Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients
Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients
复制标题
36个月药学服务项目对老年糖尿病和高血压患者药物治疗依从性的影响
DOI：
--
复制
发表时间：
2011
影响因子：
2.4
通讯作者：
R. Cuman
中科院分区：
文献类型：
--
作者：
P. R. Obreli;C. Guidoni;Andre Oliveira Baldoni;D. Pilger;J. M. Cruciol;Walderez Penteado Gaeti;R. Cuman
目的：本研究的主要目的是评估药物治疗方案对老年糖尿病和高血压患者药物治疗依从性的影响。该药物治疗依从性方法的临床结局是本研究的次要目的。背景：巴西圣保罗州一个市的公共初级卫生保健单位。方法：一项为期36个月的随机、对照、前瞻性临床试验，200例患者分为两组：对照组（n = 100）和干预组（n = 100）。对照组接受初级保健单位提供的常规护理（医疗和护士咨询）。干预组在常规护理的基础上进行药学服务干预。主要结果测量：在基线和长达36个月时评价药物治疗依从性（Morisky-Green试验翻译成葡萄牙语并计算机化分发药物史）和临床测量（血压、空腹血糖、A1 C血红蛋白、甘油三酯和总胆固醇）。P值<0.05为有统计学意义。结果：干预组97例患者和对照组97例患者完成了研究（n = 194）。根据Morisky-Green检验，干预组的药物治疗依从性得到了显著改善（基线时50.5%的依从性患者vs 36个月后83.5%的依从性患者; P < 0.001）和计算机化分发药物史（基线时52.6%的依从性患者vs. 36个月后83.5%的依从性患者; P < 0.001）;对照组中未证实有显著变化。达到适当血压值的患者数量显著增加（基线时为26.8%，36个月后为86.6%; P < 0.001），空腹血糖（基线时为29.9%，36个月后为70.1%; P < 0.001），A1 C血红蛋白（基线时3.3% vs 36个月后63.3%; P < 0.001），甘油三酯（基线时为47.4%，36个月后为74.2%; P < 0.001）和总胆固醇（基线时为59.8%，36个月后为80.4%; P = 0.002）在干预组中得到验证，但在对照组中保持不变。结论：这些结果表明，药学服务在提高药物治疗依从性方面的有效性，对研究患者的临床结局有积极影响。
Objective: The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Setting: Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. Method: A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Main outcome measure: Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value <0.05 was considered statistically significant. Results: A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001), fasting glucose (29.9% at baseline vs. 70.1% after 36 months; P < 0.001), A1C hemoglobin (3.3% at baseline vs. 63.3% after 36 months; P < 0.001), triglycerides (47.4% at baseline vs. 74.2% after 36 months; P < 0.001) and total cholesterol (59.8% at baseline vs. 80.4% after 36 months; P = 0.002) were verified in the intervention group, but remained unchanged in the control group. Conclusion: These results indicated the effectiveness of pharmaceutical care in improving pharmacotherapy adherence, with positive effects in the clinical outcomes of the patients studied.