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Over-the-counter antibiotic dispensing: knowledge and practice of community pharmacists in the United Arab Emirates 非处方抗生素配药:阿拉伯联合酋长国社区药剂师的知识和实践
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-03-16 DOI: 10.1093/jphsr/rmad013
Sumaya Jairoun, D. Alkhalidi, Ammar Abdulrahman Jairoun, Hanan S. Anbar
This paper aimed to assess the knowledge and practice of community pharmacists in regard to dispensing over-the-counter (OTC) antibiotics with the aim of bringing their professional knowledge up to date and promoting best practices to optimize the use of antibiotics and slow the rise in resistance. A cross-sectional descriptive study design was used to assess the knowledge and practice of community pharmacists towards OTC Antibiotic Dispensing. Participants were issued an invitation through verified and official WhatsApp and Facebook accounts of community pharmacists residing in the United Arab Emirates to fill in a validated-web-based questionnaire. The questionnaire was composed of four sections. It aimed to gather basic demographic data, and address knowledge and practice amongst pharmacists of dispensing OTC antibiotics. Data were analysed using SPSS version 26. A total number of 438 participating community pharmacists in the study completed the whole questionnaire. The average knowledge score was 68.6% with a 95% confidence interval (CI) of [66.9%, 70.2%]. The average practice score was 71.4% with a 95% confidence interval (CI) of [69.5%, 73.2%]. It is recommended that several interventions are launched to promote improved prescribing behaviour, particularly ensuring that all pharmacies receive standardized guidelines on antibiotic use and inviting pharmacists to workshops and other training programmes dedicated to promoting rational drug use. Moreover, regulatory bodies must devise, enforce and monitor the implementation of policies governing how antibiotic prescriptions and patient consultations are managed by community pharmacists.
本文旨在评估社区药师在非处方抗生素(OTC)配药方面的知识和实践,以使他们的专业知识与时俱进,促进最佳实践,优化抗生素的使用,减缓耐药性的上升。采用横断面描述性研究设计来评估社区药剂师对OTC抗生素配药的知识和实践。通过居住在阿拉伯联合酋长国的社区药剂师的经过验证的WhatsApp和Facebook官方账户向参与者发出邀请,让他们填写一份经过验证的基于网络的问卷。问卷由四个部分组成。它旨在收集基本的人口统计数据,并解决药剂师分配非处方抗生素的知识和实践问题。数据采用SPSS 26进行分析。共有438名参与研究的社区药师完成了整个问卷。平均知识得分为68.6%,95%置信区间(CI)为[66.9%,70.2%]。平均练习分数为71.4%,95%可信区间(CI)为[69.5%,73.2%]。建议开展若干干预措施,以促进改进处方行为,特别是确保所有药房获得关于抗生素使用的标准化准则,并邀请药剂师参加专门促进合理用药的讲习班和其他培训规划。此外,管理机构必须制定、执行和监督政策的实施,以管理社区药剂师如何管理抗生素处方和患者咨询。
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引用次数: 1
Determining the accuracy of a medication history at the point of a Comprehensive Geriatric Assessments (CGA) within an inpatient setting on a Frailty Assessment Unit 在虚弱评估单元的住院患者环境中,在综合老年评估(CGA)时确定用药史的准确性
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-03-15 DOI: 10.1093/jphsr/rmad012
Lucy Stratton, Nick Thayer, K. Channa
This retrospective analysis aims to determine the accuracy of medication histories undertaken during a Comprehensive Geriatric Assessment (CGA) (at the point of admission) in an inpatient setting within an acute hospital. The CGA can be completed by a range of healthcare professionals, which will be directly compared. Medication reviews are an integral part of the CGA, therefore the accuracy of the history is integral to the review. A retrospective analysis of patient electronic records between October 2018 and February 2020 was conducted. The accuracy of medication histories recorded as part of the CGA completed by Advanced Nurse Practitioners, Advanced Pharmacist Practitioners and Doctors was compared. This was done using electronic records, any discrepancies were captured. Descriptive statistics were applied. Across the 50 patients and 421 medicines identified, there were 59 discrepancies; 24 (48%) patients were noted with at least one discrepancy in their medication history. An omission of current medication was the most common error (49%), followed by incorrect dose (19%) and a record of a medication not taken pre-admission (15%). The total number of prescribed medications was found to positively correlate with the rate of error (Pearson’s correlation 0.455, P > 0.001). An independent t-test determined a significant difference between the rate of errors between pharmacists and nurses (t-test: −4.48, P < 0.001). This study re-confirmed risks of medication errors when patients change care settings. This is more prevalent with higher numbers of medications, requiring greater care in instances of polypharmacy, particularly in frail patients. This can support risk stratification of patients. A difference in outcomes between pharmacists and nurses warrants further exploration to determine the reasons for this and structuring multi-disciplinary teams accordingly. Consideration to ensure that medication history taking is included as part of the Advanced Clinical Practitioner is important, particularly with the expansion of these roles in the UK.
本回顾性分析旨在确定急性医院住院患者在综合老年评估(CGA)期间(入院时)进行的用药史的准确性。CGA可以由一系列医疗保健专业人员完成,这些专业人员将直接进行比较。药物审查是CGA的组成部分,因此病史的准确性是审查的组成部分。对2018年10月至2020年2月期间的患者电子记录进行了回顾性分析。对高级执业护士、高级执业药剂师和医生完成的CGA中记录的用药史的准确性进行了比较。这是使用电子记录完成的,任何差异都被记录下来。采用描述性统计。在确定的50名患者和421种药物中,存在59种差异;24名(48%)患者的用药史至少有一处差异。遗漏当前药物是最常见的错误(49%),其次是剂量不正确(19%)和入院前未服用药物的记录(15%)。处方药的总数与错误率呈正相关(Pearson相关系数0.455,P>0.05)。一项独立的t检验确定了药剂师和护士之间的错误率之间的显著差异(t检验:−4.48,P<0.001)。这项研究再次证实了患者改变护理环境时出现药物错误的风险。随着药物数量的增加,这种情况更加普遍,在多药治疗的情况下需要更大的护理,尤其是在虚弱的患者中。这可以支持患者的风险分层。药剂师和护士之间的结果差异需要进一步探索,以确定原因,并相应地组建多学科团队。考虑确保将服药史纳入高级临床从业者是很重要的,尤其是随着这些角色在英国的扩大。
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引用次数: 0
Impact of pharmacist-led interventions on heart failure medication adherence: a prospective cohort study 药剂师主导的干预措施对心力衰竭药物依从性的影响:一项前瞻性队列研究
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-03-09 DOI: 10.1093/jphsr/rmad008
H. N. Nguyen, Cuong van Nguyen, D. T. Nguyen, Thanh Dinh Le, Quynh Thi Huong Bui
Clinical pharmacists play an important role in the optimization and individualization of treatment for heart failure patients in the multidisciplinary team. This study aims to demonstrate the impact of pharmacists’ interventions on medication adherence and adverse outcomes among heart failure patients. This is a prospective cohort study on 95 chronic heart failure patients in a national hospital of Vietnam. Participants in the intervention group received two consultations with a pharmacist on the third day of admission and one week after discharge while patients in the control group received standard care. The Vietnamese version of the Morisky Medication Adherence Scale-8 was applied to measure the medication adherence at the start of the study, at 2 months and 4 months post-discharge. Adverse outcomes including death and hospital readmissions were also collected during the follow-up period. Baseline adherence was 53.3% for the intervention group and 58.3% for the control group. After 2 months, 97.7% of the patients in the intervention group were adherent compared to 80.4% in the control group (P < 0.01). The adherent rates in these groups were 90.2% and 71.1% after 4 months, respectively. The intervention group had fewer combined adverse outcomes than their control counterpart, although the difference was not significant (24.4% versus 35.4%, P = 0.249). Pharmacist-led interventions improved self-reported medication adherence and might have a positive impact on outcomes among heart failure patients. Patient education and consultations should be a standard of practice to optimize treatment plans among heart failure patients.
临床药师在多学科团队对心力衰竭患者的优化和个性化治疗中发挥着重要作用。本研究旨在探讨药师干预对心力衰竭患者服药依从性及不良结局的影响。这是一项对越南国立医院95例慢性心力衰竭患者的前瞻性队列研究。干预组的参与者在入院第三天和出院后一周接受两次药剂师咨询,而对照组的患者接受标准治疗。采用越南版Morisky药物依从性量表-8测量研究开始时、出院后2个月和4个月的药物依从性。在随访期间还收集了包括死亡和再入院在内的不良结果。基线依从性干预组为53.3%,对照组为58.3%。2个月后,干预组患者的坚持率为97.7%,对照组为80.4% (P < 0.01)。4个月后,两组的粘附率分别为90.2%和71.1%。干预组的综合不良结局少于对照组,但差异不显著(24.4%对35.4%,P = 0.249)。药剂师主导的干预措施改善了自我报告的药物依从性,并可能对心力衰竭患者的预后产生积极影响。患者教育和咨询应成为优化心力衰竭患者治疗方案的标准做法。
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引用次数: 0
Editor-in-Chief letter of introduction 主编介绍信
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-03-01 DOI: 10.1093/jphsr/rmad005
J. Kohler
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引用次数: 0
Knowledge of and willingness for dispensing oral anticancer drug therapy among community pharmacists: a cross-sectional study from Jordan 社区药剂师对口服抗癌药物治疗的了解和意愿:约旦的一项横断面研究
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-02-27 DOI: 10.1093/jphsr/rmad007
N. Ayoub, Yazan R Alhamdan, Sara K. Jaradat, Malak Jibreel
This study aimed to assess the knowledge of and willingness for dispensing oral anticancer drugs (OADs) among community pharmacists in Jordan. A cross-sectional survey was conducted among pharmacists in community pharmacies. Five hundred pharmacists completed the questionnaire. The mean age of respondents was 30.4 ± 6.2 years (range 21–61). Most pharmacists had a bachelor’s degree in pharmacy (80.8%) and were staff pharmacists (61.6%). Two hundred and ten (42.0%) pharmacists indicated not receiving adequate education on OADs at the undergraduate level. The majority of respondents (79.8%) did not attend continuing education events in oncology in the past 2 years. Further, 44.6% of pharmacists never dispensed OADs in their pharmacies. The mean score of knowledge of OADs was 1.7 ± 1.9 out of 12 points (range 0–9). The vast majority of pharmacists surveyed (97.6%) had poor knowledge of OADs. Almost half of the pharmacists (49.8%) agreed or strongly agreed to be comfortable answering questions regarding cancer treatments. More than half of respondents (52.2%) feel comfortable providing patient education on OADs. Half of the respondents (49.6%) disagreed that their current pharmacy settings are equipped with the necessary tools to handle OADs. A large number of community pharmacists in Jordan lack the foundational knowledge regarding OADs. A substantial proportion of pharmacists never dispensed OADs and were not satisfied with the level of undergraduate education received regarding oncology and oral cancer therapies. Nevertheless, most pharmacists were willing to handle OADs and were positive about receiving further training/education on dispensing OADs. Collectively, efforts are needed to improve pharmacy education on oral chemotherapy and cancer care along with continuous training for pharmacists in their community settings.
本研究旨在评估约旦社区药剂师对口服抗癌药物(OADs)的知识和意愿。对社区药房药师进行横断面调查。500名药剂师完成了问卷调查。平均年龄30.4±6.2岁(21 ~ 61岁)。药师以药学学士(80.8%)和普通药师(61.6%)居多。210名(42.0%)药剂师表示在本科阶段没有接受足够的oad教育。大多数受访者(79.8%)在过去2年内没有参加过肿瘤学继续教育活动。此外,44.6%的药剂师从未在其药房配发过oad。oad知识平均得分为1.7±1.9分(满分12分,范围0 ~ 9分)。绝大多数受访药师(97.6%)对OADs的认识较差。几乎一半的药剂师(49.8%)同意或强烈同意在回答有关癌症治疗的问题时感到自在。超过一半的受访者(52.2%)对提供oad患者教育感到放心。一半的答复者(49.6%)不认为他们目前的药房设置配备了处理oad的必要工具。约旦大量社区药师缺乏有关oad的基础知识。相当大比例的药剂师从未配发oad,并且对接受肿瘤和口腔癌治疗的本科教育水平不满意。尽管如此,大部分药剂师仍愿意处理oad,并积极接受有关调配oad的进一步培训/教育。总的来说,需要努力改善口服化疗和癌症护理的药学教育,并在社区环境中对药剂师进行持续培训。
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引用次数: 5
Assessing the impact of Omni-Channel Engagement strategy on physicians’ prescribing behaviour in specialty pharmaceutical industry in emerging market 评估全渠道参与策略对新兴市场专业制药行业医生处方行为的影响
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-02-27 DOI: 10.1093/jphsr/rmad004
Khaled Samy Soliman, Alaa Tarek Erakat
Marketers strive to create a seamless experience across all marketing channels and with the notion of ‘phygital’ marketing in mind, that is building on the powers of both physical and digital worlds, the pharmaceutical industry could boost physicians’ engagement levels and positively affect their prescribing behaviour in specialty medicine, prescribed for complicated, rare diseases. This research study is an attempt to create the ultimate Omni-Channel Engagement (OCE) strategy in the pharmaceutical industry in emerging markets, while the researcher took the Egyptian market as an example. The researcher adopted qualitative research depending on in-depth interviews with industry experts, pharmaceutical marketing managers and physicians to have a deeper insight and more comprehensive understanding of OCE strategy success factors and challenges. Communication tools that appealed to the cognitive and behavioural attitude components of physicians are more powerful in shaping physicians prescribing attitude. As the research was concerned with drugs associated with specialty pharmaceutical market, where both the disease area and the medication are complicated and hence the product (medication) is considered a high-involvement product; communication tools that affect the cognitive and behavioural components of physicians’ attitude have a higher impact on physicians’ brand engagement levels and are most likely to lead physicians to prescribe the drug. OCE has an incremental impact over the traditional promotional mix with regard to physicians’ prescribing behaviours and habits, justified by the direct impact on physicians’ cognitive and behavioural attitude components.
营销人员努力在所有营销渠道中创造无缝的体验,并且考虑到“数字”营销的概念,即建立在物理世界和数字世界的力量之上,制药行业可以提高医生的参与水平,并积极影响他们在专业医学上的处方行为,为复杂、罕见的疾病开处方。本研究试图在新兴市场的制药行业中创建最终的全渠道参与(OCE)战略,而研究者以埃及市场为例。通过对行业专家、医药营销经理和医生的深度访谈,采用定性研究的方法,对OCE战略成功因素和挑战有更深入、更全面的了解。吸引医生的认知和行为态度成分的沟通工具在塑造医生的处方态度方面更强大。由于研究涉及的是与专业医药市场相关的药物,其中疾病领域和药物都很复杂,因此产品(药物)被认为是高介入产品;影响医生态度的认知和行为成分的沟通工具对医生的品牌参与水平有更高的影响,并且最有可能导致医生开处方。OCE对医生处方行为和习惯的影响大于传统的促销组合,对医生认知和行为态度成分的直接影响证明了这一点。
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引用次数: 0
Drug utilization, medication adherence and treatment satisfaction amongst glaucoma patients receiving care at secondary health facilities 在二级医疗机构接受治疗的青光眼患者的药物使用、药物依从性和治疗满意度
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-02-21 DOI: 10.1093/jphsr/rmad003
S. Bello, W. Ojieabu, H. Yusuf
The objective of this study was to assess treatment satisfaction, medication adherence and drug utilization amongst glaucoma patients receiving care at secondary health facilities. A cross-sectional study was conducted amongst glaucoma patients attending eye clinics of General Hospital Ilorin and Civil Service Hospital Ilorin in Kwara State, Nigeria from October 2020 to January 2021. Three hundred and eleven patients were enrolled in the study. Sampling was based on convenience as dictated by the inclusion and exclusion criteria. Ethical permission and informed consent were obtained before data collection. Validated instruments of Morisky Medication Adherence Scale and Treatment Satisfaction Questionnaire for Medication were used during the data collection process. Descriptive and Chi-square analyses were employed. Amongst the 311 patients studied 184(59.2%) were females with a mean age of 63.79 ± 14.89 years. Timolol eye drop was the drug of choice for monotherapy in (8.7%) of patients. Combination therapy of beta blockers and carbonic anhydrase inhibitors had the highest number (59.5%) of prescriptions. More than half (55.6%) of the patients were adherents. Participants reported being more satisfied with their anti-glaucoma therapy in the domain of global satisfaction (62.89 ± 21.85) followed by medication effectiveness (62.67 ± 20.78) and convenience (60.16 ± 15.79) while medication side effects had the least score (17.17 ± 11.09). There is a statistically significant relationship between patient satisfaction with treatment and medication adherence at P= 0.001. Combination therapy was the most frequently utilized anti-glaucoma agent. Most of the patients adhered to their medications and were satisfied with the treatment received.
本研究的目的是评估在二级卫生机构接受治疗的青光眼患者的治疗满意度、药物依从性和药物利用率。2020年10月至2021年1月,在尼日利亚夸拉州伊洛林综合医院和伊洛林公务员医院眼科诊所的青光眼患者中进行了一项横断面研究。311名患者参与了这项研究。根据纳入和排除标准的规定,抽样是基于方便性。在数据收集之前获得伦理许可和知情同意。数据收集过程中使用了经验证的Morisky药物依从性量表和药物治疗满意度问卷。采用描述性和卡方分析。在311名研究患者中,184名(59.2%)为女性,平均年龄为63.79±14.89岁。替莫洛尔滴眼液是(8.7%)患者单药治疗的首选药物。β受体阻滞剂和碳酸酐酶抑制剂的联合治疗处方数量最多(59.5%)。超过一半(55.6%)的患者是信徒。参与者报告称,他们对抗青光眼治疗的总体满意度(62.89±21.85)更高,其次是药物有效性(62.67±20.78)和便利性(60.16±15.79),而药物副作用得分最低(17.17±11.09)P=0.001时的粘附性。联合治疗是最常用的抗青光眼药物。大多数患者坚持服药,并对所接受的治疗感到满意。
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引用次数: 1
A systematic review on pharmacist-led pharmaceutical care optimization through virtual platforms 基于虚拟平台的药师主导药学服务优化研究综述
IF 0.7 Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-02-16 DOI: 10.1093/jphsr/rmac054
M. Karattuthodi, G. Krishnan, Aiswarya A V, S. C, S. S. Nair, Shabeer Ali Thorakkatil, Savera I Arain
To display virtual pharmaceutical care programs implemented by pharmacists across the world. Accordingly, a search in PubMed, Scopus and Embase with keywords such as ‘'Pharmacist', ‘Pharmaceutical care’, ‘Virtual platform’ and its associated medical subject headings retrieved appropriate articles. The quality of each filtered article were assessed with the Critical Appraisal Skills Program checklist. A total of 2 14 841 articles were identified through database screening and 16 articles were extracted and finalized. Twelve papers presented different forms of electronic medical record-based virtual pharmacy systems that had significantly contributed to patient care; minimizing medication errors, rectifying adverse events, modifying drug administration patterns to reduce the fatality of drug–drug interaction and further promoting medication counselling. Nevertheless, few studies had social media platforms for providing clinical pharmacy services that depicted good patient satisfaction. Additionally, we were also able to portray community pharmacies that transformed themselves to provide better and easily accessible pharmaceutical care to their society. There are limited numbers of peer-reviewed articles on pharmacist-operated virtual systems. However, owing to the benefits imparted to patient safety and care by the virtual pharmacy in the era of pandemic, it is highly recommended that more pharmacy professionals contribute and implement such programs in their settings. CRD42022307175.
展示世界各地药剂师实施的虚拟药物护理计划。因此,在PubMed、Scopus和Embase中搜索关键词,如“药剂师”、“药学护理”、“虚拟平台”及其相关的医学主题标题,可以检索到合适的文章。每一篇过滤文章的质量都用关键评估技能计划检查表进行评估。通过数据库筛选,共鉴定了214841篇文章,提取并定稿了16篇文章。12篇论文介绍了不同形式的基于电子病历的虚拟药房系统,这些系统对患者护理做出了重大贡献;最大限度地减少用药错误,纠正不良事件,改变用药模式以降低药物相互作用的致死率,并进一步促进药物咨询。尽管如此,很少有研究有社交媒体平台来提供临床药学服务,以描述良好的患者满意度。此外,我们还能够描绘出社区药房的转变,为他们的社会提供更好、更容易获得的药物护理。关于药剂师操作的虚拟系统的同行评审文章数量有限。然而,由于虚拟药房在疫情时代为患者安全和护理带来了好处,强烈建议更多的药房专业人员在他们的环境中贡献和实施此类计划。CRD42022307175。
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引用次数: 0
Involvement of community pharmacy professionals in maternal health service provision in Ethiopia: a multi-centre cross-sectional survey 埃塞俄比亚社区药房专业人员参与孕产妇保健服务:一项多中心横断面调查
Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-02-15 DOI: 10.1093/jphsr/rmad001
Asnakew Achaw Ayele, Md Shahidul Islam, Suzanne Cosh, Leah East
Abstract Objectives In countries with high maternal mortality and a shortage of healthcare professionals, community pharmacy professionals can provide important maternal healthcare services within their scope of practice. Evidence of community pharmacy professionals’ level of involvement in maternal health service provision in Ethiopia is limited. This study aimed to assess the level of involvement of community pharmacy professionals in providing maternal health services in Ethiopia. Methods A multi-centre cross-sectional survey of 238 community pharmacy professionals was conducted from March to July 2020 in 6 cities of Amhara regional state in Ethiopia. Independent samples t-test and one-way analysis of variance (ANOVA) were used to test the mean difference. Key findings Most community pharmacy professionals were either ‘involved’ in advising about vitamins (53.4%), provision of contraceptives (52.9%), advising about lifestyle changes (46.2%), responding to minor symptoms (47.5%), nutritional advice during pregnancy (45.0%) and breastfeeding guidance or ‘very involved’ in advising about screening for chronic disease (41.6%). However, the level of involvement of community pharmacy professionals differed according to study participants’ educational qualification/s, years of experience, licensure level, setting type, responsibility in the facility and previous training exposure about maternal health services. Conclusions Community pharmacy professionals in Ethiopia are involved in providing various maternal health services highlighting the importance that pharmacists can play in improving access and care within this context. However, government attention is needed to enhance their role through policy support and capacity building to improve the quality of service provided which could contribute to the reduction of maternal mortality.
摘要目的在孕产妇死亡率高、卫生保健专业人员短缺的国家,社区药学专业人员可以在其执业范围内提供重要的孕产妇保健服务。在埃塞俄比亚,社区药房专业人员参与孕产妇保健服务提供的程度有限。本研究旨在评估埃塞俄比亚社区药房专业人员在提供孕产妇保健服务方面的参与程度。方法2020年3月至7月在埃塞俄比亚阿姆哈拉地区州6个城市对238名社区药学专业人员进行多中心横断面调查。采用独立样本t检验和单因素方差分析(ANOVA)检验均数差异。大多数社区药房专业人员要么“参与”提供有关维生素(53.4%)、提供避孕药(52.9%)、改变生活方式(46.2%)、应对轻微症状(47.5%)、孕期营养咨询(45.0%)和母乳喂养指导的建议,要么“非常参与”提供有关慢性病筛查的建议(41.6%)。然而,社区药房专业人员的参与程度因研究参与者的教育程度、经验年限、执照水平、环境类型、在设施中的责任以及以前接受过的孕产妇保健服务培训而有所不同。埃塞俄比亚的社区药学专业人员参与提供各种孕产妇保健服务,突出了药剂师在改善这种情况下的获取和护理方面可以发挥的重要性。但是,需要政府注意通过政策支持和能力建设来加强它们的作用,以提高所提供服务的质量,从而有助于降低产妇死亡率。
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引用次数: 0
Associations between antidiabetic medication use and breast cancer survival outcomes among medicare beneficiaries 医疗保险受益人中抗糖尿病药物使用与乳腺癌生存结果之间的关系
Q2 Pharmacology, Toxicology and Pharmaceutics Pub Date : 2023-02-15 DOI: 10.1093/jphsr/rmad002
Shahariar Mohammed Fahim, Jingjing Qian, Chiu-Hsieh Hsu, Peng Zeng, Fang-Ju Lin, Cassidi C McDaniel, Chiahung Chou
Abstract Objective This study examined the associations between mortality (all-cause and breast cancer-specific) and different antidiabetic medication use before breast cancer diagnosis. Methods This study used a longitudinal, retrospective cohort design. Linked Surveillance, Epidemiology and End Results (SEER)-Medicare databases from 2007 to 2013 were used to identify female beneficiaries who had continuous Medicare enrollment, a new breast cancer diagnosis between 2008 and 2013, and exposure to the antidiabetic medication. Different classes of antidiabetic medications from one year before their breast cancer diagnosis were considered as users while all other non-users were excluded. Both all-cause mortality and breast cancer-specific mortality were treated as outcomes. Cox proportional hazards models for all-cause mortality and sub-distribution hazards models for breast cancer-specific mortality were employed to estimate both unadjusted and adjusted hazard ratios and 95% confidence intervals (CI) for risks of survival outcomes, controlling for severity of diabetes and other covariates. Key findings A total of 1715 women with breast cancer used antidiabetic medications one year before their breast cancer diagnosis. Compared to metformin, women using insulin, sulfonylurea and combination treatments before their breast cancer diagnosis had a higher risk for all-cause mortality (adjusted Hazard Ratio, aHR: 1.64, 95% CI 1.29, 2.07; aHR: 1.35, 95% CI 1.04, 1.75 and aHR: 1.44, 95% CI 1.14, 1.83, respectively). Women with advanced-stage breast cancer and higher levels of diabetes severity were more likely to get all-cause mortality (all P &lt; 0.05). Women with combination treatments had a statistically higher risk of breast cancer-specific mortality (aHR: 1.52, 95% CI 1.05, 2.19) than metformin users. Conclusions Among women with breast cancer, mortality risk is associated with pre-diagnosis exposure to different types of antidiabetic medications.
摘要目的探讨乳腺癌诊断前不同抗糖尿病药物使用与死亡率(全因和乳腺癌特异性)的关系。方法采用纵向、回顾性队列设计。关联监测,流行病学和最终结果(SEER)- 2007年至2013年的医疗保险数据库用于确定连续参加医疗保险,2008年至2013年期间新诊断为乳腺癌并暴露于抗糖尿病药物的女性受益人。在乳腺癌诊断前一年使用的不同种类的抗糖尿病药物被认为是使用者,而所有其他非使用者都被排除在外。全因死亡率和乳腺癌特异性死亡率均被视为结果。采用全因死亡率的Cox比例风险模型和乳腺癌特异性死亡率的亚分布风险模型来估计未调整和调整的生存结局风险的风险比和95%置信区间(CI),控制糖尿病的严重程度和其他协变量。共有1715名患有乳腺癌的女性在乳腺癌诊断前一年服用了抗糖尿病药物。与二甲双胍相比,在乳腺癌诊断前使用胰岛素、磺脲类药物和联合治疗的女性全因死亡率更高(校正风险比,aHR: 1.64, 95% CI 1.29, 2.07;aHR分别为1.35,95% CI 1.04, 1.75和aHR分别为1.44,95% CI 1.14, 1.83)。患有晚期乳腺癌和糖尿病严重程度较高的女性更有可能出现全因死亡率(all P <0.05)。与使用二甲双胍的女性相比,接受联合治疗的女性乳腺癌特异性死亡率的风险在统计学上更高(aHR: 1.52, 95% CI 1.05, 2.19)。结论:在乳腺癌女性患者中,死亡风险与诊断前接触不同类型的抗糖尿病药物有关。
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Journal of Pharmaceutical Health Services Research
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