Stading Julie A, Phan Linda, Walter Andrea, Bilslend Lisa, White Rebecca, Qi Yongyue
Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
VA Nebraska-Western Iowa Health Care System, Lincoln, NE, USA.
J Pharm Technol. 2014 Jun;30(3):76-80. doi: 10.1177/8755122513505744. Epub 2013 Oct 1.
Clinical video telepharmacy is a new initiative of the Department of Veterans Affairs (VA) to provide rural patients access to clinical pharmacy services. This article describes some of the obstacles that pharmacists faced as they initiated this service and early outcomes in diabetes and hyperlipidemia patients. This study was approved by the institutional review board. This was a single-center, retrospective review of patients seen by 3 clinical pharmacists who developed and administered the telepharmacy clinics. Patients were referred by their primary care providers. Patients traveled to their local community-based outpatient clinic where a nurse set up video conferencing and then paged the pharmacist at the Lincoln VA. Patients were referred for management of anticoagulation, diabetes, hyperlipidemia, or hypertension, with 112 patients screened and 12 patients meeting criteria for hemoglobin A1c (HbA1c) evaluation and 25 patients meeting criteria for low-density lipoprotein (LDL)-cholesterol evaluation. Pharmacists also saw new patients for medication reviews, patients just out of the hospital, and patients with questions about their medication regimens. This study looked specifically at the effect that the pharmacist had on HbA1c and LDL-cholesterol reduction and meeting goals for these 2 parameters. Patients in the diabetes group had a mean ± standard deviation reduction in HbA1c of 1.08 ± 0.85 (95% confidence interval = 0.53-1.62; = .001). The mean HbA1c decreased from 9.1% to 8% after pharmacist intervention. Patients in the hyperlipidemia group had a mean ± standard deviation reduction in LDL-cholesterol of 23.74 ± 7.76 mg/dL (95% confidence interval = 7.76-39.75; = .005). The mean LDL-cholesterol decreased from 145 to 121 mg/dL after intervention. There were no significant changes in the number of patients attaining their HbA1c or LDL-cholesterol goals after intervention. This study shows that telepharmacy allows patients to have access to pharmacy services in a rural environment with minimal inconvenience to the patient. This study also suggests that outcomes of disease management are similar to face-to-face visits.
临床视频远程药学服务是美国退伍军人事务部（VA）的一项新举措，旨在为农村患者提供临床药学服务。本文描述了药剂师在启动这项服务时所面临的一些障碍以及糖尿病和高脂血症患者的早期治疗效果。本研究已获得机构审查委员会的批准。这是一项单中心回顾性研究，研究对象为3名开展并管理远程药学诊所的临床药剂师所诊治的患者。患者由其初级保健提供者转诊。患者前往当地社区门诊诊所，由护士设置视频会议，然后呼叫林肯退伍军人事务部的药剂师。患者因抗凝、糖尿病、高脂血症或高血压的管理而被转诊，共筛查了112名患者，其中12名患者符合糖化血红蛋白（HbA1c）评估标准，25名患者符合低密度脂蛋白（LDL）胆固醇评估标准。药剂师还为新患者进行用药审查，诊治刚出院的患者以及对其用药方案有疑问的患者。本研究特别关注药剂师对降低HbA1c和LDL胆固醇以及实现这两个参数目标的影响。糖尿病组患者的HbA1c平均降低值±标准差为1.08±0.85（95%置信区间=0.53 - 1.62；P = 0.001）。药剂师干预后，平均HbA1c从9.1%降至8%。高脂血症组患者的LDL胆固醇平均降低值±标准差为23.74±7.76mg/dL（95%置信区间=7.76 - 39.75；P = 0.005）。干预后，平均LDL胆固醇从145mg/dL降至121mg/dL。干预后达到HbA1c或LDL胆固醇目标的患者数量没有显著变化。这项研究表明，远程药学服务使患者能够在农村环境中获得药学服务，且对患者造成的不便最小。这项研究还表明，疾病管理的效果与面对面就诊相似。
