Sarwar Muhammad Rehan, McDonald Vanessa Marie, Abramson Michael J, Wilson Sally, Holland Anne E, Bonevski Billie, Mahal Ajay, Paul Eldho, Meier Brian, George Johnson
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
Centre for Research Excellence in Severe Asthma and Centre of Excellence in Treatable Traits, National Health and Medical Research Council, The University of Newcastle, Newcastle, NSW, Australia.
Int J Clin Pharm. 2025 Feb;47(1):157-165. doi: 10.1007/s11096-024-01819-6. Epub 2024 Oct 28.
Patients with chronic obstructive pulmonary disease (COPD) should engage in self-management strategies targeting behavioural traits and lifestyle risk-factors for optimal outcomes.
To evaluate the impact of credentialed pharmacist-led home medicines review (HMR) targeting treatable traits (TTs) on health outcomes in COPD in primary care.
A pre- and post-intervention study was nested within a cluster-randomised controlled trial. A total of 81 participants with COPD from 21 Australian general practices received an HMR with a credentialed pharmacist targeting TTs. Changes in health outcomes at 6 and 12 months from baseline were assessed.
Ten TTs were assessed and targeted during the HMR. At baseline, no-one had a written action plan for managing exacerbations, and medication adherence was sub-optimal in 85% of patients. Additionally, 53% of participants demonstrated inadequate inhaler device technique, while 52% were current smokers. At 6-months follow-up, significant improvements were observed in health-related quality of life (St. George's Respiratory Questionnaire score = 34.6 versus 39.1 at baseline, p = 0.006), health status (COPD Assessment Test score = 12 versus 16, p = 0.002), anxiety (Hospital Anxiety and Depression Scale (HADS)-Anxiety score = 2.0 versus 5.0, p < 0.001), depression (HADS-Depression score = 1.0 versus 5.0, p < 0.001), self-reported smoking (47% versus 51.9%, p = 0.031) and treatment adherence (Tool for Adherence Behaviour Screening score = 12.5 versus 10.0, p = 0.002). At 12-months: health status, anxiety, depression, smoking abstinence and adherence to treatment, continued to show statistically significant improvements compared to baseline measurements.
HMRs targeting TTs improved health outcomes in people with COPD. Credentialed pharmacists in primary care can work alongside general practitioners to optimise COPD management.
慢性阻塞性肺疾病（COPD）患者应采取针对行为特征和生活方式风险因素的自我管理策略，以实现最佳治疗效果。
评估由具备资质的药剂师主导的、针对可治疗特征（TTs）的家庭药物审查（HMR）对初级保健中COPD患者健康结局的影响。
一项干预前后研究嵌套于一项整群随机对照试验中。来自澳大利亚21家全科诊所的81名COPD患者接受了由具备资质的药剂师针对TTs进行的HMR。评估了从基线起6个月和12个月时健康结局的变化。
在HMR期间评估并针对了10个TTs。在基线时，没有人有管理病情加重的书面行动计划，85%的患者药物依从性欠佳。此外，53%的参与者吸入装置技术欠佳，52%为当前吸烟者。在6个月随访时，观察到健康相关生活质量（圣乔治呼吸问卷评分：基线时为34.6，随访时为39.1，p = 0.006）、健康状况（慢性阻塞性肺疾病评估测试评分：基线时为12，随访时为16，p = 0.002）、焦虑（医院焦虑抑郁量表（HADS）-焦虑评分：基线时为2.0，随访时为5.0，p < 0.001）、抑郁（HADS-抑郁评分：基线时为1.0，随访时为5.0，p < 0.001）、自我报告的吸烟情况（47%对51.9%，p = 0.031）和治疗依从性（依从行为筛查工具评分：基线时为12.5，随访时为10.0，p = 0.002）有显著改善。在12个月时：与基线测量值相比，健康状况、焦虑、抑郁、戒烟和治疗依从性继续显示出统计学上的显著改善。
针对TTs的HMR改善了COPD患者的健康结局。初级保健中具备资质的药剂师可以与全科医生合作，优化COPD管理。
