J Am Pharm Assoc (2003). 2021 Jul-Aug;61(4):442-449. doi: 10.1016/j.japh.2021.02.014. Epub 2021 Feb 27.
Recent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia.
After an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program's impact on A1c, blood pressure, and cholesterol outcomes.
A total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040).
A protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.
最近的数据表明，药剂师主导的慢性病管理方案在初级保健环境中具有益处。健康指导也已被证明可以改善患者的预后并降低医疗保健成本。自 2017 年 8 月以来，在一个农村的免费诊所启动了一项计划，通过使用药剂师-提供者合作实践和慢性病患者的健康指导，为患有糖尿病、高血压和高脂血症等慢性病的患者提供基于团队的以患者为中心的护理管理。
在进行初始患者检查后，医生可以将患者转介给药剂师+健康教练团队进行管理。患者至少每年并在需要时继续接受初级保健提供者的治疗。药剂师+健康教练团队提供了一种基于方案的慢性病管理方法，以及有关饮食和生活方式建议的健康教育。每次就诊都会提供深入的药物和疾病状态教育。每次就诊还进行动机性访谈。在计划启动后定期收集临床指标，包括糖化血红蛋白（A1c）、血压和血脂。主要目标是评估该计划对 A1c、血压和胆固醇结果的影响。
共有 95 名患者纳入分析（A1c n=37；收缩压和舒张压 n=47；总胆固醇 n=40；低密度脂蛋白胆固醇 n=38；高密度脂蛋白胆固醇 n=40；和甘油三酯 n=40）。从基线到 1 年，A1c（均值±标准差，8.55±2.58 至 7.04±1.12，P<0.001）、收缩压（136.79±20.04 至 123.15±16.81，P<0.001）、舒张压（87.94±12.28 至 78.64±10.98，P<0.001）、总胆固醇（198.25±52.47 至 183.55±47.22，P=0.014）和 LDL 胆固醇（115.74±43.56 至 105.92±39.27，P=0.040）均有统计学意义上的显著改善。
在低收入农村初级保健环境中，临床药剂师通过协作实践方案，与注册护士进行健康指导，共同管理慢性病，可以改善 A1c、血压、总胆固醇和 LDL 胆固醇。
