Altowaijri Abdulaziz, Phillips Ceri J, Fitzsimmons Deborah
College of Human and Health Sciences, Vivian Tower, 2nd Fl., Swansea University, Swansea, SA2 8PP Wales, United Kingdom.
J Manag Care Pharm. 2013 Jun;19(5):408-16. doi: 10.18553/jmcp.2013.19.5.408.
Cardiovascular disease (CVD) is considered to be the main cause of death and one of the most common diseases affecting health care systems worldwide. Many methods have been used to improve CVD outcomes, one of which is to involve clinical pharmacists in the direct care of patients with CVD.
To perform a systematic review assessing the effectiveness of clinical pharmacist interventions within a multidisciplinary team in the secondary prevention of CVD, using studies conducted on patients with heart failure, coronary heart disease, or those with CVD risk factors.
Extensive searches of 13 databases were performed--with no time limitation--to identify randomized controlled trials (RCT) in English that evaluated clinical pharmacist intervention in patients with CVD or with CVD risk factors. Two independent reviewers evaluated 203 citations that were the result of this search. Studies were included if they reported direct care from a clinical pharmacist in CVD or CVD-related therapeutic areas such as disease-led management or in collaboration with other health care workers; if they were RCTs; if they were inpatients, outpatients, or in the community setting; and if they included the following outcomes: CVD control or mortality, CVD risk factor control, patient-related outcomes (knowledge, adherence, or quality of life), and cost related to health care systems.
A total of 59 studies were identified: 45 RCT, 6 non-RCT, and 8 economic studies. 68% of the outcomes reported showed that clinical pharmacy services were associated with better improvement in patients' outcomes compared with the control group.
The involvement of a pharmacist demonstrated an ability to improve CVD outcomes through providing educational intervention, medicine management intervention, or a combination of both. These interventions resulted in improved CVD risk factors, improved patient outcomes, and reduced number of drug-related problems with a direct effect on CVD control. These improvements may lead to an improvement in patient quality of life, better use of health care resources, and a reduced rate of mortality.
心血管疾病（CVD）被认为是主要死因，也是影响全球医疗保健系统的最常见疾病之一。人们已采用多种方法来改善心血管疾病的治疗效果，其中之一是让临床药剂师直接参与心血管疾病患者的护理。
进行一项系统评价，评估多学科团队中临床药剂师干预措施在心血管疾病二级预防中的有效性，研究对象为心力衰竭患者、冠心病患者或有心血管疾病危险因素的患者。
对13个数据库进行了无时间限制的广泛检索，以识别评估临床药剂师对心血管疾病患者或有心血管疾病危险因素患者进行干预的英文随机对照试验（RCT）。两名独立评审员对此次检索得到的203篇文献进行了评估。纳入标准为：报告临床药剂师在心血管疾病或心血管疾病相关治疗领域（如疾病导向管理或与其他医护人员合作）提供直接护理；为随机对照试验；研究对象为住院患者、门诊患者或社区患者；包含以下结果：心血管疾病控制或死亡率、心血管疾病危险因素控制、患者相关结果（知识、依从性或生活质量）以及与医疗保健系统相关的成本。
共识别出59项研究：45项随机对照试验、6项非随机对照试验和8项经济学研究。报告的结果中有68%表明，与对照组相比，临床药学服务与患者预后的更好改善相关。
药剂师的参与表明，通过提供教育干预、药物管理干预或两者结合，有能力改善心血管疾病的治疗效果。这些干预措施改善了心血管疾病危险因素，改善了患者预后，减少了与药物相关的问题数量，对心血管疾病控制产生了直接影响。这些改善可能会提高患者生活质量，更好地利用医疗保健资源，并降低死亡率。
