在家庭医疗诊所中，比较药剂师管理的抗凝治疗与常规医疗护理。
Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic.
机构信息
School of Pharmacy, Memorial University, St. John's, Canada.
出版信息
BMC Fam Pract. 2011 Aug 17;12:88. doi: 10.1186/1471-2296-12-88.
BACKGROUND
The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC) to usual physician care (UC) in a family medicine clinic.
METHODS
A retrospective cohort study was carried out in a family medicine clinic which included a clinical pharmacist. In 2006, the pharmacist assumed anticoagulation management. For a 17-month period, the PC group (n = 112) of patients on warfarin were compared to the UC patients (n = 81) for a similar period prior to 2006. The primary outcome was the percentage of time patients' INR was in the therapeutic range (TTR). Secondary outcomes were the percentage of time in therapeutic range within ± 0.3 units of the recommended range (expanded TTR) and percentage of time the INR was >5.0 or <1.5.
RESULTS
The baseline characteristics were similar between the groups. Fifty-five percent of the PC group was male with a mean age of 67 years; 51% of the UC group was male with a mean age of 71 years. The most common indications for warfarin in both groups were atrial fibrillation, mechanical heart valves and deep vein thrombosis. The TTR was 73% for PC and 65% for UC (p < 0.0001). The expanded TTR for PC was 91% and 85% for UC (p < 0.0001). The percentage of time INR values were <1.5 was 0.7% for PC patients and 1.9% for UC patients (p < 0.0001), and >5 were 0.3% for PC patients and 0.1% for UC (p < 0.0001).
CONCLUSION
The pharmacist-managed anticoagulation program within a family practice clinic compared to usual care by the physicians achieved significantly better INR control as measured by the percentage of time patients' INR values were kept in both the therapeutic and expanded range. Based on the results of this study, a collaborative family practice clinic using pharmacists and physicians may be an effective model for anticoagulation management with these results verified in future prospective randomized studies.
背景
口服抗凝治疗的有益结果取决于是否达到并维持理想的 INR 治疗范围。越来越多的证据表明，当抗凝治疗由具有抗凝管理专业知识的药剂师管理，而不是由家庭医生进行常规护理时，可获得更好的结果。本研究比较了家庭医学诊所中由药剂师管理的抗凝治疗方案（PC）与常规医生护理（UC）。
方法
在一家家庭医学诊所进行了一项回顾性队列研究，该诊所包括一名临床药剂师。2006 年，药剂师开始负责抗凝治疗管理。在 17 个月的时间里，将接受华法林治疗的 PC 组（n=112）与 2006 年前类似时期的 UC 患者（n=81）进行比较。主要结局是患者 INR 在治疗范围内的时间百分比（TTR）。次要结局是 INR 在推荐范围内 ± 0.3 单位的治疗范围内的时间百分比（扩展 TTR）和 INR 大于 5.0 或小于 1.5 的时间百分比。
结果
两组患者的基线特征相似。PC 组 55%为男性，平均年龄为 67 岁；UC 组 51%为男性，平均年龄为 71 岁。两组最常见的华法林适应证为心房颤动、机械心脏瓣膜和深静脉血栓形成。PC 组的 TTR 为 73%，UC 组为 65%（p<0.0001）。PC 组的扩展 TTR 为 91%，UC 组为 85%（p<0.0001）。PC 组 INR 值小于 1.5 的时间百分比为 0.7%，UC 组为 1.9%（p<0.0001）；PC 组 INR 值大于 5 的时间百分比为 0.3%，UC 组为 0.1%（p<0.0001）。
结论
与医生的常规护理相比，家庭诊所中由药剂师管理的抗凝治疗方案可显著更好地控制 INR，这体现在患者 INR 值保持在治疗和扩展范围内的时间百分比上。基于这项研究的结果，使用药剂师和医生的合作家庭诊所可能是抗凝管理的有效模式，这些结果需要在未来的前瞻性随机研究中得到验证。
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