社区药剂师提供信息方案对 2 型糖尿病患者随访的影响：一项整群随机对照研究。
Impact of a Community Pharmacist-Delivered Information Program on the Follow-up of Type-2 Diabetic Patients: A Cluster Randomized Controlled Study.
机构信息
Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne, Switzerland.
Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
出版信息
Adv Ther. 2019 Jun;36(6):1291-1303. doi: 10.1007/s12325-019-00957-y. Epub 2019 May 2.
INTRODUCTION
Low-quality communication between patients and care providers and limited patient knowledge of the disease and the therapy are important factors associated with poor glycemic control in patients with type 2 diabetes. We conducted a multicenter study to determine whether structured and tailored information delivered by pharmacists to type 2 diabetic patients could improve patient treatment adherence, hemoglobin A1c (HbA1c) levels and knowledge about diabetes.
METHODS
One hundred seventy-four pharmacies were randomized to deliver an educational program on diet, drug treatment, disease and complications during three 30-min interviews over a 6-month period, or to provide no intervention, to type 2 diabetic patients treated with oral antidiabetic agents. Medication adherence was assessed by measuring the medication possession ratio and diabetes control by collecting HbA1c values. Levels of patient treatment self-management and disease knowledge were assessed using self-questionnaires.
RESULTS
Three hundred seventy-seven patients were analyzed. The medication possession ratio, already very high at baseline in the intervention (94.8%) and control (92.3%) groups, did not vary significantly after 6 months with no difference between the two groups. Significant decreases in HbA1c were observed in both groups at 6 months (p < 0.001) and 12 months (p < 0.01), with significantly greater changes from baseline in the intervention group than in the control group at 6 months (- 0.5% vs. - 0.2%, p = 0.0047) and 12 months (- 0.6% vs. - 0.2%, p = 0.0057). Patients in the intervention group showed greater improvement in their ability to self-manage treatment (+ 4.86 vs. + 1.58, p = 0.0014) and in the extent of their knowledge about diabetes (+ 0.6 vs. + 0.2, p < 0.01) at 6 months versus baseline compared with the control group.
CONCLUSION
Tailored information provided by the pharmacist to patients with type 2 diabetes did not significantly improve the already high adherence rates, but was associated with a significant decrease in HbA1c and an improvement of patient knowledge about diabetes.
TRIAL REGISTRATION
ISRCTN33776525.
FUNDING
MSD France.
简介
在 2 型糖尿病患者中，患者与医护人员之间沟通质量差以及患者对疾病和治疗方案的了解有限是导致血糖控制不佳的重要因素。我们开展了一项多中心研究，旨在确定药师向 2 型糖尿病患者提供的结构化、量身定制的信息是否可以提高患者的治疗依从性、血红蛋白 A1c（HbA1c）水平以及对糖尿病的认识。
方法
174 家药店被随机分为两组，在 6 个月的时间内，通过 3 次 30 分钟的访谈，为接受口服降糖药物治疗的 2 型糖尿病患者提供有关饮食、药物治疗、疾病和并发症的教育项目（干预组），或不进行任何干预（对照组）。通过测量药物持有率评估药物依从性，通过收集 HbA1c 值评估糖尿病控制情况。使用自我问卷评估患者的治疗自我管理水平和疾病知识水平。
结果
共分析了 377 例患者。干预组（94.8%）和对照组（92.3%）的药物持有率在基线时已经非常高，6 个月后没有显著变化，两组之间没有差异。两组患者在 6 个月（p<0.001）和 12 个月（p<0.01）时 HbA1c 均显著下降，与对照组相比，干预组在 6 个月（-0.5%对-0.2%，p=0.0047）和 12 个月（-0.6%对-0.2%，p=0.0057）时从基线的变化更大。与对照组相比，干预组患者在治疗自我管理能力（+4.86 对+1.58，p=0.0014）和对糖尿病认识程度（+0.6 对+0.2，p<0.01）方面的改善更为显著。
结论
为 2 型糖尿病患者提供的药师定制信息并未显著提高已较高的依从率，但与 HbA1c 的显著下降以及患者对糖尿病认识的提高有关。
试验注册
ISRCTN33776525。
资金来源
MSD 法国。
Zotero 插件