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Impact of pharmaceutical care on self-administration of outpatient low-molecular-weight heparin therapy

机译:药学服务对门诊低分子肝素治疗自我管理的影响

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摘要

Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatmentof different diseases. The effectiveness of community-pharmacy-based interventions in preventingproblems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown. Our objective was to provide a standard operating procedure (SOP) for community pharmacists and to compare pharmaceutical vs. standard care in both clinical and daily life settings. We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction, and in fewer complications; the interventions used are feasible in daily life; and the resultsachieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlledtrial), patients were recruited sequentially in hospital wards; in the daily life setting (quasi-experimental design with a comparison group), recruitment took place in community pharmacies by pharmacists and trained master students during their internship. Interventionswere offered according to patient needs. Data were collected by means of a monitored self-injectionat home and structured questionnaire-based telephone interviews at the beginning and theend of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills; syringe count to assess adherence; and frequency, effectiveness, and patient’s assessment of received interventions. The results show a median age of the 139 patients of 54 years. Interventions resulted in improved application quality (p > 0.01) and knowledge (p = 0.03). Oral instructions were pivotal for improving patients’ application quality. We found no significant score differences between the intervention groups in the clinical and daily life settings. Patients’ baseline skills were high, with the lowest score being 0.86 (score range −2.00 to +2.00). Adherence rate was high (95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, appreciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies ifadequate assistance is provided.
机译:门诊皮下(s.c.)疗法在不同疾病的治疗中变得越来越普遍。基于社区药房的干预措施在预防s.c.低分子量肝素(LMWH)的自我注射尚不清楚。我们的目标是为社区药剂师提供标准的操作程序(SOP),并在临床和日常生活环境中比较药物与标准护理。我们假设:药物治疗可提高依从性,安全性和满意度,并减少并发症。所采用的干预措施在日常生活中是可行的;在临床和日常生活中所获得的结果是可比的。在临床环境中(随机对照试验),患者在医院病房中按顺序招募;在日常生活环境中(带有比较组的准实验设计),药剂师和训练有素的硕士生在实习期间在社区药房进行了招募。根据患者需要提供干预措施。在LMWH治疗的开始和结束时,通过在家中监测的自我注射和基于问卷的结构化电话访谈的方式收集数据。主要结果指标包括:评估患者技能的分数;注射器计数以评估依从性;频率,有效性以及患者对收到的干预措施的评估。结果显示139名54岁患者的中位年龄。干预可以提高应用程序质量(p> 0.01)和知识(p = 0.03)。口服说明对于提高患者的应用质量至关重要。我们发现,在临床和日常生活环境中,干预组之间没有明显的分数差异。患者的基线技能很高,最低得分为0.86(得分范围-2.00至+2.00)。遵守率很高(95.8%)。总之,我们针对药剂师干预的SOP在日常生活中具有良好的质量,足够的价值,值得赞赏且可行的。患者有能力进行s.c.如果提供足够的协助,则应进行注射疗法。

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