1 Western University of Health Sciences, Pomona, California.
2 Los Angeles Jewish Home, Reseda, California.
Sr Care Pharm. 2022 Feb 1;37(2):62-72. doi: 10.4140/TCP.n.2022.62.
To illustrate the impact of a pharmacist-led hypertension medication management program on skilled nursing facility residents. Sixteen-week retrospective, observational study. Long-term care, local skilled nursing facility. Subjects with a diagnosis of hypertension and treated with at least one antihypertensive medication were identified using electronic health records. The subjects also needed to be enrolled in the Hypertension Medication Management Program, and were excluded if receiving hospice or psychiatric treatment or had active infection with COVID-19. Initially, 120 residents were eligible with 54 in an intervention and 66 in a control group. At 16-weeks, a total of 67 residents remained after some were lost to follow-up. Under a collaborative practice agreement, a pharmacist optimized medications, ordered monitoring of vital signs, and relevant labs in conjunction with standard physician care (intervention): these subjects were compared to those who received standard physician care alone (control). There was a significant difference in the proportion of subjects who attained treatment goals for diastolic BP, but not for systolic BP or mean arterial pressure. The proportion of subjects in the intervention group who had falls, hospitalization or death was not significantly different between groups. diastolic pressure (90.9% and 38.0%; < 0.0001; 86.7% and 32.4%; < 0.0001) but not for systolic and mean arterial pressure at 8 and 16 weeks. For secondary endpoints, there was clinical significance in de-prescribing incidence ( < 0.0001) but not for fall events, hospitalizations, and death. However, control group had 11% more falls and 1.2% more hospitalizations. A pharmacist-led hypertension program appeared to impact skilled nursing facility residents by allowing attainment of maintaining diastolic blood pressure, goals de-prescribing events, and reducing fall incidence and hospitalization. The intervention has the potential to promote de-prescribing but does not appear to have increased the prevalence of serious adverse outcomes relative to standard practice.
为了说明药师主导的高血压药物管理方案对长期护理机构居民的影响。这是一项为期 16 周的回顾性观察研究。长期护理机构，当地的长期护理机构。通过电子健康记录确定患有高血压并至少使用一种降压药物治疗的患者。这些患者还需要参加高血压药物管理计划，如果正在接受临终关怀或精神科治疗或患有活动性 COVID-19 感染，则将被排除在外。最初，有 120 名居民符合条件，其中 54 名在干预组，66 名在对照组。在 16 周时，由于一些居民失去了随访，共有 67 名居民留了下来。根据合作实践协议，药剂师优化药物治疗，与标准医生护理一起（干预组），监测生命体征和相关实验室，并与标准医生护理进行比较（对照组）。接受治疗的患者中，达到舒张压治疗目标的患者比例有显著差异，但收缩压或平均动脉压治疗目标无显著差异。干预组和对照组的跌倒、住院或死亡发生率无显著差异。干预组达到舒张压（90.9%和 38.0%；<0.0001；86.7%和 32.4%；<0.0001）治疗目标的患者比例明显更高，但收缩压和平均动脉压在 8 周和 16 周时没有差异。对于次要终点，减少处方发生率（<0.0001）有临床意义，但跌倒事件、住院和死亡没有意义。然而，对照组的跌倒事件增加了 11%，住院事件增加了 1.2%。高血压管理方案由药师主导，似乎通过维持舒张压、减少减药事件、降低跌倒发生率和住院率，对长期护理机构居民产生了影响。该干预措施有减少药物使用的潜力，但与标准实践相比，似乎并未增加严重不良事件的发生率。
