PDF(Pubmed)
Abstract：
Polypharmacy is common among patients with antithrombotic medication, giving rise to concerns about Drug-Related Problems (DRPs). Therefore, these patients would benefit from a Medication Review (MR) along with pharmacist counselling to reduce the risks accompanying polymedication. This prospective study presents a concept for MRs that are applicable in German community pharmacies and can efficiently support pharmacist counselling and improve the safety of drug therapy. As this is a major challenge in everyday pharmacy practice, we used a Decision Support System (DSS) to evaluate its ability to support the process of pharmacist-led MRs. The primary endpoint was the impact of a community pharmacist on the reduction of DRPs. We investigated the impact of the interventions resulting from MRs on patients taking at least one antithrombotic drug as part of their polymedication regimen. Secondary endpoints were the reduction in the number of patients with bleeding risks and the improvement of patients\' Quality of Life (QoL) and therapy adherence. Furthermore, the DSS used in the study was controlled for correct data assessment and plausibility of data. We selected adult patients who were taking no less than three different medications for long-term treatment, at least one of which had to be an antithrombotic drug, and who were customers in one of eight selected pharmacies over a period of 6 months. Data from 87 patients were analyzed with DSS-support. A total of 234 DRPs were identified by the pharmacist (2.7 DRPs per patient). MR reduced DRPs by 43.2% which, resulting to a reduction of 1.2 DRPs per patient. The intervention also led to a significant improvement in the patients\' QoL (assessed via EQ-5D-5L questionnaire; p < 0.001) and enhanced therapy adherence (assessed via A14 questionnaire; p < 0.001). The control of correct data assessment (with 93.8% concordance) and plausibility of data (with 91.7% concordance) of the DSS software were conducted by an external auditor. No significant effect was found for overall bleeding risk. The results of this study indicate that DSS-supported and structured MR conducted by pharmacists can contribute to a reduction in DRPs and significantly improve patient\'s QoL and adherence to treatment.
摘要：
多药在使用抗血栓药物的患者中很常见，引起对药物相关问题（DRP）的担忧。因此,这些患者将受益于药物审查(MR)以及药剂师咨询,以降低多重用药伴随的风险.这项前瞻性研究提出了适用于德国社区药房的MR概念，可以有效地支持药剂师咨询并提高药物治疗的安全性。由于这是日常药学实践中的主要挑战，我们使用决策支持系统(DSS)来评估其支持药剂师主导的MRs流程的能力.主要终点是社区药剂师对减少DRPs的影响。我们调查了由MRs引起的干预措施对患者服用至少一种抗血栓药物作为其多重治疗方案的一部分的影响。次要终点是有出血风险的患者数量减少、患者生活质量(QoL)和治疗依从性改善。此外，本研究中使用的DSS进行控制,以确保数据评估的正确性和数据的合理性.我们选择了服用不少于三种不同药物进行长期治疗的成年患者，其中至少一种必须是抗血栓药物，在6个月的时间里，他们是8家选定药房之一的客户。在DSS支持下分析了87例患者的数据。药剂师总共鉴定了234个DRP（每个患者2.7个DRP）。MR将DRPs降低了43.2%，导致每位患者减少1.2个DRPs。干预还导致患者的QoL显著改善（通过EQ-5D-5L问卷评估；p<0.001）和治疗依从性提高（通过A14问卷评估；p<0.001）。DSS软件的正确数据评估（一致性为93.8％）和数据合理性（一致性为91.7％）的控制由外部审计师进行。对总体出血风险没有发现显著影响。这项研究的结果表明，由药剂师进行的DSS支持和结构化MR可以有助于减少DRPs，并显着改善患者的QoL和对治疗的依从性。
