Olson Kari L, Stine Jessica M, Stadler Sheila L, Angleson Jessica, Campbell Stephanie M, Friesleben Cari, Schimmer Jennifer J
J Am Pharm Assoc (2003). 2022 Mar-Apr;62(2):604-611. doi: 10.1016/j.japh.2021.10.014. Epub 2021 Oct 20.
This study aimed to compare lipid and blood pressure (BP) control before and after implementing a certified pharmacy technician (CPhT) protocol that optimized electronic health record (EHR) capabilities and shifted work from clinical pharmacy specialists (CPSs) to CPhT.
Kaiser Permanente Colorado's pharmacist-managed cardiac risk reduction service (which manages dyslipidemia, hypertension, and diabetes for all patients with atherosclerotic cardiovascular disease).
In 2019, a protocol that optimized EHR capabilities and allowed work to be offloaded from CPS to CPhT was implemented. Filtered views within the EHR were created that bucketed patients with specific lipid results criteria. The CPhT protocol provided guidance to CPhT on determining whether patients were at low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein (non-HDL) goals, on appropriate statin intensity, adherent to medications, and whether the most recent BP was controlled. The CPhT notified CPS of uncontrolled patients who would assess and manage these patients, as necessary. The CPhT notified controlled patients of their results.
Data on the outcomes of incorporating pharmacy technicians to support CPS clinical activities in ambulatory clinical pharmacy are limited.
This retrospective study compared a "Pharmacist-Driven" (index date: January 1, 2016) with a "Tech-Enhanced" (index date: January 1, 2019) group. The primary outcome was the proportion of patients at all goals defined as LDL-C < 70 mg/dL, non-HDL < 100 mg/dL, and BP < 140/90 mm Hg at 1 year after the index dates.
There were 6813 patients included (mean age: 70.2 ± 11.1 years, 71.4% male): 3130 and 3683 in the "Pharmacist-Driven" and "Tech-Enhanced" groups, respectively. The proportion of patients who attained LDL-C, non-HDL, and BP goals was higher in the "Tech-Enhanced" group (51.1% vs. 39.7%, P < 0.001) than the "Pharmacist-Driven" group.
A protocol integrating EHR decision support and CPhTs enabled work to shift to from CPS to CPhT and improved clinical outcomes.
本研究旨在比较实施一项认证药剂师技术员（CPhT）方案前后的血脂和血压（BP）控制情况，该方案优化了电子健康记录（EHR）功能，并将工作从临床药学专家（CPS）转移至CPhT。
科罗拉多州凯撒医疗集团的药剂师管理的心脏风险降低服务（为所有动脉粥样硬化性心血管疾病患者管理血脂异常、高血压和糖尿病）。
2019年，实施了一项优化EHR功能并允许将工作从CPS转移至CPhT的方案。在EHR中创建了经过筛选的视图，将具有特定血脂结果标准的患者分类。CPhT方案为CPhT提供指导，以确定患者是否达到低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白（非HDL）目标、他汀类药物的适当强度、药物依从性以及最近的血压是否得到控制。CPhT将未得到控制的患者通知CPS，CPS将在必要时对这些患者进行评估和管理。CPhT将结果通知得到控制的患者。
关于纳入药剂师技术员以支持门诊临床药学中CPS临床活动的结果的数据有限。
这项回顾性研究将一个“药剂师驱动”组（索引日期：2016年1月1日）与一个“技术增强”组（索引日期：2019年1月1日）进行了比较。主要结局是在索引日期后1年时达到所有目标（定义为LDL-C<70mg/dL、非HDL<100mg/dL和BP<140/90mmHg）的患者比例。
共纳入6813例患者（平均年龄：70.2±11.1岁，男性占71.4%）：“药剂师驱动”组和“技术增强”组分别有3130例和3683例。“技术增强”组中达到LDL-C、非HDL和BP目标的患者比例（51.1%对39.7%，P<0.001）高于“药剂师驱动”组。
一项整合EHR决策支持和CPhT的方案使工作能够从CPS转移至CPhT，并改善了临床结局。
