Svarstad Bonnie L, Kotchen Jane Morley, Shireman Theresa I, Crawford Stephanie Y, Palmer Pamela A, Vivian Eva M, Brown Roger L
Social and Administrative Sciences, University of Wisconsin-Madison, Madison, Wis 53705, USA.
Circ Cardiovasc Qual Outcomes. 2009 May;2(3):264-71. doi: 10.1161/CIRCOUTCOMES.109.849992.
Recent studies suggest that involving pharmacists is an effective strategy for improving patient adherence and blood pressure (BP) control. To date, few controlled studies have tested the cost-effectiveness of specific models for improving patient adherence and BP control in community pharmacies, where most Americans obtain prescriptions. We hypothesized that a team model of adherence monitoring and intervention in corporately owned community pharmacies can improve patient adherence, prescribing, and BP control among hypertensive black patients. The Team Education and Adherence Monitoring (TEAM) Trial is a randomized controlled trial testing a multistep intervention for improving adherence monitoring and intervention in 28 corporately owned community pharmacies. Patients in the 14 control pharmacies received "usual care," and patients in the 14 intervention pharmacies received TEAM Care by trained pharmacists and pharmacy technicians working with patients and physicians. Data collectors screened 1250 patients and enrolled 597 hypertensive black patients. The primary end points were the proportion of patients achieving BP control and reductions in systolic and diastolic BP measured after 6 and 12 months. Secondary end points were changes in adherence monitoring and intervention, patient adherence and barriers to adherence, prescribing, and cost-effectiveness. Researchers also will examine potential covariates and barriers to change. Involving pharmacists is a potentially powerful means of improving BP control in blacks. Pharmacists are in an excellent position to monitor patients between clinic visits and to provide useful information to patients and physicians.
近期研究表明，让药剂师参与其中是提高患者依从性和控制血压（BP）的有效策略。迄今为止，很少有对照研究测试过在社区药房改善患者依从性和血压控制的特定模式的成本效益，而大多数美国人都是在社区药房获取处方的。我们假设，在连锁社区药房采用团队模式进行依从性监测和干预，可以提高高血压黑人患者的依从性、处方合理性以及血压控制水平。团队教育与依从性监测（TEAM）试验是一项随机对照试验，测试了一种多步骤干预措施，以改善在28家连锁社区药房的依从性监测和干预。14家对照药房的患者接受“常规护理”，14家干预药房的患者接受由经过培训的药剂师和药房技术人员与患者及医生合作提供的团队护理。数据收集人员筛查了1250名患者，招募了597名高血压黑人患者。主要终点是在6个月和12个月后实现血压控制的患者比例以及收缩压和舒张压的降低情况。次要终点是依从性监测和干预、患者依从性及依从性障碍、处方合理性以及成本效益方面的变化。研究人员还将研究潜在的协变量和变化障碍。让药剂师参与是改善黑人血压控制的一种潜在有力手段。药剂师处于极佳的位置，可以在门诊就诊期间对患者进行监测，并向患者和医生提供有用信息。
