Primary, Community and Personalised Care Directorate, NHS England, London, UK
Primary, Community and Personalised Care Directorate, NHS England, London, UK.
BMJ Open Qual. 2023 Jan;12(1). doi: 10.1136/bmjoq-2022-002002.
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for their analgesic and anti-inflammatory action, but the gastrointestinal (GI) adverse effects are a known cause of preventable harm. A medication safety audit was incentivised for community pharmacies in England in 2 successive years as part of the Pharmacy Quality Scheme (PQS) to address GI safety of NSAIDs.
To evaluate community pharmacy's contributions to NSAID safety and determine any change between audit 1 (2018-2019) and audit 2 (2019-2020).
Patients aged 65 years or over prescribed an NSAID were included in both audits. The audit tool assessed compliance with national standards relating to co-prescribed gastroprotection, referrals to the prescriber and patient advice on long-term NSAID use and effects, with responses submitted via an online portal. Descriptive analyses were performed to explore differences between the years and tested for significance using Χ tests. Qualitative data were analysed using an inductive thematic approach.
Data from 91 252 patients in audit 1 and 73 992 in audit 2 were analysed. More patients were prescribed gastroprotection in audit 2 (85.0%) than audit 1 (80.7%, p<0.001). More patients without gastroprotection in audit 2 had a current or recent referral (67.5%) than in audit 1 (58.8%, p<0.001). Verbal or other communications between pharmacists and patients about their NSAID medication were reported more frequently in audit 2 (76.0% vs 63.5%, p<0.001).
During two audits, community pharmacists in England reported referring more than 15 000 patients at risk of preventable harm from NSAIDs to prescribers for review. The audits demonstrated significant potential for year-on-year improvement in GI safety for a large cohort of older patients prescribed NSAIDs. This evaluation provides evidence of how the PQS can effectively address a specific aspect of medicines safety and the place of community pharmacy more broadly in improving medicines safety.
非甾体抗炎药（NSAIDs）因其镇痛和抗炎作用而被广泛应用，但胃肠道（GI）不良反应是可预防损害的已知原因。作为 Pharmacy Quality Scheme（PQS）的一部分，英格兰的社区药房在连续两年内进行了药物安全审核，以解决 NSAIDs 的胃肠道安全性问题。
评估社区药房在 NSAID 安全性方面的贡献，并确定审核 1（2018-2019 年）和审核 2（2019-2020 年）之间的任何变化。
在两次审核中，均纳入年龄在 65 岁或以上并开具 NSAID 的患者。审核工具评估了与共同开具胃保护剂、向处方医生转介以及患者关于长期 NSAID 使用和影响的建议相关的国家标准的遵守情况，通过在线门户提交回复。使用 Χ 检验进行描述性分析，以探索各年之间的差异，并检验其显著性。使用归纳主题方法对定性数据进行分析。
对审核 1 的 91252 名患者和审核 2 的 73992 名患者的数据进行了分析。在审核 2 中，开具胃保护剂的患者比例（85.0%）高于审核 1（80.7%，p<0.001）。在审核 2 中，没有开具胃保护剂的患者中，有当前或近期转介的比例（67.5%）高于审核 1（58.8%，p<0.001）。在审核 2 中，药剂师与患者之间就 NSAID 药物进行口头或其他交流的报告频率更高（76.0% vs 63.5%，p<0.001）。
在两次审核中，英格兰的社区药剂师报告称，将 15000 多名有 NSAID 相关可预防损害风险的患者转介给医生进行审查。这些审核表明，在为大量开具 NSAID 的老年患者提供胃肠道安全性方面，每年都有显著的改善潜力。该评估提供了证据，证明了 PQS 如何能够有效地解决药品安全的一个特定方面，以及社区药房在改善药品安全方面的更广泛作用。
