Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial
Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial
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DOI：
10.1111/1475-6773.13152
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发表时间：
2019-06-01
影响因子：
3.4
通讯作者：
Goyenechea, Estibaliz
中科院分区：
文献类型：
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作者：
Onatibia-Astibia, Ainhoa;Malet-Larrea, Amaia;Goyenechea, Estibaliz
目的评价医务人员干预对高胆固醇血症患者他汀类药物依从性、总胆固醇水平和生活方式的影响，并分析不同招募中心的差异。西班牙46个社区药房和50个初级保健中心。随机对照试验设计（n = 746）。根据患者最初对他汀类药物的依从性，将患者分为依从组（ADH）或非依从组。非依从性患者随机分为干预组（INT）和非干预组（NOINT）。入选INT组的患者根据不依从的原因接受干预。ADH组和NOINT组患者接受常规护理。采用多重插补进行意向治疗（ITT）分析，以替换缺失数据。数据收集依从性、总胆固醇水平和生活方式行为。结果INT组在6个月内的依从性高于NOINT组（OR = 1.49; 95%CI：1.30-1.76; P < 0.001），尤其是社区药房组（OR = 2.34; 95%CI：1.81-3.03; P < 0.001）。在基线（ADH：200.3 mg/dL vs NOADH：216.7 mg/dL; P < 0.001）和终点（ADH：197.3 mg/dL vs NOADH：212.2 mg/dL; P < 0.001）时，依从性患者的总胆固醇值低于非依从性患者。更多的患者在研究结束时参加了INT组的锻炼（INT：+26.6%; P = 0.002），更多的患者遵循饮食治疗高胆固醇血症（+30.2%; P < 0.001）。结论：卫生专业人员，特别是社区药剂师进行的干预，提高了高胆固醇血症患者对他汀类药物的依从性，这种依从性的改善伴随着总胆固醇水平的降低和更健康的生活方式。
Objective To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. Study Setting Forty-six community pharmacies and 50 primary care centers of Spain. Study Design Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention-to-treat (ITT) analysis was performed with multiple imputation to replace the missing data. Data Collection Adherence, total cholesterol levels, and lifestyle behaviors. Findings The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30-1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81-3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). Conclusions The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.