Ambulatory Care Clinical Pharmacist, NYC Health+Hospitals, Brooklyn, NY, USA.
Arnold and Marie Schwartz College of Pharmacy & Health Sciences Long Island University, Brooklyn, NY, USA.
J Pharm Pract. 2023 Oct;36(5):1192-1200. doi: 10.1177/08971900221097246. Epub 2022 May 6.
Current literature and practice have demonstrated that pharmacists have an integral role in deprescribing. However, research regarding their impact on patients with chronic diseases is limited. To assess the impact of a pharmacist-led intervention on deprescribing inappropriate medication for patients with chronic diseases within a four-month study period compared to patients receiving usual care. This study was conducted at NYU Langone Health. Patients of the intervention group were referred by a provider and met the criteria of polypharmacy, required chronic disease states management, were nonadherent to medications, had poor health literacy, or required titration for heart failure (HF) guideline directed medical therapy. A total of 142 patients were reviewed over a two-year period. At the end of the study period, the median number of medications for the two respective groups was similar (11 [4 - 30] vs 11 [2 - 23]). The pharmacist-led intervention had on average one medication deprescribed (m = -1.00, sd = 2.57), whereas the control group had on average .44 additional medications (m = 0.44, sd = 3.32) prescribed. Furthermore, the intervention group presented statistically significant differences (P = 0.046) regarding their diastolic blood pressure after the pharmacists' intervention (m = 72.69, sd = 11.64). Most importantly, patients with HF presented statistically significant improvement in their ejection fractions after the intervention (m = 41.46%, sd = 19.28%). The pharmacist-led intervention resulted in significant discontinuation of medications for patients in the intervention group compared to those in the usual care group within four-months.
目前的文献和实践表明，药剂师在减少用药方面发挥着重要作用。然而，关于他们对慢性病患者影响的研究有限。本研究旨在评估在四个月的研究期间，与接受常规护理的患者相比，由药剂师主导的干预措施对减少慢性病患者不适当药物治疗的影响。这项研究在纽约大学朗格尼健康中心进行。干预组的患者由医生推荐，并符合以下标准：多种药物治疗、需要慢性病管理、不遵医嘱、健康素养差或需要心力衰竭（HF）指南指导的药物治疗滴定。在两年的时间里，共对 142 名患者进行了评估。在研究期末，两组患者的平均用药数量相似（11 [4-30] vs 11 [2-23]）。药剂师主导的干预平均减少一种药物（m = -1.00，sd = 2.57），而对照组平均增加 0.44 种药物（m = 0.44，sd = 3.32）。此外，干预组在药剂师干预后的舒张压方面存在统计学显著差异（P = 0.046）（m = 72.69，sd = 11.64）。最重要的是，HF 患者在干预后射血分数有显著改善（m = 41.46%，sd = 19.28%）。与常规护理组相比，在四个月内，干预组的患者有更多药物被停用。
