Miller Amy E, Hansen Laura B, Saseen Joseph J
Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Pharmacotherapy. 2008 May;28(5):553-61. doi: 10.1592/phco.28.5.553.
STUDY OBJECTIVE. To evaluate the effectiveness of switching statin therapy using a therapeutic conversion program versus usual care conversion among patients enrolled in the Colorado Indigent Care Program when atorvastatin was removed from the formulary.
Prospective cohort study.
Family medicine center and other ambulatory care clinics of a university-based health care system.
One hundred seventeen ambulatory care patients with dyslipidemia who were treated with atorvastatin.
Clinical pharmacists in the family medicine center implemented a therapeutic conversion program (30 patients), switching atorvastatin to a new formulary regimen of simvastatin, rosuvastatin, or ezetimibe-simvastatin, using an algorithm designed to achieve patient-specific goals for low-density lipoprotein cholesterol (LDL). Usual care occurred in the other ambulatory care clinics without clinical pharmacists (87 patients), where medical providers switched atorvastatin to a formulary regimen based on a suggested (but optional) equipotency conversion algorithm.
Primary end points were LDL concentration and LDL goal attainment before and after conversion. Before and after conversion, respectively, mean LDL concentrations were 86.7 and 82.3 mg/dl in the therapeutic conversion group (p=0.44) versus 78.3 and 85.2 mg/dl in the usual care group (p=0.01). Percentages of patients attaining LDL goal were 80% before and 97% after conversion in the therapeutic conversion group (p=0.04) compared with 90% before and 75% after conversion in the usual care group (p=0.01).
Use of a prospective, therapeutic statin conversion program was associated with increased control of dyslipidemia, whereas usual care statin conversion was associated with decreased control. These data suggest that proactive involvement of clinical pharmacists in converting lipid-lowering drugs results in superior patient care outcomes compared with a less aggressive approach.
研究目的。评估在科罗拉多贫困医疗计划的参保患者中，当阿托伐他汀从处方集剔除时，使用治疗性转换方案与常规护理转换相比，转换他汀类药物治疗的有效性。
前瞻性队列研究。
一所大学医疗系统的家庭医学中心和其他门诊护理诊所。
117名接受阿托伐他汀治疗的门诊血脂异常患者。
家庭医学中心的临床药师实施了一项治疗性转换方案（30名患者），使用一种旨在实现患者特定低密度脂蛋白胆固醇（LDL）目标的算法，将阿托伐他汀转换为辛伐他汀、瑞舒伐他汀或依折麦布 - 辛伐他汀的新处方方案。常规护理在没有临床药师的其他门诊护理诊所进行（87名患者），医疗提供者根据建议的（但非强制性的）等效性转换算法将阿托伐他汀转换为处方方案。
主要终点是转换前后LDL浓度和LDL目标达成情况。转换前后，治疗性转换组的平均LDL浓度分别为86.7和82.3mg/dl（p = 0.44），而常规护理组为78.3和85.2mg/dl（p = 0.01）。治疗性转换组达到LDL目标的患者百分比在转换前为80%，转换后为97%（p = 0.04），而常规护理组在转换前为90%，转换后为75%（p = 0.01）。
使用前瞻性的治疗性他汀转换方案与血脂异常控制的改善相关，而常规护理他汀转换与控制的下降相关。这些数据表明，与不太积极的方法相比，临床药师积极参与降脂药物的转换可带来更好的患者护理结果。
