经皮冠状动脉介入治疗术后患者服药依从性与生活质量的相关性研究

目的 探讨PCI术后患者服药依从性与生活质量之间的相关性.方法 采用Morisky 服药依从性问卷调查PCI术后患者的服药依从性,SAQ和SF-36评价PCI术后患者的生活质量.结果 PCI术后患者服用的四类药物服药依从性均与躯体健康方面呈显著相关,精神健康方面只有Aspirin依从性与精神健康显著相关,其余三种药物依从性与精神健康无显著相关.结论 PCI术后服药依从性与生活质量的躯体健康维度具有显著相关性,而与精神健康相关性不大.因此提高PCI术后患者服药依从性对改善生活质量至关重要,同时也要加强精神心理健康方面的干预.     

某院门诊处方点评与用药分析

目的通过对本院处方点评的总结分析,提高药物治疗水平,促进本院合理用药。方法随机点评我院2011年1月至2011年12月门急诊处方4000张,根据卫生部《医院处方点评管理规范(试行)》,对其中处方的书写规范化、用药的适宜性指标及有无超常情况进行分类分析。结果合理处方3572张,占总处方数的89%,不合理处方428张,占总处方数的11%。结论加强处方点评,能促进合理用药,提高医疗质量。     

精细管理对社区高血压患者服药依从性的影响

目的探讨与分析精细管理对于社区高血压患者服药依从性的影响。方法选取社区高血压患者520例并随机性分为2组,观察组在日常管理的过程中加用精细管理,对照组的患者采用常规管理,对比两组患者服药依从性。结果观察组患者服药依从性明显强于对照组患者,且其血压控制更加良好。结论精细管理对于社区高血压患者的血压控制以及服药依从性具有积极正面的影响。     

Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies

Medication-overuse headache (MOH) is relatively common, but its incidence has not been calculated and there are no prospective population-based studies that have evaluated risk factors for developing MOH. The aim of this study was to estimate incidences of and identify risk factors for developing chronic daily headache (CDH) and MOH. This longitudinal population-based cohort study used data from the Nord-Trøndelag Health Surveys performed in 1995-1997 and 2006-2008. Among the 51,383 participants at baseline, 41,766 were eligible approximately 11 years later. There were 26,197 participants (responder rate 63%), among whom 25,596 did not report CDH at baseline in 1995-1997. Of these, 201 (0.8%) had MOH and 246 (1.0%) had CDH without medication overuse (CDHwoO) 11 years later. The incidence of MOH was 0.72 per 1000 person-years (95% confidence interval 0.62-0.81). In the multivariate analyses, a 5-fold risk for developing MOH was found among individuals who at baseline reported regular use of tranquilizers [odds ratio 5.2 (3.0-9.0)] or who had a combination of chronic musculoskeletal complaints, gastrointestinal complaints, and Hospital Anxiety and Depression Scale score ?11 [odds ratio 4.7 (2.4-9.0)]. Smoking and physical inactivity more than doubled the risk of MOH. In contrast, these factors did not increase the risk of CDHwoO. In this large population-based 11-year follow-up study, several risk factors for MOH did not increase the risk for CDHwoO, suggesting these are pathogenetically distinct. If the noted associations are causal, more focus on comorbid condition, physical activity, and use of tobacco and tranquilizers may limit the development of MOH.     

Dependence scores predict prognosis of medication overuse headache: a prospective cohort from the Akershus study of chronic headache

Medication overuse headache (MOH) is a chronic headache that is common in the general population. It has characteristics similar to drug dependence, and detoxification is established as the main treatment. The majority of MOH cases are in contact with general practitioners. Our objective was to investigate whether the Severity of Dependence Scale (SDS) score could be used as predictor for the prognosis of MOH in the general population. In a cross-sectional epidemiological survey, an age- and gender-stratified sample of 30,000 persons 30 to 44 years of age was recruited via a posted questionnaire. Those individuals with self-reported chronic headache (≥15 days per month) were interviewed by neurological residents at Akershus University Hospital, Oslo. The International Classification of Headache Disorders was used. Those with MOH were re-interviewed by telephone 2 to 3 years after the initial interview. SDS scores and medication information were collected at baseline and follow-up. The main outcomes were SDS scores, termination of MOH and chronic headache from baseline to follow-up. We found the predominant overused analgesics in this sample to be simple analgesics. At follow-up, 65% of participants no longer had medication overuse, and 37% had changed to episodic headache (<15 days per month). The SDS score at baseline successfully predicted improvement for primary MOH, but not secondary MOH. The SDS scores decreased slightly from baseline to follow-up in those who stopped medication overuse, but were still significantly higher than in subjects with chronic headache without medication overuse at baseline. We conclude that the SDS score can predict successful prognosis related to detoxification of primary MOH but not in secondary MOH.     

维生素E用药安全性研究

目的:正确使用维生素E,使维生素E能得到合理应用,避免药品不良反应(ADR)的发生。方法:采用市场调查,对大众使用维生素E的情况进行统计分析,查阅文献分析大剂量使用维生素E的ADR,对其使用和每日摄取量进行分析研究。结果与结论:经过研究分析,建立合理用药,避免滥用维生素E造成不良后果。普遍认为维生素E的人体日需要量为15～25 mg,最好通过食物补充,如需特别补充,应在医生指导下进行。     

开展药物整合教学 深化临床药学教育改革

阐述药物整合概念以及临床药师通过药物整合开展临床药学服务的意义,探讨如何在临床药学教学中开展药物整合教学,以培养具有实践能力的临床药师,体现临床药师的价值,深化临床药学教育改革。     

Development and psychometric evaluation of the German version of the Medication Regimen Complexity Index (MRCI-D)

Background Several factors contribute to the complexity of pharmacotherapeutic regimens, like the total number of medications to be taken, the number of dosage units to take at a time, dosage frequency, as well as specific directions concerning the administration. The Medication Regimen Complexity Index (MRCI) is a validated instrument developed in English for the measurement of the complexity of a given pharmacotherapeutic regimen. Objectives Translation of the MRCI into German and evaluation of the translated instrument (MRCI‐D) in order to make it more easily accessible for use in German practice and research. Methods The process of validation included the translation of the English version to German, back‐translation into English, comparison of the back‐translated and the original versions, pre‐tests, and pilot‐testing of the German version by three raters using 20 medication regimens for inpatients. The subsequent psychometric evaluation included the calculation of inter‐rater and test–retest reliability, as well as the assessment of convergent validity. Results The number of medications correlated highly and statistically significantly with the MRCI‐D score (0.91, P < 0.001), indicating sufficient convergent validity of the instrument. Both inter‐rater and test–retest reliability were very high (intraclass correlation coefficients above 0.80 in all cases). Conclusion Our results demonstrate that the German version of the MRCI reflects the complexity of therapeutic regimens with similar validity and reliability as the established English version. Thus, it may be a valuable tool to analyse therapeutic regimens in both clinical practice and science.     

Co-occurring marijuana use is associated with medication nonadherence and nonplanning impulsivity in young adult heavy drinkers

Few studies have examined the co-occurrence of alcohol and marijuana use in clinical samples of young adults. The present study investigated whether co-occurring marijuana use is associated with characteristics indicative of a high level of risk in young adult heavy drinkers. Individuals between the ages of 18 and 25 years (N=122) participated in an ongoing 8-week randomized clinical trial that tested the efficacy of placebo-controlled naltrexone plus brief individual counseling to reduce heavy drinking. At intake participants completed self-report assessments on alcohol consumption, alcohol-related negative consequences, motivation to reduce drinking, trait impulsivity, expectancies for alcohol-induced disinhibition, use of cigarettes, and history of medication nonadherence. In univariate tests heavy drinkers with and without co-occurring marijuana use did not differ on alcohol consumption, most alcohol-related negative consequences, and motivation to reduce drinking. In multivariate tests controlling for demographic characteristics, co-occurring heavy alcohol and marijuana use was significantly associated with nonplanning impulsivity (β=2.95) and a history of both unintentional (adjusted odds ratio [aOR]=3.30) and purposeful (aOR=3.98) nonadherence to medication. Findings suggest that young adult heavy drinkers with co-occurring marijuana use exhibit a high-risk clinical profile and may benefit from interventions that increase adherence to medications.     

Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program

Objective

To evaluate Positive Choices (PC), a program that employed lay health workers to motivate antiretroviral adherence among persons living with HIV with coverage from Indiana's high-risk insurance pool.

Methods

Four hundred and forty nine participants living in the greater Indianapolis area were randomly allocated to treatment (n = 91) or control (n = 358) groups and followed for one year.

Results

Compared to control subjects, PC subjects were more likely to adhere to HIV medications (medication possession ratio adherence ≥0.95, OR = 1.83, p = 0.046), and to achieve undetectable viral load (<50 copies/mL, OR = 2.01, p = 0.011) in the 12 months following introduction of PC. There were no significant differences observed between groups in any of self-reported health status indicators.

Conclusion

Estimates suggest that PC clients were 16% more likely to have undetectable viral loads than clients in standard care. The incremental program cost was approximately $10,000 for each additional person who achieved an undetectable viral load.

Practice implications

As persons living with HIV experience greater longevity and healthcare reform expands coverage to these high-risk populations, greater demands will be placed on the HIV-care workforce. Results suggest lay health workers may serve as effective adjuncts to professional care providers.