Description of pharmacist interventions during physician-pharmacist co-management of hypertension
Description of pharmacist interventions during physician-pharmacist co-management of hypertension
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DOI：
10.1007/s11096-007-9155-6
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发表时间：
2008-01-01
影响因子：
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通讯作者：
Xu, Yinghui
中科院分区：
文献类型：
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作者：
Von Muenster, Shannon J.;Carter, Barry L.;Xu, Yinghui
目的探讨临床药师与内科医生共同管理高血压时的建议。设置在美国中西部的一家主要教学医院的两个家庭医学诊所。方法本报告详细介绍了药师在一项前瞻性随机对照临床试验中提出的具体建议。患有不受控制的高血压的患者入组了一项为期9个月的强化药剂师-医生共同管理研究。临床药师在基线、2、4、6和8个月访视时观察患者。在要求的访视之间允许进行可选访视。主要结果测量对于这项分析，药剂师的建议进行了分组。还评估了医生对药剂师建议的接受程度。结果共纳入101例患者的临床资料。对这101例患者建议改变药物治疗267次。大多数改变治疗的建议包括增加新的降压药物（46.4%）或增加剂量（33.3%）。大多数药剂师在基线访视（41.6%）时提出修改药物治疗的建议，76.8%的建议在2个月访视时提出。医生接受并执行了267名药剂师修改药物治疗建议的95.9%。药剂师361次建议不改变治疗计划，大多数情况下是因为患者的血压（BP）达到了目标。平均血压从基线时的153.1 +/-10.0/84.9 +/-12.0 mmHg（平均值+/-SD）降至9个月结束时的124.2 +/-9.7/74.7 +/-9.6 mmHg（P <0.001），89.1%（P <0.001）的患者达到了血压目标。结论：药剂师建议改变药物治疗通常发生在研究过程的早期，主要是通过更高的剂量或额外的药物来加强治疗。药师-医师共同管理血压可有效降低血压并提高血压控制率。
Objective The aim of this study is to describe recommendations made by clinical pharmacists when co-managing hypertension with physicians. Setting Two family medicine clinics at a major teaching hospital in the mid-western United States. Method This report details the specific recommendations made by pharmacists during a prospective randomized controlled clinical trial. Patients with uncontrolled hypertension were enrolled in a 9-month intensive pharmacist-physician co-management study. Clinical pharmacists saw patients at baseline, 2, 4, 6, and 8 month visits. Optional visits were allowed between required visits. Main outcome measure For this analysis, pharmacist recommendations were grouped. Physician acceptance of the pharmacists' recommendations was also evaluated. Results Data from 101 patients were included and analyzed in this study. Changes in drug therapy were recommended 267 times for these 101 patients. Most recommendations for a change in treatment involved adding a new antihypertensive medication (46.4%) or increasing a dose (33.3%). The majority of pharmacist recommendations to modify drug therapy were made at the baseline visit (41.6%), with 76.8% of recommendations made by the 2 month visit. Physicians accepted and implemented 95.9% of the 267 pharmacist recommendations to modify drug therapy. Pharmacists recommended no change in the treatment plan 361 times, most often because the patient's blood pressure (BP) had achieved the goal. Average BP decreased from 153.1 +/- 10.0/84.9 +/- 12.0 mmHg (average +/- SD) at baseline to 124.2 +/- 9.7/74.7 +/- 9.6 mmHg (P < 0.001) at the end of 9 months, with 89.1% (P < 0.001) of patients reaching their BP goal. Conclusion Pharmacist recommendations for alterations in drug therapy generally occurred early in the course of the study and were largely to intensify therapy through higher dosages or additional medications. Pharmacist-physician co-management of BP is effective at reducing BP and improving BP control rates.