O'Neill Jessica L, Cunningham Tori L, Wiitala Wyndy L, Bartley Emily P
Department of Ambulatory Care, Veterans Affairs (VA) Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA,
J Gen Intern Med. 2014 Jul;29 Suppl 2(Suppl 2):S675-81. doi: 10.1007/s11606-014-2774-4.
Clinical Pharmacy Specialists (CPSs) and Registered Nurses (RNs) are integrally involved in the Patient Aligned Care Teams (PACT) model, especially as physician extenders in the management of chronic disease states. CPSs may be an alternative to physicians as a supporting prescriber for RN case management (RNCM) of poorly controlled hypertension.
To compare CPS-directed versus physician-directed RNCM for patients with poorly controlled hypertension.
Non-randomized, retrospective comparison of a natural experiment.
A large Midwestern Veterans Affairs (VA) medical center.
Utilizing CPSs as alternatives to physicians for directing RNCM of poorly controlled hypertension.
All 126 patients attended RNCM appointments for poorly controlled hypertension between 20 September 2011 and 31 October 2011 with either CPS or physician involvement in the clinical decision making. Patients were excluded if both a CPS and a physician were involved in the index visit, or they were enrolled in Home Based Primary Care, or if they displayed non-adherence to the plan.
All data were obtained from review of electronic medical records. Outcomes included whether a patient received medication intensification at the index visit, and as the main measure, blood pressures between the index and next consecutive visit.
All patients had medication intensification. Patients receiving CPS-directed RNCM had greater decreases in systolic blood pressure compared to those receiving physician-directed RNCM (14 ± 13 mmHg versus 10 ± 11 mmHg; p = 0.04). After adjusting for the time between visits, initial systolic blood pressure, and prior stroke, provider type was no longer significant (p = 0.24). Change in diastolic blood pressure and attainment of blood pressure < 140/90 mm Hg were similar between groups (p = 0.93, p = 0.91, respectively).
CPS-directed and physician-directed RNCM for hypertension demonstrated similar blood pressure reduction. These results support the utilization of CPSs as prescribers to support RNCM for chronic diseases.
临床药学专家（CPS）和注册护士（RN）全面参与患者协调护理团队（PACT）模式，尤其是在慢性病管理中作为医生的延伸角色。对于血压控制不佳的高血压患者，临床药学专家可以替代医生，作为注册护士病例管理（RNCM）的支持开方者。
比较由临床药学专家指导的与由医生指导的针对血压控制不佳的高血压患者的注册护士病例管理。
自然实验的非随机回顾性比较。
中西部一家大型退伍军人事务（VA）医疗中心。
利用临床药学专家替代医生来指导血压控制不佳的高血压患者的注册护士病例管理。
2011年9月20日至2011年10月31日期间，所有126名因血压控制不佳而接受注册护士病例管理预约的患者，临床决策过程中有临床药学专家或医生参与。如果索引就诊时有临床药学专家和医生同时参与，或者患者参加了居家初级保健，或者患者未遵守计划，则将其排除。
所有数据均通过查阅电子病历获得。结果包括患者在索引就诊时是否加强了药物治疗，作为主要指标的是索引就诊与下一次连续就诊之间的血压。
所有患者均加强了药物治疗。与接受医生指导的注册护士病例管理的患者相比，接受临床药学专家指导的注册护士病例管理的患者收缩压下降幅度更大（14±13 mmHg对10±11 mmHg；p = 0.04）。在对就诊间隔时间、初始收缩压和既往中风进行校正后，提供者类型不再具有统计学意义（p = 0.24）。两组之间舒张压的变化以及血压达到<140/90 mmHg的情况相似（分别为p = 0.93，p = 0.91）。
临床药学专家指导的和医生指导的高血压注册护士病例管理在降低血压方面效果相似。这些结果支持利用临床药学专家作为开方者来支持慢性病的注册护士病例管理。
