差异(干预)。药剂师主导的干预措施审核了开处方者对南非 STGs 和基本药物清单的遵守情况,以及开处方者对药剂师建议的回应(干预后)记录为接受,部分接受或拒绝。在 MTM 过程中,计算了合理和不合理使用阿司匹林的估计费用。结果。在审核的 104 个病历夹中,大多数为女性(n=70;67.3%)。共发现 453 个 MTP,每个审核的病历夹平均有四个干预措施。发现最常见的 MTP 是缺乏基本临床数据:病历夹中未记录体重指数(22.5%),没有临床医生注意到的医学指征(19.2%),并且没有要求进行实验室检查(18.3%)。发现开处方者接受药剂师建议的比例较低(26.8%),表明临床惯性。发现阿司匹林被不合理地开给 DM 患者(15.4%)。结论。药剂师可以识别,解决和预防 MTP 并合理调整 DM 患者的药物治疗。开处方者似乎忽略了对药剂师药物治疗建议的接受。需要由药剂师主导的研讨会来倡导合理的处方,以减轻公立医疗机构中 2 型 DM 稳定患者的 MTP。

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