Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults.
Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults.
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DOI：
10.1016/j.japh.2021.04.007
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Chui MA
中科院分区：
文献类型：
--
作者：
Gilson AM;Stone JA;Morris AO;Brown RL;Xiong KZ;Jacobson N;Holden RJ;Albert SM;Phelan CH;Walbrandt Pigarelli DL;Breslow RM;Welch L;Chui MA
目前还没有任何干预措施试图通过解决系统障碍来减少 65 岁以上成年人（老年人）对非处方药 (OTC) 的滥用。创新的药房结构重新设计（高级部分™）的概念是为了提高对高风险非处方药的认识。高级部分包含精心挑选的非处方药，并且靠近处方部门，以促进药房工作人员/患者参与以减少误用。这项试点研究探讨了高级部门在影响老年人非处方药滥用方面的有效性。采用前测后测非等效组设计从三个药房招募了 87 名老年人。使用假设场景，参与者选择一种非处方药，将其与他们的药物清单和健康状况进行比较，并将他们报告的使用情况与产品标签进行比较。滥用结果包括药物/药物、药物/疾病、药物/年龄和药物/标签，有五个子类型。将患者特征编译成倾向评分匹配逻辑回归模型，以估计其对高级部分与实施前/实施后滥用的关联的影响。实施前/实施后的患者特征是一致的，一旦进入倾向评分匹配模型，药物/标签滥用（超过每日剂量）随着时间的推移显着减少（z=−2.42，p=0.015）。此外，对于原始评分模型（z=-6.38，p=0.011）或添加患者特征倾向评分的模型（z=-5.82，p=0.011），高级部分减少了药物/标签滥用（超过单剂量）。尽管统计效果有限，但在 11 次比较中的 7 次实施后，发现误用有所减少。这些初步成果开始提供证据基础，以支持基于药房的精心设计的非处方药通道重新设计，以减少老年人非处方药滥用。高级部门在广泛实施后，会创建永久性的结构和流程，以帮助老年人在选择更安全的非处方药时获取风险信息。
No interventions have attempted to decrease misuse of over-the-counter (OTC) medications for adults older than 65 (older adults) by addressing system barriers. An innovative structural pharmacy redesign (the Senior Section™) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications and is close to the prescription department to facilitate pharmacy staff/patient engagement to reduce misuse. This pilot study examines the Senior Section’s effectiveness at influencing OTC medication misuse in older adults. A pretest-posttest non-equivalent groups design was used to recruit 87 older adults from three pharmacies. Using a hypothetical scenario, participants selected an OTC medication, which was compared to their medication list and health conditions, and their reported use was compared against the product labeling. Misuse outcomes comprised Drug/Drug, Drug/Disease, Drug/Age, and Drug/Label with five sub-types. Patient characteristics were compiled into a propensity-score matching logistic-regression model to estimate their effects on the Senior Section’s association with misuse at pre-/post-implementation. Patient characteristic were uniform between pre-/post-implementation and, once entered into a propensity-score matching model, Drug/Label Misuse (Exceeds Daily-Dosage) significantly lessened over time (z=−2.42, p=0.015). In addition, the Senior Section reduced Drug/Label Misuse (Exceeds Single-Dosage) for both the raw score model (z=−6.38, p=0.011) or for the model in which the patient characteristics propensity score was added (z=−5.82, p=0.011). Despite these limited statistical effects, misuse was found to decrease after implementation for 7 of 11 comparisons. These nascent outcomes begin providing an evidence base to support a well-conceived pharmacy-based OTC aisles redesign for reducing older adult OTC medication misuse. The Senior Section, when broadly implemented, creates permanent structures and processes to assist older adults to access risk information when selecting safer OTC medications.
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DOI：
10.1331/1544-3191.46.5.574.lam
发表时间：
2006-09-01
影响因子：
2.1
作者：
Lam, Annie;Bradley, George
通讯作者：
Bradley, George
影响因子：
6.3
作者：
Radcliff, Sue;Yue, Jirong;Beers, Mark H.
通讯作者：
Beers, Mark H.
影响因子：
--
作者：
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通讯作者：
Chui MA
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
DOI：
10.3390/pharmacy8030175
发表时间：
2020-09-18
期刊：
Pharmacy (Basel, Switzerland)
影响因子：
--
作者：
Shah S;Gilson AM;Jacobson N;Reddy A;Stone JA;Chui MA
通讯作者：
Chui MA