School of Pharmacy, University of Maryland, Shady Grove Campus, Rockville, MD, USA.
Ann Pharmacother. 2013 May;47(5):665-70. doi: 10.1345/aph.1R648. Epub 2013 Apr 12.
Diabetes-related complications are more pronounced in Hispanic patients versus patients of other ethnicities. It is documented that medication therapy management (MTM) can improve diabetes outcomes; however, data regarding Hispanic patients are limited.
To evaluate the impact of MTM on hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in underserved, primarily Hispanic patients who use a safety-net clinic as their medical home.
A retrospective, observational study of uninsured, primarily Hispanic patients with diabetes who received MTM from October 2009 through March 2011. Patients were stratified into 2 cohorts: A1C less than 9% and A1C greater than or equal to 9%. Patients were also stratified by frequency of MTM visits and insulin use, regardless of A1C. A chart review was conducted to evaluate diabetes-related outcomes pre- and postimplementation of MTM. The primary study outcome was reduction of A1C. Secondary outcomes included reduction of BP and LDL-C and reduction of A1C based on MTM visit frequency or insulin use.
Sixty-four patients with at least 1 MTM visit and pre- and postimplementation A1C data were included. In the cohort with A1C greater than or equal to 9%, mean (SD) A1C values decreased from 10.9% (1.4%) to 8.8% (1.5%) versus the cohort with A1C less than 9%, whose A1C changed minimally, from 7.2% (0.9%) to 7.4% (1.4%). Regardless of their A1C, patients who were using insulin at baseline had a change in A1C of -0.8% (1.5%) versus -0.1% (1.6%) in those who were not using insulin at baseline (p = 0.04); patients who participated in multiple MTM visits had a significant reduction in A1C, from 9% to 8.3% (95% CI -1.26 to -0.03; p = 0.02) compared with patients participating in only 1 MTM visit.
Pharmacist-provided MTM can significantly improve diabetes control in uninsured, primarily Hispanic patients with poorly controlled diabetes and in those who are using insulin. Multiple MTM visits also yielded significant A1C reductions.
与其他族裔的患者相比，西班牙裔患者的糖尿病相关并发症更为明显。有文献记载，药物治疗管理（MTM）可以改善糖尿病的预后；然而，关于西班牙裔患者的数据有限。
评估 MTM 对使用医疗服务匮乏的主要为西班牙裔人群的安全网诊所作为其医疗之家的糖尿病患者的糖化血红蛋白（A1C）、血压（BP）和低密度脂蛋白胆固醇（LDL-C）的影响。
这是一项回顾性、观察性研究，纳入了 2009 年 10 月至 2011 年 3 月期间接受 MTM 的无保险、主要为西班牙裔且患有糖尿病的患者。患者分为 2 个队列：A1C<9%和 A1C≥9%。根据 MTM 就诊次数和胰岛素使用情况（无论 A1C 如何）对患者进行分层。对患者的病历进行回顾性评估，以评估 MTM 实施前后的糖尿病相关结局。主要研究结果是 A1C 的降低。次要结局包括 BP 和 LDL-C 的降低以及根据 MTM 就诊次数或胰岛素使用情况降低 A1C。
共纳入 64 名至少接受过 1 次 MTM 就诊且有就诊前后 A1C 数据的患者。在 A1C≥9%的队列中，A1C 值从 10.9%（1.4%）降至 8.8%（1.5%），而 A1C<9%的队列中，A1C 变化较小，从 7.2%（0.9%）降至 7.4%（1.4%）。无论 A1C 如何，基线时使用胰岛素的患者 A1C 变化为-0.8%（1.5%），而基线时未使用胰岛素的患者 A1C 变化为-0.1%（1.6%）（p=0.04）；多次接受 MTM 就诊的患者 A1C 显著降低，从 9%降至 8.3%（95%CI-1.26 至-0.03；p=0.02），而仅接受 1 次 MTM 就诊的患者 A1C 变化无统计学意义。
药师提供的 MTM 可显著改善未投保的、主要为西班牙裔的、糖尿病控制不佳的患者以及使用胰岛素的患者的糖尿病控制情况。多次 MTM 就诊也可显著降低 A1C。
