Maxwell Lauralee G, McFarland Michael Shawn, Baker Jennifer Waymier, Cassidy Regina F
VA Tennessee Valley Healthcare System, Nashville, Tennessee.
Pharmacotherapy. 2016 Mar;36(3):348-56. doi: 10.1002/phar.1719. Epub 2016 Mar 11.
Telemedicine has been offered as a way to ensure that all patients, including those who live in rural areas, have access to the same health care. This study was performed to evaluate the benefit of a real-time, clinic-based video telehealth (Clinical Video Telehealth [CVT]) program and the impact of a pharmacist-led CVT clinic for chronic disease state management. The primary objective was to evaluate changes from baseline values, in veterans referred by primary care providers to this clinic.
This was a single-center, prospective, pre-post pilot study that also included a post-patient satisfaction survey. The study was conducted at the Tennessee Valley Healthcare System, which is composed of two medical centers and 12 community-based outpatient clinics (CBOCs) located away from the two main facilities. Fifteen clinical pharmacy specialists (CPSs)-seven at the two main facilities and eight at the CBOCs-provide disease state management clinical pharmacy services. One of the seven CPSs at the main facilities works via telemedicine and provides services to the CBOCs where on-site clinical pharmacy services did not exist. The primary outcomes were changes from baseline in A1C, LDL level, systolic blood pressure, and diastolic blood pressure after 6 months of CVT services by the CPS. Secondary outcomes were the percentages of patients meeting American Diabetes Association treatment goals for hemoglobin A1c (A1C), low-density lipoprotein level, and blood pressure, both individually and in combination after attending a pharmacist-led CVT program; the level of patient satisfaction with pharmacists' care and with CVT as a method of receiving chronic disease management, specifically for diabetes; and medication additions or changes made by the pharmacist.
Twenty-six patients completed the 6-month evaluation. A significant decrease in A1C of 2% from baseline was observed (p=0.0002), and the percentage of patients meeting goal A1C significantly increased from 0% at baseline to 38% at 6 months (p=0.0007). Overall patient satisfaction scores were also high, with a median score 39.5 (interquartile range 36-40) of a maximum score of 40.
Six months of CVT clinic attendance significantly improved A1C values and the overall percentage of patients meeting their goal A1C values in this veteran population. In addition, patient satisfaction scores also indicated a high level of satisfaction with the pharmacist-led CVT service.
远程医疗被视为一种确保所有患者（包括居住在农村地区的患者）都能获得同等医疗服务的方式。本研究旨在评估基于诊所的实时视频远程医疗（临床视频远程医疗[CVT]）项目的益处以及药剂师主导的CVT诊所对慢性病状态管理的影响。主要目的是评估初级保健提供者转诊至该诊所的退伍军人相对于基线值的变化。
这是一项单中心、前瞻性、前后对照的试点研究，还包括患者满意度调查。该研究在田纳西河谷医疗系统进行，该系统由两个医疗中心和12个位于远离两个主要设施处的社区门诊诊所（CBOC）组成。15名临床药学专家（CPS）——两个主要设施处有7名，CBOC处有8名——提供疾病状态管理临床药学服务。主要设施处的7名CPS中有1名通过远程医疗工作，并为没有现场临床药学服务的CBOC提供服务。主要结局是CPS提供6个月CVT服务后，糖化血红蛋白（A1C）、低密度脂蛋白水平、收缩压和舒张压相对于基线的变化。次要结局是在参加药剂师主导的CVT项目后，患者分别以及综合达到美国糖尿病协会血红蛋白A1c（A1C）、低密度脂蛋白水平和血压治疗目标的百分比；患者对药剂师护理以及对CVT作为接受慢性病管理（特别是糖尿病管理）方法的满意度水平；以及药剂师进行的药物添加或更改。
26名患者完成了6个月的评估。观察到A1C较基线显著下降了2%（p = 0.0002），达到A1C目标的患者百分比从基线时的0%显著增加至6个月时的38%（p = 0.0007）。患者总体满意度评分也很高，最高分为40分，中位数评分为39.5（四分位间距为36 - 40）。
在这个退伍军人人群中，参加6个月的CVT诊所显著改善了A1C值以及达到A1C目标值的患者总体百分比。此外，患者满意度评分也表明对药剂师主导的CVT服务高度满意。
