背景:药物相关问题(MRP)对可预防的患者伤害和全球医疗保健支出有重要贡献。弱势群体,包括澳大利亚原住民(请注意,本文中使用的“土著”一词包括所有原住民和托雷斯海峡岛民,并承认他们丰富的传统和异质文化。)和患有严重和持续性精神疾病(SPMI)的人,可能会增加MRP的风险。药剂师主导的药物审查可以确定MRP的针对性行动。
目的:描述社区药剂师在对澳大利亚土著居民和SPMI患者进行药物审查时发现的MRP和提出的建议。
方法:通过两项澳大利亚试验招募参与者,测试新型社区药剂师主导的干预措施的可行性和/或有效性。土著药物审查服务(IMeRSe)可行性研究(2018年6月至2019年7月)和弥合社区药房中的身体和精神疾病之间的差距(PharMibridge)随机对照试验(2020年9月至2021年12月)。训练有素的社区药剂师根据参与者的文化和健康需求进行了药物审查。MRP,使用已建立的分类系统(DOCUMENT)记录和分类MRP严重程度和药剂师建议。MRP严重程度由药剂师和独立评估者评估。数据进行了描述性分析,和配对t检验用于比较严重程度评级。
结果:药剂师在两项试验中确定了795例MRP,其中411例参与者(n=255IMeRSe,n=156PharMibridge)。在IMeRSe和PharMIbridge中,不坚持用药是最常见的(n=157,25.1%)和第二常见的(n=25,14.7%)MRP,分别。治疗不足是澳大利亚原住民样本中第二常见的MRP(n=139,22.2%),毒性/不良反应的报告在SPMI患者中最常见(n=41,24.1%).改变药物治疗是药剂师最常见的建议(在IMeRSe和PharMibridge中分别为40.2%和55.0%,分别)。严重等级各不相同,两组中大多数为“轻度”或“中度”。试验药剂师和独立评估者分配的严重程度等级存在显着差异。
结论:社区药剂师确定了两个高危人群所经历的一系列MRP,最常见的非依从性和毒性或不良反应,在进行药物审查并提出不同的管理策略时,经常建议改变药物治疗。这些发现强调了更有针对性的方法来识别和管理初级保健中的MRP的机会,并且量身定制的社区药剂师主导的干预措施可能在这个领域具有价值。
背景:澳大利亚和新西兰临床试验注册记录(IMeRSeACTRN12618000188235注册于2018年6月2日,PharMibridgeACTRN12620000577910注册于2020年5月18日)。
BACKGROUND: Medication-related problems (MRPs) contribute significantly to preventable patient harm and global healthcare expenditure. Vulnerable populations, including Indigenous Australians (please note that the use of the term \'Indigenous\' in this paper includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures.) and people living with severe and persistent mental illness (SPMI), may be at increased risk of MRPs. Pharmacist-led medication reviews can identify MRPs for targeted action.
OBJECTIVE: To characterize MRPs identified and recommendations made by community pharmacists during medication reviews conducted with Indigenous Australians and people living with SPMI.
METHODS: Participants were recruited through two Australian trials testing the feasibility and/or effectiveness of novel community pharmacist-led interventions, the Indigenous Medication Review Service (IMeRSe) feasibility study (June 2018-July 2019) and Bridging the Gap between Physical and Mental Illness in Community Pharmacy (PharMIbridge) randomized controlled trial (September 2020-December 2021). Trained community pharmacists conducted medication reviews responsive to the cultural and health needs of participants. MRPs, MRP severity and pharmacist recommendations were documented and classified using an established classification system (DOCUMENT). MRP severity was assessed by pharmacists and an independent assessor. Data were analysed descriptively, and paired t-tests were used to compare severity ratings.
RESULTS: Pharmacists identified 795 MRPs with 411 participants across both trials (n = 255 IMeRSe, n = 156 PharMIbridge). Non-adherence to medication was the most common (n = 157, 25.1%) and second-most common (n = 25, 14.7%) MRP in IMeRSe and PharMIbridge, respectively. Undertreatment was the second-most common MRP in the sample of Indigenous Australians (n = 139, 22.2%), and
reports of toxicity/adverse reactions were most common in people living with SPMI (n = 41, 24.1%). A change in pharmacotherapy was the most frequent recommendation made by pharmacists (40.2% and 55.0% in IMeRSe and PharMIbridge, respectively). Severity ratings varied, with the majority being \'Mild\' or \'Moderate\' in both groups. Significant differences were found in the severity rating assigned by trial pharmacists and the independent assessor.
CONCLUSIONS: Community pharmacists identified a range of MRPs experienced by two at-risk populations, most commonly non-adherence and toxicity or adverse reactions, when conducting medication reviews and proposed diverse strategies to manage these, frequently recommending a change in pharmacotherapy. These findings highlight the opportunity for more targeted approaches to identifying and managing MRPs in primary care and tailored community pharmacist-led interventions may be of value in this space.
BACKGROUND: Australian and New Zealand Clinical Trial Registry records (IMeRSe ACTRN12618000188235 registered 06/02/2018 & PharMIbridge ACTRN12620000577910 registered 18/05/2020).