A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial.
A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial.
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DOI：
10.1186/s12882-015-0052-2
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发表时间：
2015-04-16
期刊：
影响因子：
2.3
通讯作者：
Drawz PE
中科院分区：
文献类型：
--
作者：
Cooney D;Moon H;Liu Y;Miller RT;Perzynski A;Watts B;Drawz PE
初级保健提供者通常不遵循慢性肾脏病（CKD）患者的护理指南。多学科的努力可以改善对慢性病患者的护理。基于药剂师的干预措施有效地改善了高血压的管理。我们进行了一项实用、随机、对照试验，以评估基于药剂师的质量改进计划对1）CKD患者结局和2）在初级保健环境中遵守CKD指南的影响。在13家社区退伍军人事务部门诊诊所接受初级保健服务的中重度CKD患者随机接受多因素干预，包括基于电话的药剂师干预、药剂师-医生合作、患者教育和CKD登记（n = 1070）或常规护理（n = 1129）。主要过程结果是在一年的研究期间测量甲状旁腺激素（PTH）。主要临床结局是基线时高血压控制不佳的受试者的血压（BP）控制。在基线血压控制不佳的患者中，研究期间末次记录的血压或目标血压百分比没有差异（对照组为42.0% vs. 41.2%）。干预组受试者在研究期间更有可能测量PTH（46.9% vs.对照组16.1%，P <0.001），并且在研究结束时使用更多种类的降压药物（P = 0.02）。基于药剂师的一次性干预在CKD患者中证明是可行的。虽然干预没有改善血压控制，但它确实改善了指南的依从性，并增加了血压控制不良受试者的降压药物处方数量。这些发现可以为质量改进计划的设计和未来的研究提供信息，以改善CKD患者的护理。ClinicalTrials.gov：NCT01290614。本文的在线版本（doi：10.1186/s12882-015-0052-2）包含补充材料，可供授权用户使用。
Primary care providers do not routinely follow guidelines for the care of patients with chronic kidney disease (CKD). Multidisciplinary efforts may improve care for patients with chronic disease. Pharmacist based interventions have effectively improved management of hypertension. We performed a pragmatic, randomized, controlled trial to evaluate the effect of a pharmacist based quality improvement program on 1) outcomes for patients with CKD and 2) adherence to CKD guidelines in the primary care setting. Patients with moderate to severe CKD receiving primary care services at one of thirteen community-based Veterans Affairs outpatient clinics were randomized to a multifactorial intervention that included a phone-based pharmacist intervention, pharmacist-physician collaboration, patient education, and a CKD registry (n = 1070) or usual care (n = 1129). The primary process outcome was measurement of parathyroid hormone (PTH) during the one year study period. The primary clinical outcome was blood pressure (BP) control in subjects with poorly controlled hypertension at baseline. Among those with poorly controlled baseline BP, there was no difference in the last recorded BP or the percent at goal BP during the study period (42.0% vs. 41.2% in the control arm). Subjects in the intervention arm were more likely to have a PTH measured during the study period (46.9% vs. 16.1% in the control arm, P <0.001) and were on more classes of antihypertensive medications at the end of the study (P = 0.02). A one-time pharmacist based intervention proved feasible in patients with CKD. While the intervention did not improve BP control, it did improve guideline adherence and increased the number of antihypertensive medications prescribed to subjects with poorly controlled BP. These findings can inform the design of quality improvement programs and future studies which are needed to improve care of patients with CKD. ClinicalTrials.gov: NCT01290614. The online version of this article (doi:10.1186/s12882-015-0052-2) contains supplementary material, which is available to authorized users.
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影响因子：
--
作者：
Coresh, J;Wei, L;Klag, MJ
通讯作者：
Klag, MJ
影响因子：
39.2
作者：
Houston, Thomas K.;Allison, Jeroan J.;Hullett, Sandral
通讯作者：
Hullett, Sandral
影响因子：
13.6
作者：
Astor, BC;Eustace, JA;Coresh, J
通讯作者：
Coresh, J
影响因子：
4.8
作者：
Isbel, NM;Haluska, B;Marwick, TH
通讯作者：
Marwick, TH
DOI：
10.1053/j.ajkd.2009.09.014
发表时间：
2010-03
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Muntner P;Anderson A;Charleston J;Chen Z;Ford V;Makos G;O'Connor A;Perumal K;Rahman M;Steigerwalt S;Teal V;Townsend R;Weir M;Wright JT Jr;Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
通讯作者：
Chronic Renal Insufficiency Cohort (CRIC) Study Investigators