Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Diabetes Res Clin Pract. 2014 Sep;105(3):327-35. doi: 10.1016/j.diabres.2014.05.013. Epub 2014 Jun 10.
To evaluate the efficacy of two maintenance strategies compared to usual care after discharge from a pharmacist-led cardiovascular risk reduction clinic (CRRC).
Open-label, randomized-controlled trial of 200 consecutive CRRC patients that met clinic discharge criteria (HbA1c ≤7% (53 mmol/mol); blood pressure ≤140/80 mmHg for those with diabetes and ≤140/90 mmHg for those without diabetes; and an LDL-cholesterol ≤2.59 mmol/l). Participants were randomized to either quarterly group medical visits or quarterly CRRC individual clinic visits, or a usual care control arm with the standard primary care alone first in a 1:1:1 ratio, followed by a 2:2:1 ratio after first 100 patients. Primary outcome measures were time to failure for guideline recommended goals of HbA1c and blood pressure over 12-months.
Of the 200 participants randomized, 89% had diabetes and were similar in other cardiovascular risk factors. After 1-year, the HbA1c failure rate was 0.36 [95% CI, 0.28-0.47] per quarter for the group medical visit arm, 0.24 [95% CI, 0.18-0.33] per quarter for the quarterly CRRC individual arm and, 0.82 [95% CI, 0.69-0.96] per quarter for the usual care control arm, p<0.001. The rate of failure for blood pressure was 0.31 [95% CI, 0.23-0.41] per quarter for the group medical visit arm, 0.22 [95% CI, 0.16-0.30] per quarter for the CRRC individual arm and, 0.53 [95% CI, 0.40-0.71] per quarter the control arm, p<0.001.
After discharge from a CRRC program, both individual and group interventions are more effective in maintaining glycemia and blood pressure control for patients with diabetes than usual care after 1-year of follow-up.
评估与常规护理相比，在药剂师主导的心血管风险降低诊所（CRRC）出院后，两种维持策略的疗效。
对 200 名符合诊所出院标准的 CRRC 患者（HbA1c≤7%（53mmol/mol）；伴有糖尿病的患者血压≤140/80mmHg，无糖尿病的患者血压≤140/90mmHg；LDL-胆固醇≤2.59mmol/l）进行开放性、随机对照试验。参与者被随机分为每季度一次的小组医疗访问或每季度一次的 CRRC 个体诊所访问，或标准初级保健单独作为常规护理对照臂，首先按 1:1:1 的比例分配，然后在前 100 名患者后按 2:2:1 的比例分配。主要观察指标为 12 个月内指南推荐的 HbA1c 和血压目标失败的时间。
在 200 名随机分组的参与者中，89%患有糖尿病，其他心血管危险因素相似。1 年后，小组医疗访问组的 HbA1c 失败率为每季度 0.36[95%可信区间，0.28-0.47]，每季度 CRRC 个体组为 0.24[95%可信区间，0.18-0.33]，常规护理对照组为 0.82[95%可信区间，0.69-0.96]，p<0.001。血压失败率为小组医疗访问组每季度 0.31[95%可信区间，0.23-0.41]，CRRC 个体组每季度 0.22[95%可信区间，0.16-0.30]，对照组每季度 0.53[95%可信区间，0.40-0.71]，p<0.001。
在 CRRC 计划出院后，与常规护理相比，个体和小组干预在 1 年随访后更有效地维持糖尿病患者的血糖和血压控制。
