临床药师参与治疗管理对门诊2型糖尿病合并高血压患者血压控制的影响

Role of Clinical Pharmacists on Blood Pressure Control in Outpatients with Type 2 Diabetes and Hypertension

目的:探究临床药师参与治疗管理及对门诊Ⅱ型糖尿病合并高血压患者血压控制的作用。方法:纳入2017年6月至2018年6月500例心内科门诊Ⅱ型糖尿病合并高血压患者,随机分为对照组和药师干预组,各25例。对照组完成常规诊疗流程,每月电话咨询其药物使用情况;药师干预组现场记录患者一般情况,与医生讨论处方优化并决定是否执行,对患者进行用药指导。就诊后1个月内每2周随访1次,其后每4周随访1次,随访期间药师可根据情况与医生讨论是否调整降压方案并作出最终决定,患者根据药师建议或自己意愿回医院随诊,随访时间1年。主要终点事件为12个月后血压≤130/80 mmHg;次要终点事件为药物调整情况、药师建议采纳率、药物持有率(评估患者依从性)。结果:最终378例完成随访。对照组68名(36.4%)及干预组152名(79.6%)患者血压≤130/80 mmHg,P<0.01;干预组收缩压与舒张压降幅显著>对照组(P<0.01)。对照组药物调整35次,干预组调整129次,药师建议采纳率为85.18%。1年后,对照组药物持有率为0.22±0.04,干预组为0.77±0.11,P<0.01。结论:临床药师参与治疗管理有助于优化降压方案,提升用药依从性,提高了门诊Ⅱ型糖尿病合并高血压患者的血压控制达标率。

Objective:To explore the role of clinical pharmacists on blood pressure control in patients with type 2 diabetes(T2DM)and hypertension.Methods:A total of 500 outpatients with T2DM and hypertension were divided into control group and clinical pharmacist intervention group.Patients in the control group consulted physicians routinely.Patients in the clinical pharmacist intervention group received medication education just as they got the medicine,pharmacists recorded their characters,optimized their prescriptions with physicians and followed-up every 2 weeks in the first month and every 4 weeks in the 2th-12th months,the pharmacists should discuss with the physicians for therapy adjustment when needed.Patients could also check back in with physicians on their own will or under the advice of pharmacists.The primary outcome was a blood pressure≤130/80 mmHg,the secondary outcome were times of treatment changes,the adoption ratio of pharmacists`suggestion and the medication possession ratio(MPR)were also used for assessment.Results:A total of 378 patients completed the research and 68 patients in the control group and 152 patients in the intervention group achieved the primary outcome(P<0.01).Treatment changes occurred 35 times in the control group and 129 times in the intervention group with adoption ratio at 85.18%.Adding of a new medication was the most common type of changes,occurred 25 times in the control group and 97 times in the intervention group,respectively.After the one-year follow-up,the MPR was 0.22±0.04 in the control group and 0.77±0.11 in the intervention group(P<0.01).Conclusion:Participation of pharmacists into medication therapy management would help optimize the antihypertensive therapy strategy and increase the medication adherence,which finally improved the blood pressure control rate.