Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, the Netherlands.
Res Social Adm Pharm. 2023 May;19(5):783-792. doi: 10.1016/j.sapharm.2022.11.009. Epub 2022 Nov 26.
Potential overtreatment with cardiometabolic medication (i.e., glucose lowering medication, antihypertensives and statins) has been observed in 10-40% of older people with type 2 diabetes (T2D).
The potential effects of a pharmacist-led clinical medication review targeted at T2D patients who were at high risk of hypoglycaemia will be investigated.
A quasi-experimental study was conducted in 14 Dutch community pharmacies. Patients with a high risk of hypoglycaemia were identified using a previously developed algorithm. Pharmacists confirmed eligibility and selected patients for the intervention. Remaining eligible patients were included as controls receiving usual care. The primary outcome was the proportion of intervention patients for whom an action on deprescribing or appropriate use of cardiometabolic medication was implemented. After three months, changes in cardiometabolic medication were compared between the intervention and control group using a Fischer exact test.
In total 90 intervention patients and 107 control patients were included. Intervention patients had an average age of 70, used on average 10 medications, five of which were cardiometabolic medication. For half of the intervention patients an action on deprescribing cardiometabolic medication was implemented (n = 25) and/or an advice about appropriate use of cardiometabolic medication was given (n = 22). In 48% of intervention patients at least one cardiometabolic medication (e.g. insulin, sulfonylurea, diuretic, beta-blocker, statin) was either stopped or reduced in dose compared to 31% of control patients (p = 0.018).
A pharmacist-led tailored clinical medication review has the potential to increase deprescribing and improve appropriate use of cardiometabolic medication in half of T2D patients at high risk of hypoglycaemia.
在 10%-40%的 2 型糖尿病（T2D）老年患者中，观察到潜在的过度使用心血管代谢药物（即降血糖药物、降压药和他汀类药物）。
研究药剂师主导的针对低血糖高风险 T2D 患者的临床药物治疗评估的潜在效果。
在 14 家荷兰社区药店进行了一项准实验研究。使用先前开发的算法确定低血糖高风险患者。药剂师确认合格并选择患者进行干预。其余合格患者被纳入对照组，接受常规护理。主要结局是实施去处方或适当使用心血管代谢药物的干预患者比例。三个月后，使用 Fischer 精确检验比较干预组和对照组的心血管代谢药物变化。
共纳入 90 名干预患者和 107 名对照患者。干预患者的平均年龄为 70 岁，平均使用 10 种药物，其中 5 种为心血管代谢药物。对于一半的干预患者，实施了去处方心血管代谢药物的行动（n=25）和/或提供了关于适当使用心血管代谢药物的建议（n=22）。与对照组（n=31%）相比，在 48%的干预患者中，至少有一种心血管代谢药物（如胰岛素、磺脲类、利尿剂、β-受体阻滞剂、他汀类药物）被停止或减少剂量（p=0.018）。
药剂师主导的个性化临床药物治疗评估有可能增加低血糖高风险 T2D 患者的去处方率，并改善心血管代谢药物的合理使用。
