School of Pharmacy, University of Colorado-Denver, Aurora, CO, USA.
Am J Health Syst Pharm. 2010 Feb 15;67(4):290-4. doi: 10.2146/ajhp090009.
The influence of pharmacist intervention on the prescribing of angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), and aspirin for patients with diabetes was evaluated.
A retrospective chart review was performed for diabetic patients seen in a family medicine clinic. Patients were included in the analyses if they were 18-88 years old, had a diagnosis of type 1 or type 2 diabetes, had been seen in the family medicine clinic between July 2006 and October 2008, and had received a consultation by pharmacy services. All selected charts were reviewed to assess appropriate use of ACE inhibitor, ARB, and aspirin therapy, as recommended by American Diabetes Association (ADA) guidelines, before and after pharmacist intervention. Typical pharmacist interventions consisted of direct consultation with the prescriber and therapeutic education sessions conducted by pharmacy personnel. All patients were seen and evaluated by pharmacy personnel before meeting with the prescriber.
Before pharmacist intervention, 41 (59%) of 70 patients were receiving appropriate ACE inhibitor or ARB therapy and 24 (34%) of 71 patients were receiving appropriate aspirin therapy as recommended by ADA. After pharmacist intervention, 63 (90%) of 70 patients were receiving appropriate ACE inhibitor or ARB therapy and 48 (68%) of 71 patients were receiving appropriate aspirin therapy as recommended by ADA (p < 0.0001 for both differences).
A pharmacy intervention program in a primary care setting was associated with a significant increase in prescriber adherence to ADA guidelines for ACE inhibitor or ARB therapy and for aspirin therapy in diabetic patients.
评估药师干预对糖尿病患者开处方使用血管紧张素转换酶（ACE）抑制剂、血管紧张素 II 受体阻滞剂（ARB）和阿司匹林的影响。
对家庭医学诊所就诊的糖尿病患者进行回顾性病历审查。如果患者年龄在 18-88 岁之间，患有 1 型或 2 型糖尿病，于 2006 年 7 月至 2008 年 10 月在家庭医学诊所就诊，并且接受了药学服务咨询，则将其纳入分析。所有选定的病历均进行了审查，以评估在接受药师干预前后，根据美国糖尿病协会（ADA）指南，ACE 抑制剂、ARB 和阿司匹林治疗的使用是否合理。典型的药师干预措施包括与处方医生直接协商以及由药学人员进行治疗教育课程。所有患者在与处方医生会面之前均由药学人员进行评估。
在药师干预之前，70 名患者中有 41 名（59%）接受了适当的 ACE 抑制剂或 ARB 治疗，71 名患者中有 24 名（34%）接受了适当的阿司匹林治疗，符合 ADA 推荐的标准。在药师干预之后，70 名患者中有 63 名（90%）接受了适当的 ACE 抑制剂或 ARB 治疗，71 名患者中有 48 名（68%）接受了适当的阿司匹林治疗，符合 ADA 推荐的标准（差异均为 p < 0.0001）。
在初级保健环境中实施药学干预计划可显著提高处方医生对 ADA 指南的依从性，使糖尿病患者接受 ACE 抑制剂或 ARB 治疗和阿司匹林治疗的比例增加。
