Doucette William R, Witry Matthew J, Farris Karen B, McDonough Randal P
Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA.
Ann Pharmacother. 2009 May;43(5):882-9. doi: 10.1345/aph.1L605. Epub 2009 Apr 28.
Pharmacists in various settings have been effective in initiating diabetes treatment. Patients with diabetes require ongoing disease management, and community pharmacists are in a strategic position to provide such extended care. Little is known, however, about the effects of community pharmacist-provided interventions beyond the initial treatment period.
To evaluate the effect of community pharmacist-provided extended diabetes care service on primary clinical outcomes, including hemoglobin A(1c) (A1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure, and on patients' reported self-care activities.
A randomized controlled trial was conducted in patients with diabetes. Participants had already completed at least 2 diabetes education sessions at a local diabetes education center. Nine specially trained pharmacists administered interventions during up to 4 quarterly visits per patient. Interventions included discussing medications, clinical goals, and self-care activities with patients and recommending medication changes to physicians when appropriate. The main outcome measures were 12-month changes in A1C, LDL-C, blood pressure, and self-report of self-care activities.
Seventy-eight patients participated in the study (36 intervention, 42 control); 66 were included in the final analysis (31 intervention, 35 control). Compared with changes in the control group, patients who received interventions significantly increased the number of days per week that they engaged in a set of diet and diabetes self-care activities (1.25 and 0.73 more days/wk, respectively). The mean 12-month changes for A1C, LDL-C, and blood pressure were not significantly different between the 2 study groups.
Although pharmacist-provided interventions did not demonstrate statistically significant improvements in clinical outcomes over the study period, study results did show that pharmacists were effective at increasing the number of days that patients spent engaging in healthy diet and diabetes self-care activities. Addressing lifestyle and self-care behaviors can be a beneficial component of a pharmacist-provided extended diabetes care service.
不同工作场景下的药剂师在启动糖尿病治疗方面已取得成效。糖尿病患者需要持续的疾病管理，而社区药剂师处于提供此类长期护理的战略位置。然而，对于社区药剂师在初始治疗期之后提供的干预措施的效果，人们了解甚少。
评估社区药剂师提供的糖尿病长期护理服务对主要临床结局（包括糖化血红蛋白A（1c）[A1C]、低密度脂蛋白胆固醇[LDL-C]和血压）以及患者自我报告的自我护理活动的影响。
对糖尿病患者进行了一项随机对照试验。参与者已在当地糖尿病教育中心完成了至少2次糖尿病教育课程。9名经过专门培训的药剂师对每位患者进行多达4次季度访视，并实施干预措施。干预措施包括与患者讨论药物、临床目标和自我护理活动，并在适当时向医生推荐药物调整。主要结局指标为A1C、LDL-C、血压在12个月内的变化以及自我护理活动的自我报告。
78名患者参与了研究（36名干预组，42名对照组）；最终分析纳入了66名患者（31名干预组，35名对照组）。与对照组的变化相比，接受干预的患者每周参与一系列饮食和糖尿病自我护理活动的天数显著增加（分别多1.25天/周和0.73天/周）。两个研究组之间A1C、LDL-C和血压的平均12个月变化无显著差异。
尽管药剂师提供的干预措施在研究期间未显示出临床结局有统计学意义的改善，但研究结果确实表明，药剂师在增加患者参与健康饮食和糖尿病自我护理活动的天数方面是有效的。解决生活方式和自我护理行为问题可以成为药剂师提供的糖尿病长期护理服务的有益组成部分。
