Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence.
Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence.
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DOI：
10.2147/ppa.s34984
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发表时间：
2012
影响因子：
2.2
通讯作者：
Yamada K
中科院分区：
文献类型：
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作者：
Watanabe N;Yamamura K;Suzuki Y;Umegaki H;Shigeno K;Matsushita R;Sai Y;Miyamoto K;Yamada K
多奈哌齐被广泛用于延缓阿尔茨海默病（AD）患者认知功能障碍的进展，但药物治疗的疗效常常因服药依从性差而降低。为了通过提供有关 AD 的信息和药物治疗的重要性来提高依从性，设立了多奈哌齐门诊咨询服务 (DOCS)。本研究评估了这项服务对药物持久性的影响。在开始多奈哌齐治疗的门诊患者中，我们入组了2008年4月至2010年9月建立DOCS之前的59名患者（非DOCS组）和2010年10月至2012年3月参加DOCS的52名患者（DOCS组）。还评估了每位患者及其护理人员对 AD 临床特征和多奈哌齐药物治疗的理解。比较他们在DOCS前后的理解，并调查1年用药坚持率和停药原因。 DOCS组1年用药坚持率显着高于非DOCS组（73.1% vs 49.2%，P = 0.008）。我们研究了药物治疗持续性与年龄、性别、临床痴呆评级、独居和参加 DOCS 的关系。结果，参加 DOCS 的患者的药物坚持率明显更高。停用多奈哌齐的主要原因是非 DOCS 组的转移（11 例）和胃肠道副作用（5 例），以及 DOCS 组的转移（9 例）和胃肠道副作用（3 例）。参加 DOCS 之前理解的总体得分为 2.5 ± 1.7，之后显着增加至 5.7 ± 0.7 (P < 0.001)。医院药剂师为 AD 患者及其护理人员提供的 DOCS 咨询提高了对痴呆症临床特征的了解，并提供了抗痴呆药物的药理学知识，从而更好地坚持药物治疗，从而最大限度地发挥其效果。
Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer’s disease (AD), but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS) was set up. The influence of this service on medication persistence was assessed in the present study. Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group) and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group). Each patient’s and their caregiver’s understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated. The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73.1% vs 49.2%, P = 0.008). We examined the association of medication persistence with age, sex, clinical dementia rating, living alone, and attending the DOCS. As a result, medication persistence was significantly higher in patients attending the DOCS. The main reasons for discontinuation of donepezil were transfer elsewhere (11) and gastrointestinal side effects (5) in the non-DOCS group, and transfer (9) and gastrointestinal side effects (3) in the DOCS group. The overall score for understanding was 2.5 ± 1.7 before attending the DOCS and it increased significantly to 5.7 ± 0.7 afterward (P < 0.001). The DOCS consultation provided by hospital pharmacists for AD patients and their caregivers improved understanding about the clinical features of dementia and provided pharmacological knowledge about antidementia drugs, leading to better adherence to pharmacotherapy that could maximize its effect.