Physician and pharmacist collaboration to improve blood pressure control.
Physician and pharmacist collaboration to improve blood pressure control.
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DOI：
10.1001/archinternmed.2009.358
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发表时间：
2009-11-23
影响因子：
--
通讯作者：
Xu, Yinghui
中科院分区：
文献类型：
--
作者：
Carter, Barry L.;Ardery, Gail;Dawson, Jeffrey D.;James, Paul A.;Bergus, George R.;Doucette, William R.;Chrischilles, Elizabeth A.;Franciscus, Carrie L.;Xu, Yinghui
研究表明，当临床药剂师协助患者管理时，血压(BP)控制可以得到改善。这项研究的目的是评估医生/药剂师干预改善血压控制的有效性。这是一项前瞻性、整群随机对照临床试验，临床随机分为对照组(n=3)或干预组(n=3)。这项研究纳入了402名未受控制的高血压患者(平均年龄58.3岁)。临床药剂师根据国家指南向医生提出药物治疗建议。研究护士进行血压测量和24小时血压监测。对照组的指南依从性评分从基线的49.4±19.3分增加到6个月时的53.4±18.1分(增加9%)，干预组从40.4%±22.6分增加到62.8士13.5分(增加57%)(p=0.089调整后的组间比较)。对照组和干预组的平均血压分别降低6.8/4.5和20.7/9.7 mm Hg(P<；0.05用于组间收缩压(SBP)比较)。调整后的SBP差值为−12.0(95%CI：−2 4.0，0.0)mm Hg，而舒张压差值为−1.8(CI：−11.9，8.3)。24小时的血压水平显示出相似的效应大小。对照组和干预组分别有29.9%和63.9%的患者血压得到控制(调整后优势比为3.2CI：2.05.1；p<；0.001)。与对照组相比，医生/药剂师协同干预取得了显著更好的平均血压和总体血压控制率。应该进行更多的研究，以评估实施基于团队的慢性病管理的有效战略。
Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The purpose of this study was to evaluate the effectiveness of a physician/pharmacist intervention to improve BP control. This was a prospective, cluster-randomized controlled clinical trial with clinics randomized to control (n=3) or intervention (n=3) groups. The study enrolled 402 patients with uncontrolled hypertension (mean age 58.3 years). Clinical pharmacists made drug-therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. Guideline adherence scores increased from 49.4 ± 19.3 at baseline to 53.4 ± 18.1 at 6 months (9% increase) in the control group and from 40.4 ± 22.6 to 62.8 ± 13.5 (57% increase) in the intervention group (p=0.089 adjusted comparison between groups). Mean BP decreased 6.8/4.5 and 20.7/9.7 mm Hg in the control and intervention groups, respectively, (p<0.05 for between-group systolic BP (SBP) comparison). The adjusted difference in SBP was −12.0 (95% CI: −24.0, 0.0) mm Hg, while the difference in diastolic BP (DBP) was −1.8 (CI: −11.9, 8.3). The 24-hour BP levels showed similar effect sizes. BP was controlled in 29.9% of patients in the control group and 63.9% in the intervention group (adjusted odds ratio 3.2; CI: 2.0, 5.1; p<0.001). A physician/pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates when compared to a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management.
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影响因子：
105.7
作者：
O'Brien, E;Coats, A;Mee, F
通讯作者：
Mee, F
影响因子：
12.7
作者：
MORISKY, DE;LEVINE, DM;SMITH, CR
通讯作者：
SMITH, CR
DOI：
10.1001/jama.296.21.joc60162
发表时间：
2006-12-06
影响因子：
120.7
作者：
Lee, Jeannie K.;Grace, Karen A.;Taylor, Allen J.
通讯作者：
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影响因子：
12.7
作者：
HILL, MN;LEVINE, DM;WHELTON, PK
通讯作者：
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影响因子：
37.8
作者：
MCKENNEY, JM;SLINING, JM;BARR, M
通讯作者：
BARR, M