Fang Fang, Zhai Xiaobo, Fan Xiucong, Bai Ron, Bao Siwei, Ma Yabin, Dong Xiaohui
Department of Pharmacy, Affiliated Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
J Eval Clin Pract. 2025 Aug;31(5):e70218. doi: 10.1111/jep.70218.
Improving the adherence of patients is importance for disease management and treatment outcomes.
To investigate the efficacy of medication therapy management services for patients with chronic diseases (PCD) including COPD in pharmacists-managed outpatient clinic (PMC).
This study was a prospective before-and-after intervention study, which was conducted at Tongji University Affiliated East Hospital, a grade A tertiary hospital in Shanghai, China. PCD, including COPD, who visited the PMC from October 2019 to April 2023 were included in this study. Pharmacists administered interventions to patients with COPD during their initial visit, followed by a 3-month monitoring period. All patients received medication therapy management services and medication adherence assessments conducted by pharmacists. Drug-related problems (DRPs) were documented and the health-related quality of life (HRQoL) was evaluated using the European Five-dimensional questionnaire (EQ-5D). The medication adherence of patients with the top 10 chronic diseases was analyzed. The adherence and lung function of patients with COPD were assessed both before and after intervention.
A total of 713 patients were included in the study, with 768 DRPs identified. The mean EQ-5D utility and EQ visual analog scale (EQ-VAS) score were 0.91 ± 0.17 and 73.74 ± 14.3, respectively. Among the 425 patients, 8.5% exhibited high compliance, 69% medium compliance, and 22.5% poor compliance. Notably, patients with COPD demonstrated the highest proportion of medium adherence and the lowest proportion of high adherence. Following interventions for COPD patients, there was a notable increase in the proportion of medium adherence, and a significant improvement in overall adherece and FEV1 compared to pre-intervention levels (p < 0.05).
Pharmacists have the expertise to evaluate the DRPs, HRQoL and adherence of patients with PCD. Pharmacists performing medication therapy management services can enhance adherence and further improve the lung function of COPD patients.
提高患者的依从性对于疾病管理和治疗效果至关重要。
探讨在药剂师管理的门诊诊所（PMC）中，药物治疗管理服务对包括慢性阻塞性肺疾病（COPD）在内的慢性病患者（PCD）的疗效。
本研究是一项前瞻性干预前后研究，在中国上海的一家三级甲等医院同济大学附属东方医院进行。本研究纳入了2019年10月至2023年4月期间到PMC就诊的包括COPD在内的PCD患者。药剂师在患者初次就诊时对COPD患者进行干预，随后进行为期3个月的监测期。所有患者均接受药剂师提供的药物治疗管理服务和药物依从性评估。记录药物相关问题（DRP），并使用欧洲五维问卷（EQ-5D）评估健康相关生活质量（HRQoL）。分析了前10种慢性病患者的药物依从性。对COPD患者干预前后的依从性和肺功能进行评估。
本研究共纳入713例患者，共识别出768个DRP。EQ-5D效用值和EQ视觉模拟量表（EQ-VAS）评分的平均值分别为0.91±0.17和73.74±14.3。在425例患者中，8.5%表现为高依从性，69%为中等依从性，22.5%为低依从性。值得注意的是，COPD患者中等依从性的比例最高，高依从性的比例最低。对COPD患者进行干预后，中等依从性的比例显著增加，总体依从性和第1秒用力呼气容积（FEV1）较干预前水平有显著改善（p<0.05）。
药剂师具备评估PCD患者的DRP、HRQoL和依从性的专业知识。提供药物治疗管理服务的药剂师可以提高依从性，并进一步改善COPD患者的肺功能。
