评估临床药剂师主导的哮喘布地奈德-福莫特罗单一维持和缓解疗法(SMART)处方后的效果

IF 1.3 Q4 PHARMACOLOGY & PHARMACY
Ila M. Harris Pharm.D., FCCP, Ann M. Philbrick Pharm.D., FCCP, Kristen C. Klemenhagen Ph.D.
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引用次数: 0

摘要

根据全球哮喘倡议和国家哮喘教育与预防计划指南,吸入皮质类固醇-福莫特罗联合吸入剂的单一维持和缓解疗法(SMART)是首选的哮喘治疗方法。本研究是一项观察性队列研究,在全科住院医师培训项目诊所进行。该研究评估了由临床药剂师主导的 SMART 实施计划,该计划包括对医疗服务提供者进行教育和开发临床工具,以促进 SMART 处方的开具。主要结果是评估该举措对 SMART(布地奈德-福莫特罗,不含阿布特罗)处方频率的影响。此外,还分别比较了阿布特罗和布地奈德-福莫特罗的处方频率。次要结果是哮喘控制测试(ACT)得分以及教师和住院医师的处方频率。符合条件的门诊患者总数为 807 人,其中 459 人符合纳入标准。其中女性多于男性,平均年龄为 39 岁。约 24% 的患者使用英语以外的语言,22% 的患者需要翻译。接受 SMART 治疗的患者比例从 0.44% 显著增加到 11.5%(p < 0.001)。布地奈德-福莫特罗处方从 7.4% 增加到 34.6%(p < 0.001)。阿布特罗计量吸入器处方从 79.7% 降至 66.2%(p < 0.001)。教职医师(n = 258)和住院医师(n = 196)的患者处方模式相似。只有 164 名(35.7%)患者在第一年和第二年进行了 ACT 评分,且第一年和第二年的平均 ACT 评分无显著差异(p = 0.973)。由临床药师主导的 SMART 哮喘处方计划与 SMART 处方的显著增加、布地奈德-福莫特罗处方的显著增加以及阿布特罗处方的显著减少有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Evaluation of single maintenance and reliever therapy (SMART) prescribing of budesonide-formoterol for asthma after a clinical pharmacist-led initiative

Evaluation of single maintenance and reliever therapy (SMART) prescribing of budesonide-formoterol for asthma after a clinical pharmacist-led initiative

Introduction

Single maintenance and reliever therapy (SMART) with a combination inhaled corticosteroid-formoterol inhaler is the preferred asthma treatment by the Global Initiative for Asthma and the National Asthma Education and Prevention Program guidelines. These recommendations have been slow to be implemented routinely into clinical practice.

Methods

This was an observational cohort study conducted in a family medicine residency program clinic. A clinical pharmacist-led initiative to implement SMART, which included provider education and the development of clinical tools to facilitate SMART prescribing, was assessed. Year 1 (Y1; pre-intervention) and year 2 (Y2; post-intervention) were compared.

Outcomes

The primary outcome was to evaluate the impact of this initiative on the frequency of SMART (budesonide-formoterol without albuterol) prescribing. Prescription frequencies for albuterol and budesonide-formoterol were also compared separately. Secondary outcomes were Asthma Control Test (ACT) scores and prescribing frequencies among faculty and resident physicians.

Results

The total number of eligible patients in the clinic population was 807, and 459 of these patients met the inclusion criteria. There were more females than males, and the mean age was 39. About 24% had a language preference other than English and 22% required an interpreter. The percentage of patients who were prescribed SMART significantly increased from 0.44% to 11.5% (p < 0.001). Budesonide-formoterol prescriptions increased from 7.4% to 34.6% (p < 0.001). Albuterol metered-dose inhaler prescriptions decreased from 79.7% to 66.2% (p < 0.001). Prescribing patterns were similar for patients of faculty physicians (n = 258) and resident physicians (n = 196). Only 164 (35.7%) patients had an ACT score in Y1 and Y2, and the mean ACT score was not significantly different between Y1 and Y2 (p = 0.973).

Conclusion

A clinical pharmacist-led SMART asthma prescribing initiative was associated with a significant increase in SMART prescribing, a significant increase in budesonide-formoterol prescribing, and a significant decrease in albuterol prescribing.

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