基层医疗嵌入的临床药师主导的干预措施在糖尿病黑人患者中的效果评估。
An Effectiveness Evaluation of a Primary Care-Embedded Clinical Pharmacist-Led Intervention Among Blacks with Diabetes.
机构信息
Department of Medicine, Division of General Internal Medicine and Health Services Research (GIM/HSR), University of California, Los Angeles, Los Angeles, CA, 90024, USA.
Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
出版信息
J Gen Intern Med. 2020 Sep;35(9):2569-2575. doi: 10.1007/s11606-020-05750-0. Epub 2020 Mar 6.
BACKGROUND
Black individuals with type 2 diabetes suffer disproportionate morbidity and mortality relative to whites with type 2 diabetes, irrespective of health insurance coverage.
OBJECTIVE
Examine the impact of a primary care-embedded clinical pharmacist-led intervention (UCMyRx) on cardiovascular risk factor control among blacks with type 2 diabetes in a large healthcare system.
DESIGN
We used data extracted from the electronic health records (EHR) system and a difference-in-differences study design with a propensity-matched comparison group to evaluate the impact of UCMyRx on HbA1c and systolic blood pressure (SBP) among black patients with type 2 diabetes, relative to usual care.
PARTICIPANTS
Individuals with type 2 diabetes identified as either black or African American in the EHR that were ≥ 18 years of age that had the following observations during the study window (03/02/2013-12/31/18: (1) HbA1C ≥ 8%, at least once, anywhere between 365 days before and 14 days after the UCMyRx visit and a follow-up HbA1c measure within 120 to 365 days after the visit and/or (2) SBP ≥ 140 mmHg at least once between 365 days before and 14 days after the UCMyRx visit that had a follow-up SBP measure within 120 to 450 days after the visit.
INTERVENTION
UCMyRx pharmacists review labs and vital signs, perform medication reconciliation, use a standardized survey to assess barriers to medication adherence, and develop tailored interventions to improve medication adherence.
MAIN MEASURES
Change in HbA1c and change in SBP from before to after the first UCMyRx visit.
KEY RESULTS
Having at least one visit with a UCMyRx clinical pharmacist was associated with a significant reduction in HbA1c (- 0.4%, p value = .01); however, there was no significant impact on SBP (- .051 mmHg, p value = 0.74).
CONCLUSIONS
The UCMyRx intervention is a useful strategy for improving HbA1c control among blacks with type 2 diabetes.
背景
无论是否拥有医疗保险，黑人 2 型糖尿病患者的发病率和死亡率都与白人 2 型糖尿病患者不成比例。
目的
在一个大型医疗保健系统中，研究初级保健嵌入式临床药师主导的干预措施（UCMyRx）对黑人 2 型糖尿病患者心血管风险因素控制的影响。
设计
我们使用从电子健康记录（EHR）系统中提取的数据，并采用倾向匹配对照组的差异分析研究设计，评估 UCMyRx 对黑人 2 型糖尿病患者的糖化血红蛋白（HbA1c）和收缩压（SBP）的影响，与常规护理相比。
参与者
EHR 中被确定为黑人或非裔美国人的 2 型糖尿病患者，年龄≥18 岁，在研究窗口（2013 年 3 月 2 日至 2018 年 12 月 31 日）内有以下观察结果：（1）HbA1C≥8%，至少一次，在 UCMyRx 就诊前 365 天至就诊后 14 天之间的任何地方，并且在就诊后 120 至 365 天之间有后续 HbA1c 测量值；或（2）SBP≥140mmHg，至少一次，在 UCMyRx 就诊前 365 天至就诊后 14 天之间，并且在就诊后 120 至 450 天之间有后续 SBP 测量值。
干预措施
UCMyRx 药剂师审查实验室和生命体征，进行药物重整，使用标准化调查评估药物依从性的障碍，并制定针对性的干预措施以提高药物依从性。
主要测量指标
从第一次 UCMyRx 就诊前后的 HbA1c 和 SBP 的变化。
主要结果
至少有一次 UCMyRx 临床药剂师就诊与 HbA1c 的显著降低（-0.4%，p 值=0.01）相关；然而，SBP 没有显著影响（-0.051mmHg，p 值=0.74）。
结论
UCMyRx 干预措施是改善黑人 2 型糖尿病患者 HbA1c 控制的有效策略。
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