Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Ann Pharmacother. 2013 Jan;47(1):43-8. doi: 10.1345/aph.1R552. Epub 2013 Jan 16.
Antiplatelet therapy is recommended as part of a strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. However, compliance with these guideline-recommended therapies appears to be less than ideal.
To assess the effect of adding pharmacists to primary care teams on initiation of guideline-concordant antiplatelet therapy in type 2 diabetic patients.
Prespecified secondary analysis of randomized trial data. In the main study, the pharmacist intervention included a complete medication history, limited physical examination, provision of guideline-concordant recommendations to the physician to optimize drug therapy, and 1-year follow-up. Controls received usual care without pharmacist interactions. Patients with an indication for antiplatelet therapy, but not using an antiplatelet drug at randomization were included in this substudy. The primary outcome was the proportion of patients using an antiplatelet drug at 1 year.
At randomization, 257 of 260 study patients had guideline-concordant indications for antiplatelet therapy, but less than half (121; 47%) were using an antiplatelet drug. Overall, 136 patients met inclusion criteria for the substudy (71 intervention and 65 controls): 60% were women, with mean (SD) age 58.0 (11.9) years, diabetes duration 5.3 (6.0) years, and hemoglobin A(1c) 7.6% (1.5). Sixteen (12%) had established cardiovascular disease at enrollment. At 1 year, 43 (61%) intervention patients and 15 (23%) controls were using an antiplatelet drug (38% absolute difference; number needed to treat, 3; relative increase, 2.6; 95% CI 1.5-4.7; p < 0.001). Of these 58 patients, 52 (90%) were using aspirin 81 mg daily.
Adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy.
抗血小板治疗被推荐作为降低 2 型糖尿病患者心血管事件风险的策略的一部分。然而，这些指南推荐的治疗方法的依从性似乎并不理想。
评估在初级保健团队中加入药剂师对 2 型糖尿病患者开始使用符合指南的抗血小板治疗的效果。
对随机试验数据的预设二次分析。在主要研究中，药剂师干预包括完整的用药史、有限的体检、向医生提供符合指南的建议以优化药物治疗，以及 1 年随访。对照组接受没有药剂师参与的常规护理。这项亚研究纳入了有抗血小板治疗指征但在随机分组时未使用抗血小板药物的患者。主要结局是在 1 年内使用抗血小板药物的患者比例。
在随机分组时，260 例研究患者中有 257 例有符合指南的抗血小板治疗指征，但只有不到一半（121 例；47%）正在使用抗血小板药物。总体而言，136 例患者符合亚研究的纳入标准（71 例干预组和 65 例对照组）：60%为女性，平均（标准差）年龄 58.0（11.9）岁，糖尿病病程 5.3（6.0）年，糖化血红蛋白 7.6%（1.5）。16 例（12%）在入组时已有心血管疾病。在 1 年时，43 例（61%）干预组患者和 15 例（23%）对照组患者正在使用抗血小板药物（38%的绝对差异；需要治疗的人数为 3；相对增加 2.6；95%CI 1.5-4.7；p<0.001）。这 58 例患者中，52 例（90%）每天服用 81 毫克阿司匹林。
在初级保健团队中加入药剂师可显著且实质性地增加使用符合指南的抗血小板治疗的 2 型糖尿病患者比例。
