Sensitivity of patient outcomes to pharmacist interventions. Part II: Systematic review and meta-analysis in hypertension management
Sensitivity of patient outcomes to pharmacist interventions. Part II: Systematic review and meta-analysis in hypertension management
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DOI：
10.1345/aph.1k311
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发表时间：
2007-11-01
影响因子：
2.9
通讯作者：
Einarson, Thomas R.
中科院分区：
文献类型：
--
作者：
Machado, Marcio;Bajcar, Jana;Einarson, Thomas R.
背景：高血压因其有害影响而成为全世界的主要健康问题。很少有研究对药剂师对高血压患者的干预进行定量评估。目的：识别和量化对药剂师干预敏感的结果。方法：检索国际药学文摘、MEDLINE、Cochrane Central 和 EMBASE，从最初到 2006 年 12 月。两位独立审稿人确定了文章；对结果进行比较并通过协商一致解决。提取的数据包括干预类型、患者数量、人口统计、研究特征、使用的仪器、数据比较和报告的结果。使用随机效应荟萃分析来合并数据。使用 Downs-Black 量表评估研究质量。 结果：在确定的 203 篇潜在文章中，选择了 98 篇并阅读了其摘要。其中 9 篇经过全文审查，另外 19 篇从参考文献中确定，总共 28 篇文章。研究设计包括 18 项随机对照试验、6 项单臂临床试验、3 项非随机比较试验和 1 项数据库研究。平均质量得分为 66% +/- 12%（一般）。药物管理（82%）和高血压教育（68%）是最常用的干预措施。 39 项研究结果（占所有评估结果的 57%）对药剂师的干预敏感。对 13 项研究中 2246 项专利的荟萃分析发现，药剂师的干预措施显着降低了收缩压（10.7 +/- 11.6 mm Hg；p = 0.002），而对照组则保持不变（3.2 +/- 12.1 mm Hg；p = 0.361）。与对照组相比，药剂师的干预进一步降低了收缩压（6.9±12.1 mm Hg；p = 0.047）。非敏感性结果包括舒张压进一步降低（3.6 +/- 3.7 mm Hg；p = 0.06）、生活质量（8 项中的 1 项显着）和依从性（13 项中的 5 项显着）。结论：收缩压对药剂师的干预敏感。其他结果也可能很敏感；然而，需要更多高质量的研究来进行全面的定量评估。
BACKGROUND: Hypertension is a major health concern worldwide due to its deleterious impact. Few studies have quantitatively assessed pharmacists' interventions in hypertensive patients.OBJECTIVES: To identify and quantify outcomes sensitive to pharmacists' interventions.METHODS: Intemational Pharmaceutical Abstracts, MEDLINE, Cochrane Central, and EMBASE were searched from inception through December 2006. Two independent reviewers identified articles; results were compared and resolved through consensus. Data extracted included intervention type, patient numbers, demographics, study characteristics, instruments used, data compared, and outcomes reported. A random effects meta-analysis was used to combine data. Study quality was assessed using the Downs-Black scale.RESULTS: Of 203 potential articles identified, 98 were selected and their abstracts were read. Nine of these were reviewed full-text and 19 more were identified from references, resulting in a total of 28 articles. Research designs included 18 randomized controlled trials, 6 single-arm clinical trials, 3 nonrandomized comparative trials, and 1 database study. Average quality score was 66% +/- 12% (fair). Medication management (82%) and hypertension education (68%) were the interventions most used. Thirty-nine study results (57% of all outcomes evaluated) were sensitive to pharmacists' interventions. Meta-analysis of 2246 patents in 13 studies found that pharmacists' interventions significantly reduced systolic blood pressure (10.7 +/- 11.6 mm Hg; p = 0.002), while controls remained unchanged (3.2 +/- 12.1 mm Hg; p = 0.361). Pharmacists' interventions further reduced systolic blood pressure (6.9 12.1 mm Hg; p = 0.047) over controls. Nonsensitive results included further reduction in diastolic blood pressure (3.6 +/- 3.7 mm Hg; p = 0.06), quality of life (1 of 8 significant), and adherence (5 of 13 significant).CONCLUSIONS: Systolic blood pressure is sensitive to pharmacists' interventions. Other outcomes may also be sensitive; however, more high-quality studies are needed for a comprehensive quantitative assessment.