Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatment
of different diseases. The effectiveness of community-pharmacy-based interventions in preventing
problems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown.
Our objective was to provide a standard operating procedure (SOP) for community pharmacists
and to compare pharmaceutical vs. standard care in both clinical and daily life settings.
We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction,
and in fewer complications; the interventions used are feasible in daily life; and the results
achieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlled
trial), patients were recruited sequentially in hospital wards; in the daily life setting
(quasi-experimental design with a comparison group), recruitment took place in community
pharmacies by pharmacists and trained master students during their internship. Interventions
were offered according to patient needs. Data were collected by means of a monitored self-injection
at home and structured questionnaire-based telephone interviews at the beginning and the
end of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills;
syringe count to assess adherence; and frequency, effectiveness, and patient’s assessment of received
interventions. The results show a median age of the 139 patients of 54 years. Interventions
resulted in improved application quality (p < 0.01) and knowledge (p = 0.03). Oral instructions
were pivotal for improving patients’ application quality. We found no significant score differences
between the intervention groups in the clinical and daily life settings. Patients’ baseline skills
were high, with the lowest score being 0.86 (score range −2.00 to +2.00). Adherence rate was high
(95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, ap-
*Corresponding author.
S. Mengiardi et al.
373
preciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies if
adequate assistance is provided.
Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatmentof different diseases. The effectiveness of community-pharmacy-based interventions in preventingproblems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown.Our objective was to provide a standard operating procedure (SOP) for community pharmacistsand to compare pharmaceutical vs. standard care in both clinical and daily life settings.We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction,and in fewer complications; the interventions used are feasible in daily life; and the resultsachieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlledtrial), patients were recruited sequentially in hospital wards; in the daily life setting(quasi-experimental design with a comparison group), recruitment took place in communitypharmacies by pharmacists and trained master students during their internship. Interventionswere offered according to patient needs. Data were collected by means of a monitored self-injectionat home and structured questionnaire-based telephone interviews at the beginning and theend of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills;syringe count to assess adherence; and frequency, effectiveness, and patient’s assessment of receivedinterventions. The results show a median age of the 139 patients of 54 years. Interventionsresulted in improved application quality (p < 0.01) and knowledge (p = 0.03). Oral instructionswere pivotal for improving patients’ application quality. We found no significant score differencesbetween the intervention groups in the clinical and daily life settings. Patients’ baseline skillswere high, with the lowest score being 0.86 (score range −2.00 to +2.00). Adherence rate was high(95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, appreciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies ifadequate assistance is provided. |
