School of Management, Zunyi Medical University, Zunyi, People's Republic of China.
The Second Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China.
Glob Health Sci Pract. 2021 Dec 21;9(4):890-904. doi: 10.9745/GHSP-D-20-00505. Print 2021 Dec 31.
We aimed to test the effects of pharmacist intervention on the community control of hypertension through a comparative randomized controlled trial.
We recruited adult hypertensive patients with comorbidity or confusion with medication (n=636) from 2 community health centers in Zunyi, China. They were randomly and equally divided into 2 groups. Both groups received the usual care and participated in the community systematic management program of hypertension. Participants in the intervention group were given interventions from pharmacists, including a monthly review of medications, patient education, and medication adjustment advice to medical doctors over 6 months. Participants' blood pressure was assessed at baseline, 3 months, and 6 months. Participants' knowledge and medication adherence were measured using a questionnaire before and after the trial.
Compared to the control group (n=298), a significantly higher percentage of participants in the intervention group (n=290) had their blood pressure under control 3 months (46.9% vs. 38.3%, =.034) and 6 months (60.7% vs. 40.9%, <.001) after the interventions. Difference-in-differences analyses showed that the pharmacist intervention resulted in an increase in knowledge scores by 12.55 points (<.001), a decrease in systolic blood pressure by 6.65 mmHg (=.001), and a decrease in diastolic blood pressure by 7.26 mmHg (<.001) compared to the controls after adjustment for variations in potential confounding factors. The odds of participants passing the hypertension knowledge tests in the intervention group was 4.45 times those in the control group (<.001). Similarly, it was found that the intervention group had higher odds of not needing any medication adjustments (adjusted odds ratio [AOR]=2.75, <.001) and having their blood pressure under control (AOR=2.18, =.002) compared to the control group.
It is evident that pharmacist intervention has significant short-term effects on improving the knowledge and medication adherence of hypertensive patients, as well as timely medication adjustments from medical doctors, resulting in lowered blood pressure and an increased control rate. Further studies should explore the long-term sustainability of the effects of community pharmacist intervention.
通过一项对照随机对照试验，检验药剂师干预对社区高血压控制的影响。
我们从中国遵义的 2 家社区卫生中心招募了患有合并症或药物使用混淆的成年高血压患者（n=636）。他们被随机均等分为 2 组。两组均接受常规护理，并参与高血压社区系统管理项目。干预组患者接受药剂师的干预，包括每月审查药物、患者教育和在 6 个月内向医生提供药物调整建议。在基线、3 个月和 6 个月时评估参与者的血压。在试验前后使用问卷测量参与者的知识和药物依从性。
与对照组（n=298）相比，干预组（n=290）有更多的参与者在干预 3 个月（46.9% vs. 38.3%，=.034）和 6 个月（60.7% vs. 40.9%，<.001）时血压得到控制。差异分析表明，与对照组相比，药剂师干预使知识评分增加了 12.55 分（<.001），收缩压降低了 6.65mmHg（=.001），舒张压降低了 7.26mmHg（<.001），在调整潜在混杂因素的变异后。与对照组相比，干预组参与者通过高血压知识测试的几率增加了 4.45 倍（<.001）。同样，与对照组相比，干预组需要任何药物调整的几率较低（调整后的优势比 [AOR]=2.75，<.001），血压得到控制的几率较高（AOR=2.18，=.002）。
显然，药剂师干预对改善高血压患者的知识和药物依从性以及及时调整医生的药物具有显著的短期效果，从而降低血压并提高控制率。进一步的研究应该探索社区药剂师干预效果的长期可持续性。
