药剂师主导的改善COPD患者用药依从性的干预研究

doi:10.5246/jcps.2023.01.005

中国药学(英文版) ›› 2023, Vol. 32 ›› Issue (1): 52-63.DOI: 10.5246/jcps.2023.01.005

• 【药事管理与临床药学专栏】 • 上一篇下一篇

药剂师主导的改善COPD患者用药依从性的干预研究

袁菱¹, 杨青¹, 胥新平², 童德银¹, 耿立惠²^,^*()

1. 宿迁市第一人民医院药学部, 江苏宿迁 223800
2. 宿迁市第一人民医院呼吸内科, 江苏宿迁 223800

收稿日期:2022-07-14 修回日期:2022-08-12 接受日期:2022-09-10 出版日期:2023-01-31 发布日期:2023-01-31
通讯作者: 耿立惠
作者简介:
+ Tel./Fax: +86-527-80525101, E-mail: yuanl.china@sina.com
基金资助:
The Jiangsu Youth Medical Talents Project (Grant No. QNRC2016483) and the Jiangsu Pharmaceutical Association-Tianqing Clinical Pharmaceutical Fund Scientific Research Project (Grant No. Q2019154).

A pharmacist-led intervention study to improve treatment adherence in patients with chronic obstructive pulmonary disease

Ling Yuan¹, Qing Yang¹, Xinping Xu², Deyin Tong¹, Lihui Geng²^,^*()

1 Department of Hospital Pharmacy, Suqian First Hospital, Suqian 223800, Jiangsu, China
2 Department of Respiratory medicine, Suqian First Hospital, Suqian 223800, Jiangsu, China

Received:2022-07-14 Revised:2022-08-12 Accepted:2022-09-10 Online:2023-01-31 Published:2023-01-31
Contact: Lihui Geng

摘要/Abstract

摘要：

慢性阻塞性肺疾病(COPD)治疗的用药依从性与疾病控制相关。本文通过调查药剂师对干粉吸入剂(DPI)的使用进行干预后COPD患者吸入技术、满意度和依从性的改善情况, 探讨使用干粉吸入剂患者的吸入技术、满意度与用药依从性之间的关系。研究对象为至少使用2个月DPIs的COPD患者, DPIs包括都宝(Turbohaler), 准纳器(Discus)和吸乐(Handihaler)。当患者第一次进入研究时, 吸入器技术、满意度和依从性等由训练有素的药剂师进行评估。第一次评估后, 药剂师通过指导患者吸入剂使用, 并针对患者用药满意度调查结果中不满意问题进行解答和干预, 并对其进行1个月、3个月进行随访, 6个月评估患者干预后吸入技术、满意度和依从性。共有135名患者完成本研究, 患者吸入装置使用时间越长错误率越低, 依从性越好, 而CAT分越高及过去1年内病情加重次数越多, 依从性越差。在干预前吸入技术中至少有一个错误的患者比例: 都宝86.44%, 准纳器76.60%, 吸乐54.17%。药师干预后至少有一个错误的患者比例: 都宝32.20%, 准纳器29.79%, 吸乐22.92%。干预后PASAPQ满意度平均分由基线时的74.44 ± 7.48升高为83.97 ± 5.88 (P < 0.001), 依从性平均分由4.78 ± 1.46升高为6.52 ± 1.11, 较基线时显著升高(P < 0.001)。三种装置的易用性满意度得分显著升高(P < 0.001), 有意类依从性相比无意类升高更为显著(P < 0.001)。研究发现药剂师的吸入器培训及使用治疗干预是可行的, 可以改善吸入器技术及满意度, 提高患者依从性。

关键词: 满意度, 依从性, 干粉吸入剂, 慢性阻塞性肺疾病, 干预

Abstract:

Non-adherence to chronic obstructive pulmonary disease (COPD) treatment is associated with poor disease control. Little data exist from China on inhalation adherence and patient satisfaction. We investigated the improvement in inhalation adherence in patients with COPD following a pharmacist’s intervention on dry powder inhaler (DPI) use. The participants were patients with COPD who used DPIs for at least 2 months. DPIs included Turbohaler, Discus, and HandiHaler. On enrolment, the inhaler technique, patient satisfaction, and adherence were assessed by a pharmacist, who guided the patients on the use of inhalants and addressed dissatisfaction issues based on the results of a medication satisfaction survey. Follow-ups were conducted at 1 and 3 months. Finally, the inhalation technique, satisfaction, and adherence at 6 months were compared with those before the intervention. A total of 135 patients completed the study. The higher the COPD assessment test (CAT) score and the higher the number of disease exacerbations in the past year, the worse the adherence. The proportion of patients with at least one error in the inhalation technique at baseline was 86.44% for Turbohaler, 76.60% for Discus, and 54.17% for HandiHaler. After pharmacist intervention, the error rate was decreased to 32.20% for Turbohaler, 29.79% for Discus, and 22.92% for HandiHaler. The average score of the Patient Satisfaction and Preference Questionnaire was increased from 74.44 ± 7.48 to 83.97 ± 5.88 (P < 0.001), and the average adherence score was increased from 4.78 ± 1.46 to 6.52 ± 1.11 (P < 0.001). Users of all three devices showed significant increases in satisfaction with performance (P < 0.001), and the increase in intentional adherence was more significant than that in unintentional adherence (P < 0.001). This study found that inhaler training and medication management by pharmacists were feasible and could improve inhaler technique, patient satisfaction, and adherence.

Key words: Satisfaction, Adherence, Dry powder inhaler, Chronic obstructive pulmonary disease, Intervention

Supporting:

Supplementary Table 1. Validated questions included in the PASAPQ

袁菱, 杨青, 胥新平, 童德银, 耿立惠. 药剂师主导的改善COPD患者用药依从性的干预研究[J]. 中国药学(英文版), 2023, 32(1): 52-63.

Ling Yuan, Qing Yang, Xinping Xu, Deyin Tong, Lihui Geng. A pharmacist-led intervention study to improve treatment adherence in patients with chronic obstructive pulmonary disease[J]. Journal of Chinese Pharmaceutical Sciences, 2023, 32(1): 52-63.

图/表 6

Table 1. Univariate analysis of factors associated with COPD patients’ adherence to inhaler therapy.

Table 2. Numbers and percentages of mistakes per step in patients with an incorrect inhalation technique.

Figure 1. Correlation between MMAS-8 and PASAPQ scores at 0 and 6 months (n = 154).

Figure 2. Mean PASAPQ and MMAS-8 scores regarding DPI use before and after intervention (n = 154).

Table 3. Assessment of PASAPQ scores (x ± s).

Table 4. Investigation results of patients' adherence to inhalation devices (x ± s).

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药剂师主导的改善COPD患者用药依从性的干预研究

A pharmacist-led intervention study to improve treatment adherence in patients with chronic obstructive pulmonary disease

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