为资源匮乏患者实施由门诊药剂师主导的高血压管理：一项试点研究。
Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study.
作者信息
Stewart Brittany, Brody Aaron, Garwood Candice L, Zhang Liying, Levy Phillip D
机构信息
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University.
Department of Emergency Medicine, School of Medicine and Integrative Biosciences Center, Wayne State University.
出版信息
Innov Pharm. 2021 Apr 27;12(2). doi: 10.24926/iip.v12i2.3895. eCollection 2021.
BACKGROUND
The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship.
METHODS
This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data.
RESULTS
There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17).
CONCLUSION
The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.
背景
本研究的目的是为资源匮乏的患者实施并评估一项由药剂师主导的高血压（HTN）项目，这些患者是从急诊科（ED）出院或在社区健康活动中接受筛查的，且缺乏与正规初级保健提供者（PCP）的关系。
方法
这是一项单臂、前瞻性的试点研究，旨在从底特律医疗中心（DMC）西奈格雷斯医院（SGH）急诊科和社区健康活动中招募患者。由门诊药剂师主导的过渡性护理诊所（TCC）通过与急诊科医生的合作实践协议（CPA）实施。符合条件的18至60岁血压升高（BP）（>140/90 mmHg）且缺乏与PCP关系的患者被转诊至TCC进行高血压管理。主要结局指标是收缩压和舒张压（SBP和DBP）的变化。使用Wilcoxon符号秩检验评估血压值的差异，并使用描述性统计来解释人口统计学数据。
结果
2017年5月至2018年8月共招募了116名患者；44名（37.9%）完成了第一次就诊[队列1]，30名（25.9%）完成了至少三次就诊[队列2]，16名（13.8%）完成了五次就诊[队列3]。大多数患者是非裔美国人（AA），占97.7%，47.8%为男性，平均年龄为42.11岁（标准差9.70）。对于队列2和队列3，在TCC的第一次和第二次就诊之间血压有显著降低，并且对于留在研究中的患者，这种降低在五次就诊中一直保持。完成五次就诊的患者（n = 16）从第一次就诊到第五次就诊时收缩压有显著变化，下降了23 mmHg（p = 0.002），平均收缩压达到139 mmHg（标准差19.33），舒张压达到90 mmHg（标准差10.17），实现了血压目标。
结论
由药剂师主导的TCC成功实施。门诊药剂师与急诊科医生合作增加了高血压管理的可及性，对资源匮乏人群的血压结局产生了积极影响。
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