Carter B L
Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.
Vnitr Lek. 2009 Apr;55(4):389-94.
Studies have shown that it is very important to control blood pressure in patients with diabetes. Unfortunately, blood pressure control throughout the world is poor. Numerous studies have used interdisciplinary team-based care to improve the control of many chronic conditions including hypertension and diabetes. This discussion will focus on the results of a study we recently conducted involving clinical pharmacists located in physician offices. The study was a randomized, cluster trial in five clinics. The pharmacists assessed patients with poorly controlled blood pressure and made recommendations to the physicians to change therapy. The patients in control sites received usual care. Blood pressure was controlled in 89% of patients in the intervention group compared to 53% in the control group (p < 0.001). Blood pressure was controlled in 82% of patients with diabetes in the intervention group compared to 24% in the control group (p = 0.002). This was the first study of team-based care that used ambulatory BP monitoring. Ambulatory blood pressure was reduced significantly more in the intervention group compared to the control group. The primary reason for the superior results in the intervention group was more intensive use of medications to control blood pressure. This study demonstrates that blood pressure can be controlled in a high number of patients with diabetes following our physician/pharmacist collaborative model.
研究表明，控制糖尿病患者的血压非常重要。不幸的是，全球范围内的血压控制情况都很差。许多研究采用了基于跨学科团队的护理方式来改善包括高血压和糖尿病在内的多种慢性病的控制情况。本次讨论将聚焦于我们最近开展的一项研究结果，该研究涉及在医生办公室工作的临床药剂师。这项研究是在五家诊所进行的一项随机整群试验。药剂师对血压控制不佳的患者进行评估，并向医生提出更改治疗方案的建议。对照组的患者接受常规护理。干预组89%的患者血压得到控制，而对照组这一比例为53%（p<0.001）。干预组中82%的糖尿病患者血压得到控制，而对照组为24%（p = 0.002）。这是第一项使用动态血压监测的基于团队护理的研究。与对照组相比，干预组的动态血压下降幅度明显更大。干预组取得更好结果的主要原因是更密集地使用药物来控制血压。这项研究表明，按照我们的医生/药剂师协作模式，大量糖尿病患者的血压能够得到控制。
