Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA.
Ann Pharmacother. 2010 Jan;44(1):88-96. doi: 10.1345/aph.1L289. Epub 2009 Dec 29.
Hypertension affects over 50 million Americans, with only 50% of patients being adequately controlled. Several pharmacist counseling and pharmacist-physician comanagement studies have documented that community pharmacist interventions improve blood pressure (BP) management.
To determine whether community pharmacists can improve clinical endpoints including hypertension control, drug therapy dosing, adherence to prescribed regimens, adverse drug reaction incidence, patient understanding, response to therapy, and quality-of-life.
The program included the education and training of a group of 18 chain community pharmacists in hypertension therapies, monitoring, and management. Protocols and documentation tools were based on nationally accepted clinical practice guidelines for hypertension in place at the time of the study. Pharmaceutical care (PC) was then compared with usual care (UC) over a 12-month period.
The study initially enrolled 180 PC and 196 UC patients, with 44% (PC) and 32% (UC) of the patients reporting a final BP measurement. A larger proportion (50%) of PC patients who had poorly controlled hypertension at baseline (>140/90 mm Hg) were controlled compared with UC patients (22%). The average reduction in systolic BP was 9.9 mm Hg in PC patients compared with 2.8 mm Hg in UC patients (p < 0.05). Changes in diastolic BP were similar in the PC and UC groups. Based on patient self-report, PC patients were more likely to say that they take their medicines as prescribed compared with UC patients (p < 0.05). The 1- to 6-month antihypertensive adherence rate was higher in PC patients (0.91 +/- 0.15) compared to UC patients (0.78 +/- 0.30) (p = 0.02); there was no significant difference in adherence rate during the 7- to 12-month period.
Community pharmacists can positively affect patient medication adherence during the 6-month period following counseling by a pharmacist along with an improvement in patient BP. However, there is much room for improvement in PC programs and in the number of patients who properly adhere to their medications.
高血压影响了超过 5000 万美国人，其中仅有 50%的患者血压得到了有效控制。多项药师咨询和药师-医师联合管理研究表明，社区药师的干预措施可改善血压（BP）管理。
确定社区药师是否可以改善临床终点，包括高血压控制、药物治疗剂量、遵医嘱服药、药物不良反应发生率、患者理解、治疗反应和生活质量。
该项目包括对一组 18 家连锁社区药师进行高血压治疗、监测和管理方面的教育和培训。方案和文件记录工具基于研究时采用的、得到广泛认可的高血压临床实践指南。在 12 个月的时间里，比较了药物治疗（PC）与常规护理（UC）。
该研究最初纳入了 180 名 PC 和 196 名 UC 患者，其中 44%（PC）和 32%（UC）的患者报告了最终血压测量值。与 UC 患者（22%）相比，基线时血压控制不佳（>140/90mmHg）的 PC 患者中，有更大比例（50%）得到了控制。PC 患者的收缩压平均降低 9.9mmHg，而 UC 患者为 2.8mmHg（p<0.05）。两组患者的舒张压变化相似。根据患者自述，与 UC 患者相比，PC 患者更有可能按规定服药（p<0.05）。PC 患者的 1 至 6 个月降压药物依从率（0.91 +/- 0.15）高于 UC 患者（0.78 +/- 0.30）（p=0.02）；在 7 至 12 个月期间，依从率无显著差异。
在接受药师咨询和药师-医师联合管理后 6 个月内，社区药师可以积极影响患者的服药依从性，改善患者的血压。然而，PC 方案和遵医嘱服药的患者人数仍有很大的改进空间。
