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内科住院医师诊所糖尿病患者的药剂师他汀类药物处方倡议

Pharmacist Statin Prescribing Initiative in Diabetic Patients at an Internal Medicine Resident Clinic.

作者信息

Vincent Robert, Kim Jennifer, Ahmed Tasrif, Patel Vishal

机构信息

The Moses H. Cone Memorial Hospital, Greensboro, NC, USA.

Greensboro Area Health Education Center, Greensboro, NC, USA.

出版信息

J Pharm Pract. 2020 Oct;33(5):598-604. doi: 10.1177/0897190018824820. Epub 2019 Jan 29.

DOI:10.1177/0897190018824820
PMID:30696337
Abstract

BACKGROUND

Despite general increases in statin use in the United States, statin therapy may be underutilized in diabetic patients and vulnerable populations.

OBJECTIVE

To determine the impact of a collaborative pharmacist initiative on statin prescribing for diabetic patients in an internal medicine residency clinic. The primary outcome was the change in prevalence of patients on statin therapy before and after intervention implementation. Secondary outcomes included recommendation acceptance rates and reported adverse effects.

METHODS

This was a single-center, quasi-experimental pre-post intervention study. The study site was a hospital-based primary care residency clinic serving patients regardless of financial or insurance status. Diabetic patients 40 to 75 years old who were not on a statin and had an upcoming primary care physician appointment were included. Over 3 months, a clinical pharmacist and pharmacy resident evaluated clinical appropriateness and cost of statin therapy, provided recommendations to physicians, facilitated statin prescribing, and provided patient education.

RESULTS

Of 454 patients, 343 were on statin therapy (75.6%) prior to the initiative. The mean age was 58 years, 59.7% were female, 76.4% were black, and 90% had hypertension. After implementation, 375 (82.6%) patients were on statins ( < .0001). Recommendations were well received (90.2% accepted) and no significant adverse effects were reported.

CONCLUSION

Pharmacist implementation of a collaborative, patient-centered initiative increased statin prescribing in diabetic patients, most of which were black and had hypertension, in an internal medicine resident clinic.

摘要

背景

尽管美国他汀类药物的使用总体有所增加,但在糖尿病患者和弱势群体中,他汀类药物治疗的应用可能不足。

目的

确定药师协作倡议对内科住院医师诊所中糖尿病患者他汀类药物处方的影响。主要结局是干预实施前后接受他汀类药物治疗患者的患病率变化。次要结局包括建议接受率和报告的不良反应。

方法

这是一项单中心、干预前后的准实验研究。研究地点是一家以医院为基础的初级保健住院医师诊所,为所有患者提供服务,无论其经济或保险状况如何。纳入年龄在40至75岁之间、未服用他汀类药物且即将预约初级保健医生的糖尿病患者。在3个月的时间里,一名临床药师和住院药师评估了他汀类药物治疗的临床适宜性和成本,向医生提供建议,促进他汀类药物的处方开具,并提供患者教育。

结果

在454名患者中,343名(75.6%)在倡议实施前接受他汀类药物治疗。平均年龄为58岁,59.7%为女性,76.4%为黑人,90%患有高血压。实施后,375名(82.6%)患者服用他汀类药物(P<0.0001)。建议得到了很好的接受(90.2%被接受),且未报告明显的不良反应。

结论

在内科住院医师诊所中,药师实施以患者为中心的协作倡议增加了糖尿病患者(大多数为黑人和患有高血压)的他汀类药物处方量。

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