Brooks Amie D, Rihani Rami S, Derus Charles L
Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO 63110, USA.
Am J Health Syst Pharm. 2007 Mar 15;64(6):617-21. doi: 10.2146/ajhp060095.
An evaluation of the effectiveness of a program at achieving improved glycemic control, lipid levels, and adherence to preventive care measures in diabetes mellitus patients was conducted.
An interdisciplinary diabetes health management program (DHMP) was implemented, which included physicians, clinical pharmacists, registered nurses, and registered dieticians. The patients are seen by a clinical pharmacist with the option of individual or group visits with other members of the multidisciplinary team. Clinical pharmacist interventions include education and comprehensive medication management through collaborative practice agreements held with physicians. The collaborative agreements allow the clinical pharmacist to initiate, adjust, or discontinue pharmacotherapy and order pertinent laboratory tests and podiatry referrals that are within the scope of the medication management protocol. A retrospective review was conducted of the 707 patients enrolled in the program between April 2002 and April 2004. The mean +/- S.D. number of days between baseline and follow-up values was 140 +/- 62. Eighty-four percent of the enrolled patients were diagnosed with type 2 diabetes mellitus, 69% met the National Cholesterol Education Program's criteria for metabolic syndrome, and 51% were male. The mean glycosylated hemoglobin (HbA(1c)) value dropped significantly, and the percentage of patients who were at or below the American Diabetes Association's established HbA(1c) goal of < or = 7% increased significantly. Lipid values for enrolled patients improved, with the percentage achieving a low-density-lipoprotein cholesterol concentration of <100 mg/dL increasing from 25% to 44% [corrected] Adherence to preventive care measures (e.g., annual eye and foot examinations) also significantly improved from baseline to follow-up.
Involvement of pharmacists in an interdisciplinary DHMP has improved patient care.
对一项旨在改善糖尿病患者血糖控制、血脂水平并提高预防保健措施依从性的项目效果进行评估。
实施了一项跨学科糖尿病健康管理项目（DHMP），该项目包括医生、临床药师、注册护士和注册营养师。患者由临床药师诊治，也可选择与多学科团队的其他成员进行个体或小组会诊。临床药师的干预措施包括通过与医生签订的协作实践协议进行教育和全面的药物管理。这些协作协议允许临床药师在药物管理协议范围内启动、调整或停止药物治疗，并安排相关实验室检查和足病转诊。对2002年4月至2004年4月期间参与该项目的707例患者进行了回顾性分析。基线值与随访值之间的平均天数±标准差为140±62天。84%的入选患者被诊断为2型糖尿病，69%符合美国国家胆固醇教育计划代谢综合征的标准，51%为男性。糖化血红蛋白（HbA1c）的平均水平显著下降，达到或低于美国糖尿病协会设定的HbA1c目标值≤7%的患者百分比显著增加。入选患者的血脂水平有所改善，低密度脂蛋白胆固醇浓度<100mg/dL的患者百分比从25%增至44%[校正后]。从基线到随访，预防保健措施（如年度眼科和足部检查）的依从性也显著提高。
药师参与跨学科糖尿病健康管理项目改善了患者护理。
