Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.
Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA.
J Eval Clin Pract. 2021 Apr;27(2):365-370. doi: 10.1111/jep.13429. Epub 2020 Jun 16.
RATIONALE, AIMS AND OBJECTIVES: Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications.
Retrospective chart review of persons with diabetes managed by pharmacists at an academic, safety-net institution. Eligible subjects were referred to a pharmacist-managed cardiovascular risk reduction clinic while continuing to see their PCP between October 1, 2016 and June 30, 2018. All progress notes were evaluated for treatment intensification, HbA1c value, and type of medication intensification.
Three hundred sixty-three eligible patients were identified; baseline HbA1c 9.6% (7.9, 11.6) (median interquartile range [IQR]). One thousand one hundred ninety-two pharmacist and 1739 PCP visits were included in data analysis. Therapy was intensified at 60.5% (n = 721) pharmacist visits and 39.3% (n = 684) PCP visits (P < .001). The median (IQR) time between interventions was 49 (28, 92) days for pharmacists and 105 (38, 182) days for PCPs (P < .001). Pharmacists more frequently intensified treatment with glucagon-like peptide-1 agonists and sodium glucose cotransporter-2 inhibitors.
Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.
背景、目的和目标：临床惰性是指治疗强化的延迟，在糖尿病患者中很常见。糖化血红蛋白（HbA1c）值>7%的患者强化治疗率低至 37.1%。通过添加药物治疗进行强化可能需要 1.6 年以上的时间。临床惰性会增加心血管事件的风险。主要目的是评估由药剂师和初级保健提供者（PCP）共同管理糖尿病的患者的临床惰性发生率。次要目标包括描述治疗强化的类型、HbA1c 降低和治疗强化之间的时间。
对在学术性、保障安全的机构接受药剂师管理的糖尿病患者进行回顾性图表审查。合格的患者在 2016 年 10 月 1 日至 2018 年 6 月 30 日期间继续看他们的 PCP 的同时，被转介到一个由药剂师管理的心血管风险降低诊所。对所有的进展记录进行评估，以确定治疗强化、HbA1c 值和药物强化的类型。
确定了 363 名符合条件的患者；基线 HbA1c 为 9.6%（7.9，11.6）（中位数四分位距 [IQR]）。共纳入 1192 次药剂师和 1739 次 PCP 就诊的数据进行分析。在 60.5%（n = 721）的药剂师就诊和 39.3%（n = 684）的 PCP 就诊中进行了治疗强化（P<.001）。药剂师干预之间的中位数（IQR）时间为 49（28，92）天，而 PCP 为 105（38，182）天（P<.001）。药剂师更频繁地强化使用胰高血糖素样肽-1 激动剂和钠-葡萄糖共转运蛋白-2 抑制剂的治疗。
药剂师参与糖尿病管理可能会减少患者在初级保健环境中可能经历的临床惰性。
