Chong Mok Thoong
Department of Clinical and Administrative Sciences, American University of Health Sciences, California, USA.
J Res Pharm Pract. 2020 Mar 28;9(1):3-9. doi: 10.4103/jrpp.JRPP_19_75. eCollection 2020 Jan-Mar.
The objective of this study was to evaluate the impact of pharmacist's interventions through a collaborative ambulatory care pharmacy practice (CAPP) model in patients with type 2 diabetes mellitus (T2DM) among the underrepresented population.
Eligible patients were 18 years and older with a diagnosis of T2DM with or without comorbid cardiovascular disease risk factors. Patients were enrolled through routine primary care provider referrals. During a one-on-one, face-to-face scheduled clinic visit, the pharmacist provided a comprehensive medication management by reviewing vital signs and laboratory values, provided medication reconciliation and management, followed by medication counseling through a CAPP approach in a primary care setting. The pharmacist worked in close collaboration with the primary care provider to intervene on medication therapy through recommendations to initiate, adjust, modify, or discontinue drug therapy and order laboratory tests and drug concentration levels as appropriate. Each visit was documented as a "PharmD Progress Note" in the patient's electronic medical record. Follow-up visits were scheduled until patients' targeted treatment goals were achieved. Primary and secondary outcome data were collected and then analyzed.
A pharmacist saw 47 patients over 12 months. Sixty-four percent of the participating patients were able to achieve targeted treatment goals. A statistically significant decrease in the mean change in hemoglobin A1c, diastolic blood pressure, fasting blood glucose, and triglyceride levels was observed from the baseline which was -2.3%, -7.75 mmHg, -76.1 mg/dL, and -55.5 mg/dL, respectively. No significant changes in other clinical outcomes were observed.
The CAPP model demonstrated a significant reduction in clinical endpoints in patients with T2DM among the high-risk underrepresented population.
本研究的目的是评估通过协作门诊护理药房实践（CAPP）模式，药师干预对未被充分代表人群中2型糖尿病（T2DM）患者的影响。
符合条件的患者年龄在18岁及以上，诊断为T2DM，伴有或不伴有合并心血管疾病风险因素。患者通过常规初级保健提供者转诊入组。在一对一、面对面的预定门诊就诊期间，药师通过审查生命体征和实验室值提供全面的药物管理，进行药物重整和管理，然后在初级保健环境中通过CAPP方法提供药物咨询。药师与初级保健提供者密切合作，通过建议启动、调整、修改或停止药物治疗以及酌情订购实验室检查和药物浓度水平来干预药物治疗。每次就诊都在患者的电子病历中记录为“药学博士进展记录”。安排随访就诊，直到患者达到目标治疗目标。收集并分析主要和次要结局数据。
一名药师在12个月内诊治了47名患者。64%的参与患者能够实现目标治疗目标。观察到糖化血红蛋白、舒张压、空腹血糖和甘油三酯水平的平均变化与基线相比有统计学显著下降，分别为-2.3%、-7.75 mmHg、-76.1 mg/dL和-55.5 mg/dL。未观察到其他临床结局有显著变化。
CAPP模式在高风险未被充分代表人群的T2DM患者中显示出临床终点的显著降低。
