Bahrami Sumaya, Chang Christina, Alvarez Kristin Snackey, Lutek Kristin, Nguyen Sarah, Hegde Anita
J Am Pharm Assoc (2003). 2020 May-Jun;60(3):485-490. doi: 10.1016/j.japh.2019.11.013. Epub 2020 Jan 1.
The aim of this study was to analyze the effect of clinical pharmacy services on health outcomes and medication adherence concerning hypertension and diabetes in the homeless population.
This was a retrospective quasi-experimental study conducted between January 1, 2015, and December 31, 2016. The primary outcomes included median blood pressure and median glycosylated hemoglobin (A1C) change from baseline. The secondary end points included adherence to hypertension and diabetes medication, in addition to the differences in the number of admissions to urgent care clinics, emergency departments, or hospitals pre- and postpharmacist clinic visit.
One-hundred ninety-eight homeless patients were seen by a pharmacist over the study time frame, and 116 of these patients were included. There was a decrease in systolic and diastolic blood pressure in the 6-months postpharmacist visit (139 mm Hg vs. 135 mm Hg, P = 0.413, and 85 mm Hg vs. 82 mm Hg, P = 0.197, respectively). The percentage of patients who met the blood pressure goals increased from 55% to 66% (P = 0.093). A statistically significant decrease in A1C was found (7.7% vs 7.2%, P = 0.038). The number of patients who met the A1C goal increased from 20% to 41% (P = 0.267) after pharmacist intervention. No medication class was associated with a median proportion of days covered of 80% or greater. However, differences were seen with biguanides (34% vs. 43%, P = 0.004), calcium channel blockers (44% vs. 59%, P < 0.001), and thiazides (28% vs. 39%, P = 0.039) pre- and postintervention. There was no difference in the number of visits to emergency departments or urgent care clinics, or hospitalizations.
Homeless patients with hypertension and type 2 diabetes who had at least 1 visit with a pharmacist showed some improved health outcomes. Statistically significant benefits were seen in diabetes management, but not for blood pressure control.
本研究旨在分析临床药学服务对无家可归人群中高血压和糖尿病患者健康结局及用药依从性的影响。
这是一项于2015年1月1日至2016年12月31日期间进行的回顾性准实验研究。主要结局包括与基线相比收缩压和糖化血红蛋白（A1C）的中位数变化。次要终点包括高血压和糖尿病药物的依从性，以及药师门诊就诊前后急诊诊所、急诊科或医院的就诊次数差异。
在研究时间段内，有198名无家可归患者接受了药师诊治，其中116名患者被纳入研究。药师门诊就诊后6个月，收缩压和舒张压均有所下降（分别为139 mmHg对135 mmHg，P = 0.413；85 mmHg对82 mmHg，P = 0.197）。达到血压目标的患者百分比从55%增加到66%（P = 0.093）。A1C有统计学意义的下降（7.7%对7.2%，P = 0.038）。药师干预后，达到A1C目标的患者数量从20%增加到41%（P = 0.267）。没有药物类别与覆盖天数中位数达到80%或更高相关。然而，干预前后双胍类药物（34%对43%，P = 0.004）、钙通道阻滞剂（44%对59%，P < 0.001）和噻嗪类药物（28%对39%，P = 0.039）存在差异。急诊就诊次数、紧急护理诊所就诊次数或住院次数没有差异。
至少与药师就诊1次的无家可归高血压和2型糖尿病患者的健康结局有所改善。在糖尿病管理方面有统计学意义的益处，但血压控制方面没有。
