Santschi Valérie, Chiolero Arnaud, Colosimo April L, Platt Robert W, Taffé Patrick, Burnier Michel, Burnand Bernard, Paradis Gilles
Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
J Am Heart Assoc. 2014 Apr 10;3(2):e000718. doi: 10.1161/JAHA.113.000718.
Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity.
Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly.
Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.
血压控制仍是初级保健中的一项重大挑战。因此，需要创新干预措施来改善血压控制。通过更新和合并之前两项系统评价的数据，我们评估了药剂师干预对血压的影响，并确定了异质性的潜在决定因素。
从MEDLINE、EMBASE、CINAHL和CENTRAL数据库中识别评估药剂师干预对有或无糖尿病门诊患者血压影响的随机对照试验（RCT）。使用随机效应模型估计血压的加权平均差异。计算预测区间（PI）以更好地表达效应估计中的不确定性。纳入了39项RCT，共14224例患者。药剂师干预主要包括患者教育、向医生反馈和药物管理。与常规护理相比，药剂师干预使收缩压降低幅度更大（-7.6 mmHg，95%CI：-9.0至-6.3；I²=67%），舒张压降低幅度更大（-3.9 mmHg，95%CI：-5.1至-2.8；I²=83%）。收缩压的95%PI范围为-13.9至-1.4 mmHg，舒张压的95%PI范围为-9.9至+2.0 mmHg。如果干预由药剂师主导且至少每月进行一次，效果往往更大。
药剂师单独或与其他医疗保健专业人员合作进行的干预改善了血压管理。然而，药剂师干预对血压的影响存在差异，从非常大到适度或无影响；且无法确定异质性的决定因素。应通过进一步研究来确定最有效、最具成本效益且耗时最少的干预措施。
