Yakiwchuk Erin M, Jorgenson Derek, Mansell Kerry, Laubscher Tessa, Lebras Marlys, Blackburn David F
College of Pharmacy & Nutrition (Yakiwchuk, LeBras, Jorgenson, Mansell, Blackburn), University of Saskatchewan, Saskatoon, Saskatchewan.
Can Pharm J (Ott). 2013 Sep;146(5):284-92. doi: 10.1177/1715163513499303.
Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors.
This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors.
Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed.
Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention.
Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting.
以往药剂师为降低心血管（CV）风险所采取的干预措施因患者纳入率低而受到限制。本研究的主要目的是实施一项药剂师协作干预措施，该措施采用系统的病例查找程序来识别和管理心血管危险因素未得到控制的患者。
这是一项非对照的项目实施研究。我们在一家初级保健诊所实施了药剂师协作干预措施。药剂师对所有前来预约就诊的成年患者进行系统筛查，并评估其心血管危险因素的控制情况。通过标准化表格传达危险因素管理建议，并根据具体情况确定药剂师的随访水平。我们记录了弗明汉风险评分中等至高且至少有一项危险因素未得到控制的成年患者的比例。此外，我们评估了心血管危险因素的前后变化情况。
在566名就诊前接受筛查的患者中，186名（32.9%）表现出中等或高心血管风险以及至少一项未得到控制的危险因素。医生要求药剂师对其中60.8%（113/186）的患者进行随访。在接受药剂师干预的患者中，65.5%（74/113）在研究期末至少有一项危险因素目标值接近了50%或更多。还观察到危险因素较基线有显著改善。
通过药剂师代表诊所团队实施系统的病例查找方法，大量危险因素未得到控制的患者得以识别、评估并通过协作干预进行管理。
系统的病例查找似乎是在初级保健环境中成功干预以识别和管理心血管危险因素未得到控制的个体的重要组成部分。
