Kirk Cain Eric, Gordon Autumn N, Mooney Kelly D, Aikens Garrett B, Robinson Michael H, Howard Molly E
Montgomery VA Clinic, Central Alabama Veterans Health Care System, Montgomery, AL, USA.
Ft. Benning VA Clinic, Central Alabama Veterans Health Care System, Ft. Benning, GA, USA.
J Pharm Technol. 2017 Oct;33(5):177-182. doi: 10.1177/8755122517714578. Epub 2017 Jun 19.
Shared medical appointments (SMAs) are utilized across health care systems to improve access and quality of care, with limited evidence to support the use of SMAs to improve clinical outcomes and medication adherence among hypertensive patients. Improve access and quality of care provided within a Veterans Affairs health care system via implementation of a hypertension SMA to improve clinical outcomes and medication adherence. Veterans were eligible for enrollment in the SMA if they received care within the health care system, were aged ≥18 years, were receiving at least 2 antihypertensive medications, and had systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg. A pre/post cohort design was used to evaluate the improvement in antihypertensive medication adherence as well as the change in SBP and DBP for all Veterans who attended at least 2 SMAs. Twenty-one Veterans participated in at least 2 SMAs and were included in the analysis; 76.2% had a reduction in SBP with an overall average decrease of -8.3 mm Hg ( = .02). The proportion of Veterans considered to have controlled blood pressure (BP; <140/90 mm Hg) increased from 14.3% at baseline to 42.9% during the SMA period ( = .03). There was no significant difference found for the proportion of Veterans considered adherent to their prescribed antihypertensive medications (95.2% vs 85.7%, respectively; = .50). SBP significantly improved for patients enrolled in a pharmacist-led SMA at a VA health care system, and the proportion of patients considered to have controlled BP increased significantly.
共享医疗预约(SMAs)在整个医疗保健系统中得到应用,以改善医疗服务的可及性和质量,但支持使用SMAs来改善高血压患者临床结局和药物依从性的证据有限。通过实施高血压SMAs来改善临床结局和药物依从性,从而提高退伍军人事务医疗保健系统内提供的医疗服务的可及性和质量。如果退伍军人在医疗保健系统内接受治疗、年龄≥18岁、正在服用至少2种抗高血压药物且收缩压(SBP)>140 mmHg或舒张压(DBP)>90 mmHg,则有资格参加SMAs。采用前后队列设计来评估所有参加至少2次SMAs的退伍军人的抗高血压药物依从性改善情况以及SBP和DBP的变化。21名退伍军人参加了至少2次SMAs并被纳入分析;76.2%的患者SBP有所下降,总体平均下降-8.3 mmHg(P = 0.02)。被认为血压得到控制(BP;<140/90 mmHg)的退伍军人比例从基线时的14.3%增加到SMAs期间的42.9%(P = 0.03)。在被认为坚持服用规定抗高血压药物的退伍军人比例方面未发现显著差异(分别为95.2%和85.7%;P = 0.50)。在退伍军人事务医疗保健系统中,参加由药剂师主导的SMAs的患者SBP显著改善,且被认为血压得到控制的患者比例显著增加。