Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol - A randomized controlled trial
Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol - A randomized controlled trial
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DOI：
10.1001/jama.296.21.joc60162
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发表时间：
2006-12-06
影响因子：
120.7
通讯作者：
Taylor, Allen J.
中科院分区：
文献类型：
--
作者：
Lee, Jeannie K.;Grace, Karen A.;Taylor, Allen J.
背景 服药依从性差会降低药物治疗的健康益处。患有冠心病危险因素的老年患者经常需要接受多种药物治疗，这使得他们不依从治疗的风险增加。 目的 测试综合药房护理计划对提高药物依从性的有效性及其对血压 (BP) 和低密度脂蛋白胆固醇 (LDL-C) 的相关影响。 设计、设置和患者 在沃尔特·里德陆军医疗中心对 200 名 65 岁或以上社区患者进行了一项多阶段、前瞻性研究，其中包括观察期和随机对照试验。至少 4 种慢性药物。该研究于 2004 年 6 月至 2006 年 8 月进行。 干预 经过 2 个月的磨合期（测量基线依从性、血压和 LDL-C）后，患者进入 6 个月的干预阶段（标准化药物教育、药剂师定期随访以及以特定时间包分发药物）。干预阶段后，患者被随机分为继续药房护理组和常规护理组，持续 6 个月。 主要结果指标 观察阶段的主要终点是服药比例相对于基线的变化；次要终点是血压和低密度脂蛋白胆固醇的相关变化。随机阶段的主要终点是组间药物持续性比较。 结果 共有 200 名老年患者（77.1% 为男性；平均 [SD] 年龄，78 [8.3] 岁）入组，平均 (SD) 服用 9 (3) 种慢性药物。冠心病危险因素包括 184 名患者（91.5%）经药物治疗的高血压和 162 名患者（80.6%）经药物治疗的高脂血症。平均 (SD) 基线药物依从性为 61.2% (13.5%)。干预 6 个月后，药物依从性提高至 96.9%（5.2%；P
Context Poor medication adherence diminishes the health benefits of pharmacotherapies. Elderly patients with coronary risk factors frequently require treatment with multiple medications, placing them at increased risk for nonadherence.Objective To test the efficacy of a comprehensive pharmacy care program to improve medication adherence and its associated effects on blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C).Design, Setting, and Patients A multiphase, prospective study with an observational phase and a randomized controlled trial conducted at the Walter Reed Army Medical Center of 200 community-based patients aged 65 years or older taking at least 4 chronic medications. The study was conducted from June 2004 to August 2006.Intervention After a 2-month run-in phase (measurement of baseline adherence, BP, and LDL-C), patients entered a 6-month intervention phase (standardized medication education, regular follow-up by pharmacists, and medications dispensed in time-specific packs). Following the intervention phase, patients were randomized to continued pharmacy care vs usual care for an additional 6 months.Main Outcome Measures Primary end point of the observation phase was change in the proportion of pills taken vs baseline; secondary end points were the associated changes in BP and LDL-C. Primary end point of the randomization phase was the between-group comparison of medication persistence.Results A total of 200 elderly patients (77.1% men; mean[SD] age, 78 [8.3] years), taking a mean (SD) of 9 (3) chronic medications were enrolled. Coronary risk factors included drug-treated hypertension in 184 patients (91.5%) and drug-treated hyperlipidemia in 162 (80.6%). Mean (SD) baseline medication adherence was 61.2% (13.5%). After 6 months of intervention, medication adherence increased to 96.9% (5.2%; P