药师主导的教育干预对临床结局的影响：一项在高血压、2 型糖尿病和高胆固醇血症患者中进行的随机对照研究。
Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia.
机构信息
Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France
Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France.
出版信息
Eur J Hosp Pharm. 2021 Nov;28(Suppl 2):e197-e202. doi: 10.1136/ejhpharm-2021-002787. Epub 2021 Jun 28.
OBJECTIVES
In recent years, hospital pharmacists have gained more importance in the clinical support of patients. However, most of the studies evaluating the impact of clinical pharmacy have only studied patients' adherence or satisfaction. The aim of this study was to evaluate the direct clinical outcomes of a pharmacist-led educational intervention in patients with chronic disease.
METHODS
We conducted a randomised, controlled, parallel, physician-blinded study in a day hospital and a consultation unit of a French teaching hospital over a 1-year period. Patients with hypertension, type 2 diabetes or hypercholesterolaemia who did not reach their therapeutic goals despite drug therapy were eligible. Patients in the intervention group received an intervention from a hospital pharmacist who provided patient education on pathology and drug management. The primary outcome was the proportion of patients reaching their therapeutic goals for blood pressure, glycated haemoglobin level or low-density lipoprotein cholesterol level at the 3-month follow-up consultation.
RESULTS
From January to December 2015, 89 patients were included and 73 completed the study. In the intervention group, 61.7% (21/34) of the patients reached their therapeutic goals compared with 33.3% (13/39) in the control group (p=0.015). The intervention was significantly more effective in polypharmacy patients (60.0% (12/20) vs 16.7% (4/24); p=0.005), in those aged >60 years (57.9% (11/19) vs 26.1% (6/23); p=0.037) and in patients with a high education level (68.8% (11/16) vs 29.4% (5/17); p=0.024).
CONCLUSION
A single pharmacist-led educational intervention has a clinical impact, doubling the proportion of patients reaching their therapeutic goals at 3 months, especially in polypharmacy patients and those aged >60 years. This study confirms the value of clinical involvement of hospital pharmacists in patient care in a consultation unit and day hospital.
目的
近年来，医院药师在患者的临床支持中发挥了越来越重要的作用。然而，大多数评估临床药学影响的研究仅研究了患者的依从性或满意度。本研究旨在评估药剂师主导的教育干预对慢性病患者直接临床结局的影响。
方法
我们在法国一所教学医院的日间病房和咨询部门进行了一项为期 1 年的随机、对照、平行、医师盲法研究。纳入了药物治疗后仍未达到治疗目标的高血压、2 型糖尿病或高胆固醇血症患者。干预组患者接受了医院药师的干预，药师为患者提供了病理学和药物管理方面的教育。主要结局是在 3 个月随访时达到血压、糖化血红蛋白水平或低密度脂蛋白胆固醇水平治疗目标的患者比例。
结果
2015 年 1 月至 12 月，共纳入 89 例患者，73 例完成了研究。在干预组中，34 例患者中有 61.7%（21/34）达到了治疗目标，而对照组中有 33.3%（13/39）（p=0.015）。该干预在多药治疗患者中（60.0%（12/20）比 16.7%（4/24）；p=0.005）、年龄>60 岁的患者（57.9%（11/19）比 26.1%（6/23）；p=0.037）和教育程度较高的患者（68.8%（11/16）比 29.4%（5/17）；p=0.024）中更为有效。
结论
单次由药剂师主导的教育干预具有临床意义，可将 3 个月时达到治疗目标的患者比例提高一倍，尤其是在多药治疗患者和年龄>60 岁的患者中。本研究证实了医院药师在咨询部门和日间病房参与患者护理的价值。
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