Medication Abortion With Pharmacist Dispensing of Mifepristone.
Medication Abortion With Pharmacist Dispensing of Mifepristone.
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DOI：
10.1097/aog.0000000000004312
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发表时间：
2021-04-01
影响因子：
7.2
通讯作者：
Creinin MD
中科院分区：
文献类型：
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作者：
Grossman D;Baba CF;Kaller S;Biggs MA;Raifman S;Gurazada T;Rafie S;Averbach S;Meckstroth KR;Micks EA;Berry E;Raine-Bennett TR;Creinin MD
药物流产与药师配发米非司酮是有效的，与不良事件的发生率低，患者满意的护理模式。评价药师配制米非司酮药物流产的有效性和可接受性。我们于2018年7月至2020年3月在加州和华盛顿州的8家临床研究中心和药房进行了一项前瞻性队列研究。参与药房的药剂师接受了1小时的药物流产培训。我们接触了那些已经接受过评估、咨询并同意按照标准护理进行药物流产的患者。有兴趣参与研究的患者表示同意，临床医生通过电子方式向药房发送处方，口服米非司酮200 mg，24-48小时后口腔含服米索前列醇800微克。参与者在入组后第2天和第14天收到了关于他们的经验和结果的基于网络的调查，并与研究中心进行了常规随访。我们从医疗记录中提取了人口统计学和临床数据，包括流产结果和不良事件。我们进行了多变量逻辑回归，以评估药房经验和其他协变量与满意度的关联。我们招募了266名参与者，并获得了262名（98.5%）的临床结局信息，其中2名报告未服用任何药物。在260名有堕胎结果信息的参与者中，分别有252人（96.9%）和237人（91.2%）完成了第2天和第14天的调查。243例受试者发生完全药物流产（主要结局）（93.5%，95% CI 89.7-96.1%）。4例受试者（1.5%，95% CI 0.4-3.9%）发生了不良事件，均为非严重事件或与药剂师分发无关。在第2天的调查中，91.3%（95% CI 87.1-94.4%）的参与者报告对药房体验感到满意。在第14天的调查中，84.4%（95% CI 79.1-88.8%）的患者报告对药物流产体验感到满意。那些报告对药房体验非常满意的患者报告对药物流产的总体满意度的几率更高（调整后的比值比2.96，95% CI 1.38-6.32）。药师处方米非司酮用于药物流产是有效的，患者可以接受，不良事件发生率低。ClinicalTrials.gov，NCT03320057。
Medication abortion with pharmacist-dispensed mifepristone is effective, with a low prevalence of adverse events, and patients are satisfied with the model of care. To estimate effectiveness and acceptability of medication abortion with mifepristone dispensed by pharmacists. We conducted a prospective cohort study at eight clinical sites and pharmacies in California and Washington State from July 2018 to March 2020. Pharmacists at participating pharmacies underwent a 1-hour training on medication abortion. We approached patients who had already been evaluated, counseled, and consented for medication abortion per standard of care. Patients interested in study participation gave consent, and the clinician electronically sent a prescription to the pharmacy for mifepristone 200 mg orally, followed 24–48 hours later by misoprostol 800 micrograms buccally. Participants were sent web-based surveys about their experience and outcomes on days 2 and 14 after enrollment and had routine follow-up with study sites. We extracted demographic and clinical data, including abortion outcome and adverse events, from medical records. We performed multivariable logistic regression to assess the association of pharmacy experience and other covariates with satisfaction. We enrolled 266 participants and obtained clinical outcome information for 262 (98.5%), of whom two reported not taking either medication. Of the 260 participants with abortion outcome information, 252 (96.9%) and 237 (91.2%) completed day 2 and 14 surveys, respectively. Complete medication abortion (primary outcome) occurred for 243 participants (93.5%, 95% CI 89.7–96.1%). Four participants (1.5%, 95% CI 0.4–3.9%) had an adverse event, none of which was serious or related to pharmacist dispensing. In the day 2 survey, 91.3% (95% CI 87.1–94.4%) of participants reported satisfaction with the pharmacy experience. In the day 14 survey, 84.4% (95% CI 79.1–88.8%) reported satisfaction with the medication abortion experience. Those reporting being very satisfied with the pharmacy experience had higher odds of reporting overall satisfaction with medication abortion (adjusted odds ratio 2.96, 95% CI 1.38–6.32). Pharmacist dispensing of mifepristone for medication abortion is effective and acceptable to patients, with a low prevalence of adverse events. ClinicalTrials.gov, NCT03320057.