医生-护士-药师协作干预心血管疾病疗效的系统评价

Efficacy of Collaboration between Physicians-Nurses-Pharmacists for Cardiovascular Disease: A Systematic Review

目的系统评价医生-护士-药师协作干预心血管疾病患者治疗效果。方法计算机检索MEDLINE,EMbase,CENTRAL,Wan Fang,CNKI,VIP数据库,查找医生-护士-药师协作干预心血管疾病患者的随机对照试验(RCT),检索时限截至2015年3月。采用Rev Man 5.3.0软件进行Meta分析。结果最终纳入12个RCT。协作组较常规组显著降低患者收缩压和舒张压[RR=-0.41,95%CI(-0.68,-0.14),P=0.003]和[RR=-0.10,95%CI(-0.14,-0.06),P<0.000 01];协作组较常规组显著降低患者的总胆固醇[RR=-0.44,95%CI(-0.72,-0.16),P=0.002]。两组患者的病死率和住院率,差异无统计学意义(P>0.05)。结论医生-护士-药师协作对于心血管疾病患者的血压和血脂控制有效,但远期疗效有待更多高质量、大样本、长期随访的RCT加以验证。

Objective To evaluate the effectiveness of collaboration between physicians, nurses and pharmacists for cardiovascular disease. Methods Randomized Controlled Trails （RCTs） of collaboration between physicians, nurses and pharmacists for cardiovascular disease were retrieved from MEDLINE, EMhase, CENTRAL, CNKI, VIP and WanFang. The retrieved studies were screened according to the inclu- sion and exclusion criteria, the quality of included studies were evaluated, then performed meta -analyses with The Cochrane Collabora- tion＇s Revman 5.3.0 software. Results 12 RCTs of collaboration between physicians, nurses and pharmacists for cardiovascular disease were included. The results of meta- analyses showed that the change in systolic blood pressure, diastolic blood pressure and total cholesterol was significantly reduced in the collaboration group than in usual care group[ RR = -0.41, 95% CI（- 0. 68, -0. 14）, P = 0. 003], [RR= -0.10,95% CI（-0.14, -0.06）, P 〈 0.000 01], [RR= -0.44,95% CI（-0.72, -0.16）, P=0.002].There was no statistically significant difference in the death rate and hospitalization rate between the collaboration group and usual care group. Conclusion Collaboration between physicians, nurses and pharmacists is effective for cardiovascular disease. But its long -term efficacy still needs to be confirmed by performing more high quality, large sample RCTs with long term follow- up.