Capsule Commentary on Muench et. al., Scope-of-practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care.
Capsule Commentary on Muench et. al., Scope-of-practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care.
复制标题
Muench 等人的胶囊评论。
DOI：
10.1007/s11606-020-06016-5
复制
发表时间：
2021
影响因子：
5.7
通讯作者：
Lauffenburger,JulieC
中科院分区：
文献类型：
--
作者：
Lauffenburger,JulieC
药物依从性差的流行损害了健康结果；许多患者甚至在开始治疗一年后停止服用处方药物。尽管有许多旨在提高依从性的干预措施的尝试，但这些努力取得了不同程度的成功。1,2使用非医生的方法，如护士或药剂师，或那些强调团队护理的方法经常被发现是有效的基于实践的依从性杠杆。这项由Muench等人进行的准实验研究评估了扩大执业护士（NPs）的执业范围法规与药房索赔中测量的药物依从性之间的关系。研究者使用了多变量差异中差异的方法来检验3种慢性药物类别在5种扩张状态和非扩张状态之间的平均差异。结果是，在扩大实践范围法律的州，依从性提高了约2%。对研究结果的解释在一定程度上受到研究设计的限制，最值得注意的是，差异中的差异方法只能提供依从性的总结测量，尽管这些测量可以直接与关键质量指标进行比较。其他长期趋势或联合干预也不能排除。例如，在接下来的步骤中，一种中断的时间序列方法可以匹配患者并评估每月对更广泛药物的依从性，从而提供进一步的证据。虽然不可能证实扩大NPs的范围反过来会提高患者对药物的依从性，但似乎没有任何负面影响。此外，这里观察到的改善与其他政策变化是一致的。2,3这项研究符合这一更广泛的背景，它表明，增加获得执业护士的机会可能同样有助于提高药物依从性，也许是通过扩大获得处方者的机会，从而减少药物处方差距。随着医疗保健系统从主要以医生为基础的护理转向以团队为基础的护理，考虑其他团队成员（包括执业护士）对护理提供的影响可能是依从性解决方案的一部分。即使实践范围的扩大并不能完全解释观察到的依从性的提高，执业护士可能是一个有用的选择，以提高在初级保健慢性疾病管理的依从性干预的有效性。
T he epidemic of poor adherence to medications compro-mises health outcomes; many patients stop taking their medications as prescribed even 1 year after initiating therapy. Despite numerous attempts to develop interventions aimed at improving adherence, efforts have had varying degrees of success. 1, 2 Approaches using non-physicians, such as nurses or pharmacists, or those that emphasize team-based care have been often found to be effective practice-based adherence levers. 2, 3 This quasi-experimental study by Muench et al. evaluated the association between expanding scope-of-practice regulations for nurse practitioners (NPs) on medication adherence measured in pharmacy claims. 4 The investigators used a multivariable differences-in-differences approach to examine mean differences for 3 chronic drug classes between 5 expansion states and non-expansion states. The result was that adherence improved by approximately 2% in states that expanded scope-of-practice laws. Interpretation of the findings is limited somewhat by the study design, most notably that difference-in-differences approaches provide only summary measures of adherence, although these measures enable direct comparisons with key quality metrics. Other secular trends or co-interventions also cannot be ruled out. As next steps, for example, an interrupted times-series approach that matches patients and evaluates monthly adherence on a broader set of medications could provide further evidence. While it is not possible to confirm that expanding the scope of NPs in turn improves patient adherence to medications, there do not appear to be any negative effects. Moreover, the improvements observed here are in line with other policy changes. 2, 3 This study fits into that broader context by suggesting that enhanced access to nurse practitioners may similarly help improve medication adherence, perhaps by expanding access to prescribers, thereby reducing medication prescribing gaps. 5As healthcare systems shift from primarily physicianbased care to team-based care, considering the impact of other team members, including nurse practitioners, on the provision of care may be part of adherence solutions. Even if the expanded scope of practice does not entirely explain the observations of improved adherence, nurse practitioners may be a useful option to increase the effectiveness of adherence interventions for chronic disease management in primary care.