Yett Elizabeth S, Phan Ha, Mills Alex R, Fleming Joshua W, Majure Joseph M, Malinowski Scott S, Adcock Kim G
Department of Clinical Sciences (ESY), The University of Texas at Tyler Ben and Maytee Fisch College of Pharmacy, Tyler, TX.
Department of Pharmacy Practice (HP, ARM, JWF, SSM, KGA), University of Mississippi School of Pharmacy, Jackson, MS.
J Pediatr Pharmacol Ther. 2022;27(4):306-311. doi: 10.5863/1551-6776-27.4.306. Epub 2022 May 9.
Vitamin D deficiency is commonly found in patients with cystic fibrosis (CF) and can have a negative effect on patients who are not at target goal according to Cystic Fibrosis Foundation's Vitamin D Deficiency Clinical Care Guidelines. The objective of this study is to determine the effectiveness of a pharmacist-driven vitamin D protocol (PDVDP) in improving, achieving, and maintaining 25-hydroxyvitamin D levels of patients in a pediatric CF clinic.
A retrospective chart review was conducted for pediatric patients with CF from August 2018 to March 2020 to determine the percent of patients with improvement in 25-hydroxyvitamin D levels to target goal (≥ 30 ng/mL). Patients' 25-hydroxyvitamin D levels at 6, 12, and 18 months after automatic enrollment into the PDVDP were compared to determine if improvement occurred, and to calculate relative percent increase of 25-hydroxyvitamin D levels for these patients.
The mean 25-hydroxyvitamin D levels of the patients at baseline before the protocol and 6, 12, and 18 months after enrollment in the protocol were 23.2, 33.3, 32.7, and 34.6 ng/mL, respectively. These results demonstrate mean 25-hydroxyvitamin D levels at all follow-up time points were significantly greater than baseline (p < 0.001). At 6 months, 50% (n = 20) of pediatric patients reached the target 25-hydroxyvitamin D levels.
The PDVDP was effective in increasing the number of patients able to reach target 25-hydroxyvitamin D levels. Our PDVDP process may also be used at other CF clinics to improve vitamin D outcomes collaboratively with the interprofessional CF team.
维生素D缺乏在囊性纤维化（CF）患者中很常见，根据囊性纤维化基金会的维生素D缺乏临床护理指南，这可能会对未达到目标水平的患者产生负面影响。本研究的目的是确定由药剂师主导的维生素D方案（PDVDP）在改善、达到并维持儿科CF诊所患者的25-羟维生素D水平方面的有效性。
对2018年8月至2020年3月的儿科CF患者进行回顾性病历审查，以确定25-羟维生素D水平改善至目标水平（≥30 ng/mL）的患者百分比。比较患者自动纳入PDVDP后6个月、12个月和18个月时的25-羟维生素D水平，以确定是否有改善，并计算这些患者25-羟维生素D水平的相对百分比增加。
方案实施前患者基线时以及纳入方案后6个月、12个月和18个月时的平均25-羟维生素D水平分别为23.2、33.3, 32.7和34.6 ng/mL。这些结果表明，所有随访时间点的平均25-羟维生素D水平均显著高于基线水平（p < 0.001）。6个月时，50%（n = 20）的儿科患者达到了25-羟维生素D目标水平。
PDVDP在增加能够达到25-羟维生素D目标水平的患者数量方面是有效的。我们的PDVDP流程也可在其他CF诊所使用，以便与跨专业CF团队合作改善维生素D治疗效果。
