社会药房药师干预高血压的措施和成效之系统评价

A Systematic Review of the Measures and Outcomes of Community Pharmacists' Interventions on Hypertension Patients

目的:对社会药房药师干预高血压患者的措施和成效进行系统评价,为中国社会药房开展高血压管理提供参考和依据。方法:通过计算机检索Pub Med、Cochrane Library、Web of Science、Embase、Sino Med、CNKI、Wan Fang Data数据库2000年1月～2017年7月公开发表的社会药房药师对高血压患者开展干预的研究,手工检索其他相关文献。根据纳入和排除标准,筛选随机对照试验(RCTs)、观察性研究(OSs)和类试验研究(QESs)。采用Cochrane评价工具、纽卡斯尔-渥太华(NOS)等工具对最终纳入文献的偏倚风险进行评价。重点分析干预措施和患者结局指标,对部分指标采用Rev Man 5. 3软件进行Meta分析。结果:共纳入14项研究:6项RCTs、3项OSs和5项QESs。与对照组(常规药学服务)相比,干预组的高血压患者接受了社会药房药师的治疗教育和定期随访等干预。对5项RCTs的结果进行Meta分析发现,社会药房药师积极干预高血压患者可以显著降低收缩压(SBP)[MD=-5. 71 mm Hg,95%CI(-7. 79,-3. 63),P <0. 001]和舒张压(DBP)[MD=-2. 21 mm Hg,95%CI(-3. 48,-0. 95),P <0. 001],提高血压达标率[OR=1. 76,95%CI(1. 42,2. 20),P <0. 001]。此外,药师采取的不同干预措施还可以降低心脑血管事件发生率和治疗成本,改善患者生活质量和生活习惯,提高患者的用药依从性。结论:社会药房药师通过用药教育和定期随访等措施积极干预高血压患者能够改善高血压控制,降低医疗成本,提高生活质量。

Objective: To systematically review the measures and consequent outcomes of interventions with hypertension performed by community pharmacists. Methods: The related studies published between July 2000 and July 2017 were retrieved from Pub Med,Cochrane Library,Web of Science,Embase,Sino Med,CNKI and Wan Fang database. The randomized controlled trials(RCTs),observational studies(OSs) and quasi-experimental studies(QESs) were screened based on the inclusion and exclusion criteria. The risk of bias of included studies was respectively assessed using tools such as Cochrane,Newcastle-Ottawa Scale( NOS) and TREND. The intervention measures and outcomes were extracted. Some outcomes were analyzed by Meta-analysis using Rev Man 5. 3 software. Results: A total of 14 original studies were included for analysis: 6 RCTs,3 OSs and 5 QESs. Compared with the control group,hypertension patients in the intervention group received active pharmaceutical services such as medication education and regular follow-up. Meta-analysis results showed that the active interventions from community pharmacists significantly decreased systolic blood pressure [MD =-5. 71 mm Hg,95% CI(-7. 79,-3. 63),P < 0. 001] and diastolic blood pressure [MD =-2. 21 mm Hg,95%CI(-3. 48,-0. 95),P < 0. 001],improved hypertension control [OR = 1. 76,95% CI(1. 42,2. 20),P < 0. 001],reduced the incidence of cardiovascular events and treatment costs,and improved quality of life,lifestyle habits and medical adherence of patients.Conclusion: Interventions conducted by community pharmacists can improve hypertension control,reduce medical costs and improve quality of life. Patient education and follow-up are most common interventions.