药剂师管理的糖尿病护理诊所的发展及临床结果。

Development and clinical outcomes of pharmacist-managed diabetes care clinics.

作者信息

Morello Candis M, Zadvorny Emily B, Cording Margaret A, Suemoto Ryan T, Skog Jilian, Harari Amir

机构信息

Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, 92093, USA.

出版信息

Am J Health Syst Pharm. 2006 Jul 15;63(14):1325-31. doi: 10.2146/ajhp050430.

DOI:10.2146/ajhp050430

PMID:16809752

Abstract

PURPOSE

The development and outcomes of two pharmacist-managed diabetes care clinics (DCCs) are described.

METHODS

Retrospective data analysis was performed to determine the outcomes for patients with type 2 diabetes mellitus who were treated in two pharmacist-managed DCCs. Primary outcome measures included changes in glycosylated hemoglobin (HbA(1c)), fasting plasma glucose, body mass index, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein cholesterol, triglycerides, and blood pressure and documented annual retinal and micro-albumin screening. Secondary outcome measures included the use of aspirin and kidney-sparing agents and annual screening for thyroid-stimulating hormone.

RESULTS

Data from 113 patients in the DCCs were analyzed. After one year, the mean reduction in HbA(1c) levels was 1.3%, with a mean HbA(1c) of 7.8%. HbA(1c) goals were based on the institution's HbA(1c) normal range of 4.1-6.5%. Compared with baseline, over one third of patients met the HbA(1c) and blood pressure goals of <7.5% and <130/80 mm Hg, respectively. Mean LDL cholesterol concentration decreased from 110 to 94 mg/dL. The mean concentration of triglycerides decreased from 243 to 178 mg/dL. Mean systolic blood pressure decreased from 136 to 132 mm Hg. Whereas the national average for uncontrolled diabetes (HbA(1c) > 9.5%) was 36.9%, only 3.5% of patients at the pharmacist-managed DCCs had uncontrolled diabetes. Attainment rates of LDL cholesterol goals and annual retinal and microalbumin screenings were significantly higher in clinic patients compared with national averages. Three-year postclinic inception data revealed similar favorable outcomes, most notably an average HbA(1c) of 7.6% and 55% of patients meeting their target HbA(1c) goal of <7.5%.

CONCLUSION

Compared with national averages, DCCs managed by clinical pharmacists achieved higher screening rates and attained treatment goals more often.

摘要

目的

描述两家由药剂师管理的糖尿病护理诊所（DCC）的发展情况及结果。

方法

进行回顾性数据分析，以确定在两家由药剂师管理的DCC接受治疗的2型糖尿病患者的治疗结果。主要结局指标包括糖化血红蛋白（HbA1c）、空腹血糖、体重指数、低密度脂蛋白（LDL）胆固醇、高密度脂蛋白胆固醇、甘油三酯和血压的变化，以及有记录的年度视网膜和微量白蛋白筛查。次要结局指标包括阿司匹林和肾脏保护药物的使用情况以及促甲状腺激素的年度筛查。

结果

分析了DCC中113例患者的数据。一年后，HbA1c水平平均降低了1.3%，平均HbA1c为7.8%。HbA1c目标基于该机构4.1-6.5%的HbA1c正常范围。与基线相比，超过三分之一的患者分别达到了HbA1c<7.5%和血压<130/80 mmHg的目标。LDL胆固醇平均浓度从110 mg/dL降至94 mg/dL。甘油三酯平均浓度从243 mg/dL降至178 mg/dL。收缩压平均从136 mmHg降至132 mmHg。全国未控制糖尿病（HbA1c>9.5%）的平均比例为36.9%，而在由药剂师管理的DCC中，只有3.5%的患者患有未控制的糖尿病。与全国平均水平相比，诊所患者LDL胆固醇目标的达标率以及年度视网膜和微量白蛋白筛查的达标率显著更高。诊所成立三年后的数据分析显示了类似的良好结果，最显著的是平均HbA1c为7.6%，55%的患者达到了<7.5%的目标HbA1c目标。