Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence
Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence
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DOI：
10.18553/jmcp.2013.19.5.396
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发表时间：
2013-06-01
影响因子：
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通讯作者：
Dartsch, Dorothee C.
中科院分区：
文献类型：
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作者：
Stange, Dorit;Kriston, Levente;Dartsch, Dorothee C.
背景：患者依从性对于药物治疗的成功是必要的。然而，高度复杂的用药方案可能导致依从性差，这会降低治疗效果，并常常导致治疗失败、过高的发病率和死亡率以及更高的成本。
目的：通过（a）对医院医务人员进行药学咨询以及（b）在出院信中为初级医疗服务提供者（PCP）提供关于简化出院用药的额外信息来降低用药复杂性，从而检验患者依从性是否能间接提高。
方法：在德国汉堡 - 埃彭多夫医学中心（一家三级医疗大学医院），240名患有高血压、糖尿病和/或血脂异常的慢性病住院患者参与了这项前瞻性、半随机研究。对于干预组，临床药师就心血管和抗糖尿病药物的可行简化方案对医院医生进行了咨询。在1个随机分组中，PCP在出院信中收到了额外的解释性信息。在入院、出院以及出院6周时记录依从性（使用药物依从性评定量表[MARS - D]进行自我报告）和用药复杂性（使用用药方案复杂性指数[MRCI - D]）。在入院和出院后评估患者的生活质量（QoL）以及对药物信息的满意度。
结果：出院时，干预组的用药方案明显比对照组简单。然而，出院6周后，门诊用药的复杂性增加到与对照组相似的值，除非PCP在出院信中收到额外信息。出院时倾向调整后的完全依从率在干预组比对照组略高，但无显著差异。在干预组内，为PCP提供额外信息的亚组中完全依从更为常见。两组患者的生活质量和对信息的满意度相当。
结论：通过对医院医生进行咨询，可以降低心血管和抗糖尿病医院用药的复杂性。然而，为了可持续地简化门诊用药，PCP必须收到关于调整的明确信息。患者依从性未受到该干预的显著影响。为了验证这些结果，需要使用依从性的客观测量方法并在其他疾病患者中进行进一步研究。版权所有（c）2013，美国医疗保健管理药学学会。保留所有权利。
BACKGROUND: Patient adherence is necessary for successful medication therapy. However, highly complex medication regimens may lead to poor adherence, which decreases the effectiveness of treatment and often results in treatment failure, excessive morbidity and mortality, and higher costs.OBJECTIVE: To examine whether patient adherence can be increased indirectly through reducing medication complexity by (a) pharmaceutical counseling of hospital medical staff and (b) additional information in the discharge letter for the primary care provider (PCP) about the simplified discharge medication.METHODS: At the Medical Center Hamburg-Eppendorf, a tertiary care university hospital in Germany, 240 chronically ill inpatients with hypertension, diabetes, and/or dyslipidemia were enrolled in this prospective, semirandomized study. For the intervention group, hospital doctors were counseled by a clinical pharmacist on feasible simplifications of cardiovascular and antidiabetic medications. In 1 randomized subgroup, the PCP received additional explanatory information in the discharge letter. Adherence (self-reporting using the Medication Adherence Rating Scale [MARS-D]) and medication complexity (using the Medication Regimen Complexity Index [MRCI-D]) were recorded at admission to the hospital, discharge from the hospital, and 6 weeks after discharge. Patient quality of life (QoL) and satisfaction with information about medications were assessed at admission and after discharge.RESULTS: At discharge, the medication regimen in the intervention group was significantly less complex than in the comparison group. Yet, 6 weeks after discharge, the complexity of the outpatient medication had increased to values similar to the comparison group, unless the PCP received additional information in the discharge letter. Propensity adjusted complete adherence rates at discharge were slightly, but not significantly, higher in the intervention group than in the comparison group. Within the intervention group, complete adherence was more frequent in the subgroup with additional information for the PCP. Patient QoL and satisfaction with information were comparable in both groups.CONCLUSION: The complexity of cardiovascular and antidiabetic hospital medications can be reduced by counseling the hospital doctors. However, for a sustainable simplification of outpatient medication, the PCPs must receive explicit information about the modifications. Patient adherence was not significantly influenced by this intervention. To verify these results, further research with objective measures of adherence and in patients with other diseases is needed. Copyright (c) 2013, Academy of Managed Care Pharmacy. All rights reserved.