Reilly Val, Cavanagh Margaret
Burnbank Medical Centre, Burnbank, Hamilton, Lanarkshire, Scotland.
Pharm World Sci. 2003 Dec;25(6):294-8. doi: 10.1023/b:phar.0000006526.55922.8d.
A primary care practice in the West of Scotland used clinical governance funding to develop a heart disease prevention clinic to target patients with existing heart disease. The practice nurse enlisted the help of the practice pharmacist and the protocol for the clinic was subsequently developed with the involvement of both practitioners.
The aim of this project was to identify and offer health screening and appropriate disease modifying treatment to patients of a primary care (or general medical) practice suffering from cardiovascular heart disease in a clinic run jointly by a practice nurse and pharmacist.
Patients identified by the practice pharmacist were offered a full health screen. Their clinical parameters were assessed and appropriate disease modifying drug therapy and lifestyle advice was offered in a review clinic with the practice nurse and pharmacist.
The practice pharmacist identified over 212 patients over a 30-month period. A majority demonstrated hypertension (91%) and angina (89%), while over half (57%) had suffered a heart attack. Statin therapy was modified in a large number of patients (47%) and the number of patients with satisfactory total cholesterol levels has increased from 30% to 57% (P < 0.001). Aspirin and beta-blocker therapy has been initiated in a significant number of patients (53% and 26% respectively). Twelve patients (6%) stopped smoking; however, many 42% continued to smoke. The general medical doctors (GPs) who demonstrated a change in their own practice readily accepted changes to therapy recommended by the practice nurse and pharmacist. The practice pharmacist offset the additional cost of drug spend on statin therapy by making savings in other therapeutic areas.
A secondary heart disease clinic can benefit patients by optimising drug and lifestyle therapy. While the inclusion of a pharmacist confers clinical and economic benefits.
苏格兰西部的一家初级保健机构利用临床治理资金设立了一家心脏病预防诊所，目标人群为已有心脏病的患者。执业护士寻求了执业药剂师的帮助，随后在两位从业者的参与下制定了诊所的方案。
本项目的目的是在由执业护士和药剂师联合运营的诊所中，为患有心血管疾病的初级保健（或普通内科）机构的患者进行健康筛查，并提供适当的疾病改善治疗。
执业药剂师确定的患者接受了全面的健康检查。评估了他们的临床参数，并在与执业护士和药剂师共同进行的复诊诊所中提供了适当的疾病改善药物治疗和生活方式建议。
执业药剂师在30个月内确定了212多名患者。大多数患者表现出高血压（91%）和心绞痛（8%），超过一半（57%）曾心脏病发作。大量患者（47%）的他汀类药物治疗方案得到了调整，总胆固醇水平达标的患者数量从30%增加到了57%（P<0.001）。大量患者开始使用阿司匹林和β受体阻滞剂治疗（分别为53%和26%）。12名患者（6%）戒烟；然而，仍有许多患者（42%）继续吸烟。在自身诊疗行为上有改变的普通医生欣然接受了执业护士和药剂师推荐疗法的改变。执业药剂师通过在其他治疗领域节省开支，抵消了他汀类药物治疗增加的药物费用。
二级心脏病诊所可通过优化药物和生活方式治疗使患者受益。药剂师参与其中能带来临床和经济效益。
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