Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial
Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial
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DOI：
10.1136/bmj.39164.568183.ae
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发表时间：
2007-05-26
影响因子：
--
通讯作者：
Harvey, Ian
中科院分区：
文献类型：
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作者：
Holland, Richard;Brooksby, Lain;Harvey, Ian
目的 测试社区药师的药物审查、症状自我管理和生活方式建议干预是否可以减少心力衰竭患者的入院率或死亡率。设计随机对照试验。对心力衰竭患者进行家庭干预。参与者包括 293 名急诊入院后诊断为心力衰竭的患者（149 名干预患者，144 名对照患者）。干预 17 名社区药剂师中的一名在出院后两周和八周内进行两次家访。药剂师审查药物并提供症状自我管理和生活方式建议。对照组接受常规护理。主要结局指标 主要结局是六个月时的再入院总数。次要结局包括死亡率和生活质量（明尼苏达心力衰竭患者问卷和 EQ-5D）。结果 291 名参与者 (99%) 获得了主要结果数据。 136 名 (91%) 干预患者接受了一到两次就诊。干预组有 134 例入院，而对照组有 112 例入院（比率=1.15，95% 置信区间 0.89 至 1.48；P=0.28，泊松模型）。与 24 名对照组相比，30 名干预患者死亡（风险比=1.18、0.69 至 2.03；P=0.54）。尽管 EQ-5D 分数有利于干预组，但明尼苏达州患有心力衰竭的问卷分数有利于对照组；这两种差异均无统计学意义。结论 与专科护士主导的心力衰竭干预试验中发现的结果相比，这种社区药剂师干预并未导致住院人数减少。鉴于心力衰竭占入院人数的 5%，这些结果给决策者带来了一个问题，他们面临着专家资源的短缺，并希望熟练的社区药剂师能够带来同样的好处。
Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients. Design Randomised controlled trial. Setting Home based intervention in heart failure patients. Participants 293 patients diagnosed with heart failure were included (149 intervention, 144 control) after an emergency admission. Intervention Two home visits by one of 17 community pharmacists within two and eight weeks of discharge. Pharmacists reviewed drugs and gave symptom self management and lifestyle advice. Controls received usual care. Main outcome measures The primary outcome was total hospital readmissions at six months. Secondary outcomes included mortality and quality of life (Minnesota living with heart failure questionnaire and EQ-5D). Results Primary outcome data were available for 291 participants (99%). 136 (91%) intervention patients received one or two visits. 134 admissions occurred in the intervention group compared with 112 in the control group (rate ratio=1.15, 95% confidence interval 0.89 to 1.48; P=0.28, Poisson model). 30 intervention patients died compared with 24 controls (hazard ratio=1.18, 0.69 to 2.03; P=0.54). Although EQ-5D scores favoured the intervention group, Minnesota living with heart failure questionnaire scores favoured controls; neither difference was statistically significant. Conclusion This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure. Given that heart failure accounts for 5% of hospital admissions, these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits.