Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil
Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil
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DOI：
10.1007/s11096-011-9493-2
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发表时间：
2011-04-01
影响因子：
2.4
通讯作者：
Pontarolo, Roberto
中科院分区：
文献类型：
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作者：
Correr, Cassyano Januario;Melchiors, Ana Carolina;Pontarolo, Roberto
目的 评估药物治疗随访（PF）对2型糖尿病患者代谢控制和临床结局的影响。
地点 巴西库里蒂巴大都市区的6家社区药房（4家干预组和2家对照组）。
主要结局指标 糖化血红蛋白A1（HbA1）和空腹毛细血管血糖。
方法 2004年7月至2006年3月，我们在6家社区药房进行了一项为期12个月的对照试验，共涉及161名患者。药物治疗随访仅应用于干预组患者。
结果 在纳入的161名患者中，96名完成了研究（50名干预组和46名对照组）。对干预组患者进行了574次咨询，导致119次不良临床结局（2.3次/患者[标准差 = 1.6]）。检测到的大多数问题与药物治疗无效有关（68.1%）。与对照组相比，干预组糖化血红蛋白（HbA1）降低更显著（-2.2%[95%置信区间 -2.8% : -1.6%]对 -0.3[95%置信区间 -0.8 : 0.2]；P < 0.001），空腹毛细血管血糖降低也更显著（-20.1 mg/dl[95%置信区间 -31.9 mg/dl : -8.3 mg/dl]对4.3 mg/dl[95%置信区间 -13.4 mg/dl : 22.2 mg/dl]；P = 0.022）。在调整基线值后，这些差异仍然存在。两组之间在任何其他临床指标上均无显著差异。除了接受降脂治疗的患者百分比在干预组从16%增加到24%（P = 0.018）外，两组之间在药物数量和治疗方案上也没有显著变化。干预组初始药物治疗方案复杂性指数（MRCI）为15.5（标准差 = 7.8，范围4 - 40.5），12个月后降低了1.2个单位（标准差 = 5.9）（P = 0.149）。
结论 社区药房对2型糖尿病患者进行药物治疗随访可通过优化用药情况改善患者的血糖控制，而所用药物数量或方案复杂性无显著变化。
Objective To evaluate the effects of pharmacotherapy follow-up (PF) on metabolic control and clinical outcomes in type 2 diabetic patients. Setting Six community pharmacies (4 intervention and 2 control) in the Curitiba metropolitan region (Brazil). Main outcome measure Glycosylated Haemoglobin A1 (HbA1) and fasting capillary glycaemia. Methods We conducted a 12-month controlled trial involving a total of 161 patients in six community pharmacies between July 2004 and March 2006. Pharmacotherapy follow-up was applied only to patients in the intervention group. Results Of the 161 patients enrolled, 96 completed the study (50 intervention and 46 control). The administration of 574 consultations with the intervention group patients led to 119 negative clinical outcomes (2.3/patient [SD = 1.6]). The majority of detected problems were related to the ineffectiveness of pharmacotherapy (68.1%). Relative to the control group, the intervention group exhibited greater glycosylated haemoglobin (HbA1) reduction (-2.2% [95% CI -2.8%:-1.6%] vs. -0.3 [95% CI -0.8:0.2]; P < 0.001) and greater fasting capillary glycaemia reduction (-20.1 mg/dl [95% CI -31.9 mg/dl:-8.3 mg/dl] vs. 4.3 mg/dl [95% CI -13.4 mg/dl:22.2 mg/dl]; P = 0.022). These differences persisted after adjustment for baseline values. There were no significant differences in any other clinical measures between the groups. There were also no significant changes in the number of medications and treatment regimens between groups, with the exception of the percentage of patients undergoing lipid lowering treatment, which increased in the intervention group from 16% to 24% (P = 0.018). The initial medication regimen complexity index (MRCI) in the intervention group was 15.5 (SD = 7.8, range 4-40.5), and it decreased by 1.2 units (SD = 5.9) after 12 months (P = 0.149). Conclusions PF of type 2 diabetic patients in community pharmacies can improve the glycaemia control of patients through optimisation of medication profiles without significant changes in either the number of drugs used or the regimen complexity.