EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Interdisciplinary Chronic Disease Collaboration, Teaching Research and Wellness Building, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Can J Diabetes. 2017 Dec;41(6):580-586. doi: 10.1016/j.jcjd.2017.08.244. Epub 2017 Sep 28.
Cardiovascular disease (CVD) is the leading cause of death among patients with diabetes. Management and control of CV risk factors in those with diabetes are generally poor. Pharmacists are frontline primary healthcare providers who see patients with chronic diseases frequently. As such, they are in a prime position to systematically identify patients with diabetes, assess their CV risk and assist in their disease management and preventive measures.
to evaluate the effect of pharmacist case finding and intervention program on estimated CV risk in patients with diabetes.
Sub-group analysis of a randomized controlled trial (RxEACH). Patients were randomized to receive intervention or usual care for 3 months. Those who were randomized to the intervention group received a Medication Therapy Management consultation which included patient assessment, laboratory assessment, individualized CV risk assessment. Treatment regimen adjustment, as needed, in order to meet treatment targets.
Estimated CV risk was reduced from 26.9 +/- 21% to 26.5 +/- 21.3% in the control group and from 25.8 +/- 19.4% to 20.1 +/- 17.2% in the intervention group over the 3-month follow up period (an absolute reduction of 5.38; 95% confidence interval (CI) 4.24 to 6.52; p <0.001).
Community pharmacy-based case finding and intervention program reduced the risk for major CV events by 21% when compared to usual practice. This represents a promising approach to help tackle the major public health problem of diabetes in Canada.
心血管疾病 (CVD) 是糖尿病患者的主要死因。患有糖尿病的患者对心血管风险因素的管理和控制通常较差。药剂师是初级医疗保健的第一线提供者，经常接触患有慢性病的患者。因此，他们处于系统识别糖尿病患者、评估其心血管风险以及协助其疾病管理和预防措施的最佳位置。
评估药剂师病例发现和干预计划对糖尿病患者估计心血管风险的影响。
随机对照试验 (RxEACH) 的亚组分析。患者被随机分配接受干预或常规护理 3 个月。随机分配到干预组的患者接受药物治疗管理咨询，包括患者评估、实验室评估、个体化心血管风险评估。根据需要调整治疗方案，以达到治疗目标。
在 3 个月的随访期间，对照组的估计心血管风险从 26.9%±21%降至 26.5%±21.3%，干预组从 25.8%±19.4%降至 20.1%±17.2%（绝对减少 5.38；95%置信区间 [CI] 4.24 至 6.52；p<0.001）。
与常规实践相比，基于社区药房的病例发现和干预计划使主要心血管事件的风险降低了 21%。这代表了一种有前途的方法，可以帮助解决加拿大糖尿病这一主要公共卫生问题。
