Krass I, Armour C L, Mitchell B, Brillant M, Dienaar R, Hughes J, Lau P, Peterson G, Stewart K, Taylor S, Wilkinson J
Faculty of Pharmacy, Sydney University, NSW, Australia.
Diabet Med. 2007 Jun;24(6):677-83. doi: 10.1111/j.1464-5491.2007.02143.x.
To assess the impact of a community pharmacy diabetes service model on patient outcomes in Type 2 diabetes.
The study utilized a multisite, control vs. intervention, repeated-measures design within four states in Australia. Fifty-six community pharmacies, 28 intervention and 28 control, were randomly selected from a representative sample of urban and rural areas. Intervention pharmacies delivered a diabetes service to patients with Type 2 diabetes, which comprised an ongoing cycle of assessment, management and review, provided at regular intervals over 6 months in the pharmacy. These services included support for self monitoring of blood glucose, education, adherence support, and reminders of checks for diabetes complications. Control pharmacists assessed patients at 0 and 6 months and delivered no intervention.
A total of 289 subjects (149 intervention and 140 control) completed the study. For the intervention subjects, the mean blood glucose level decreased over the 6-month study from 9.4 to 8.5 mmol/l (P < 0.01). Furthermore, significantly greater improvements in glycaemic control were seen in the intervention group compared with the control: the mean reduction in HbA(1c) in the intervention group was -0.97% (95% CI: -0.8, -1.14) compared with -0.27% (95% CI: -0.15, -0.39) in the control group. Improvements were also seen in blood pressure control and quality of life in the intervention group.
A pharmacy diabetes service model resulted in significant improvements in clinical and humanistic outcomes. Thus, community pharmacists can contribute significantly to improving care and health outcomes for patients with Type 2 diabetes. Future research should focus on clarifying the most effective elements of the service model.
评估社区药房糖尿病服务模式对2型糖尿病患者预后的影响。
本研究在澳大利亚四个州采用多中心、对照与干预、重复测量设计。从城乡代表性样本中随机选取56家社区药房，其中28家为干预组，28家为对照组。干预组药房为2型糖尿病患者提供糖尿病服务，包括持续的评估、管理和复查周期，在药房定期进行，为期6个月。这些服务包括支持血糖自我监测、教育、依从性支持以及糖尿病并发症检查提醒。对照组药剂师在0个月和6个月时对患者进行评估，不进行干预。
共有289名受试者（149名干预组和140名对照组）完成了研究。对于干预组受试者，在为期6个月的研究中，平均血糖水平从9.4 mmol/l降至8.5 mmol/l（P < 0.01）。此外，与对照组相比，干预组血糖控制的改善更为显著：干预组糖化血红蛋白（HbA₁c）的平均降低幅度为-0.97%（95%置信区间：-0.8，-1.14），而对照组为-0.27%（95%置信区间：-0.15，-0.39）。干预组在血压控制和生活质量方面也有改善。
药房糖尿病服务模式使临床和人文预后得到显著改善。因此，社区药剂师可为改善2型糖尿病患者的护理和健康预后做出重大贡献。未来研究应侧重于明确该服务模式最有效的要素。
