临床药师实践指南：骨关节炎的管理

PRACTICE GUIDELINESPeeR-ReViewedPractice guidelines for pharmacists:The management of osteoarthritisJason Kielly,BSc(Pharm),PharmD;Erin M.Davis,BSc(Pharm),PharmD;Carlo Marra,PharmD,PhD,ACPR,FCSHPOsTEoARTHRiTis (OA)is THE mosT commoNResearch conducted in Canadian pharmacies hasform of arthritis,affecting more than 1 in 8 Cana-shown that pharmacists can effectively screen fordians.1 With an aging population,the prevalenceOA.Community pharmacists in Edmonton andof OA in Canada is rising.From 2010 to 2031,theVancouver,using a simple screening question-prevalence of OA is projected to increase fromnaire(<10 minutes to complete),identified >80%13.8%to 18.6%,with the total direct costs projectedof patients with knee pain who had undiagnosedto increase from $2.9 billion to $7.6 billion,anknee OA.3 Within 6 months of receiving theiralmost 2.6-fold increase.OA has traditionally beendiagnosis,>90%of participants had visited theirthought to be a progressive disease of the synovialfamily physician to discuss their OA,>50%tookjoints that is due to daily "wear and tear"fromeither a prescription or nonprescription analge-excessive and repetitive force on joint cartilage.sic and a significant number (p 0.001 for all)ofWhile this is partially true,OA is now believed topatients saw improvements in their pain,functionbe a systemic disorder due to an imbalance betweenand daily activity scores.10 Canadian pharmacistsjoint destruction and repair.6 The result is a break-have also effectively launched multidisciplinarydown of cartilage and bone,leading to symptoms ofinterventions to improve health outcomes forpain,stiffness and functional disability.patients with undiagnosed knee OA.11 PatientsThe joints most commonly affected by OAwho reported knee pain at community phar-(in order of prevalence)are the hands,knees,macies in Vancouver were effectively screenedhips and spine.OA is more prevalent with age,for OA and assigned to either "usual care"(i.e.,affecting nearly half the population older thanprovided with a pamphlet on knee OA created by70.3 In addition to advancing age,female gen-the Arthritis Society)or "intervention care"(i.e.,der is a significant risk factor.Other risk factorsone-on-one consultation where the pharmacistinclude obesity,quadriceps muscle weakness,offered arthritis education,medication reviewsfamily history,joint injury and joint overuse orand referral to a physiotherapist-guided exer-injury (e.g.,participation in certain sports).37cise program).Outcomes from the pharmacist-patient consultation were recorded and faxed toEvidence for pharmacist care in OAthe patient's primary care physician.ComparedPharmacists are frontline,accessible health careto "usual care,"significantly more patients in theprofessionals who see patients 5 times more fre-intervention group noted improvements in theirquently than family physicians.3 Communityquality of care and significant improvements inpharmacists have proven they can address gapsglobal,pain and functional scal