Huff Jamie M, Falter Rebecca A, Scheinberg Nataliya
Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA.
Diabetes Spectr. 2019 Nov;32(4):349-354. doi: 10.2337/ds18-0067.
The purpose of this study was to compare statin prescribing practices according to the American Diabetes Association's between diabetes patients managed by pharmacists versus those managed by internal medicine providers.
A retrospective observational study was completed using the electronic health record of a multispecialty private practice. A total of 176 patients were included in the study, with 88 each in the pharmacy and internal medicine groups. Patients were ≥40 years of age with diabetes and managed by an internal medicine provider or a pharmacist between January and December 2017. Descriptive statistics, χ, and unpaired tests were used to describe between-group differences.
More pharmacy than internal medicine patients were prescribed appropriate statin therapy (47.7 vs. 34.1%, = 0.092), particularly those needing high-intensity statins (44.3 vs. 27.4%, = 0.03). Females, patients 40-75 years of age, and patients with no history of atherosclerotic cardiovascular disease in the pharmacy group were more likely to receive appropriate treatment (37.5 vs. 15.0%, = 0.022; 46.8 vs. 29.7%, = 0.039; and 45.3 vs. 23.5%, = 0.015, respectively). Overall, more males than females were prescribed appropriate statin therapy (53.1 vs. 26.3%, = 0.001).
Although there were no overall significant differences in statin prescribing between the pharmacy and internal medicine groups, patients needing high-intensity statins, those who were female, and those who were younger were more likely to receive appropriate therapy when managed by a pharmacist. Appropriate statin prescribing remains low among diabetes patients, and optimization of this therapy should be prioritized.
本研究旨在比较根据美国糖尿病协会指南，由药剂师管理的糖尿病患者与由内科医生管理的糖尿病患者的他汀类药物处方情况。
采用多专科私人诊所的电子健康记录完成一项回顾性观察研究。共有176名患者纳入研究，药房组和内科组各88名。患者年龄≥40岁，患有糖尿病，于2017年1月至12月期间由内科医生或药剂师管理。采用描述性统计、χ²检验和非配对t检验来描述组间差异。
与内科患者相比，更多药房管理的患者接受了适当的他汀类药物治疗（47.7%对34.1%，P = 0.092），尤其是那些需要高强度他汀类药物的患者（44.3%对27.4%，P = 0.03）。药房组中的女性、40 - 75岁的患者以及无动脉粥样硬化性心血管疾病病史的患者更有可能接受适当治疗（分别为37.5%对15.0%，P = 0.022；46.8%对29.7%，P = 0.039；45.3%对23.5%，P = 0.015）。总体而言，接受适当他汀类药物治疗的男性多于女性（53.1%对26.3%，P = 0.001）。
虽然药房组和内科组在他汀类药物处方方面总体无显著差异，但需要高强度他汀类药物的患者、女性患者以及较年轻患者由药剂师管理时更有可能接受适当治疗。糖尿病患者中适当的他汀类药物处方率仍然较低，应优先优化这种治疗。
