Ibrahim Osama Mohamed, Meslamani Ahmad Z Al, Ibrahim Rana, Kaloush Rawan, Mazrouei Nadia Al
Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah. United Arab Emirates. Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Egypt.
College of Pharmacy, AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates.
Pharm Pract (Granada). 2022 Oct-Dec;20(4):2734. doi: 10.18549/PharmPract.2022.4.2734. Epub 2022 Oct 12.
To assess the effectiveness of telepharmacy services delivered by community pharmacies in hypertension management and examine its influence on pharmacists' ability to identify drug-related problems (DRPs).
This was a 2-arm, randomised, clinical trial conducted among 16 community pharmacies and 239 patients with uncontrolled HTN in the U.A.E over a period of 12 months. The first arm (n=119) received telepharmacy services and the second arm (n=120) received traditional pharmaceutical services. Both arms were followed up to 12 months. Pharmacists self-reported the study outcomes, which primarily were the changes in SBP and DBP from baseline to 12-month meeting. Blood pressure readings were taken at baseline, 3, 6, 9, and 12 months. Other outcomes were the mean knowledge, medication adherence and DRP incidence and types. The frequency and nature of pharmacist interventions in both groups were also reported.
The mean SBP and DBP differences were statistically significant across the study groups at 3-, 6-, and 9-month follow-up and 3-, 6-, 9-, 12- month follow-up, respectively. In detail, the mean SBP was reduced from 145.9 mm Hg in the intervention group (IG) and 146.7 mm Hg in the control group (CG) to 124.5, 123.2, 123.5, and 124.9 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the IG and 135.9, 133.8, 133.7, and 132.4 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the CG. The mean DBP was reduced from 84.3 mm Hg in IG and 85.1 mm Hg in CG to 77.6, 76.2, 76.1, and 77.8 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the IG and 82.3, 81.5, 81.5, and 81.9 mm Hg at 3-, 6-, 9-, and 12-month follow-up in the CG. Medication adherence and knowledge of participants in the IG towards hypertension were significantly improved. The DRP incidence and DRPs per patient identified by pharmacists in the intervention and control groups were 2.1% versus 1.0% (p=0.002) and 0.6 versus 0.3 (p=0.001), respectively. The total numbers of pharmacist interventions in the IG and CG were 331 and 196, respectively. The proportions of pharmacist interventions related to patient education, cessation of drug therapy, adjustment of drug dose, and addition of drug therapy across the IG and CG were 27.5% versus 20.9%, 15.4% versus 18.9%, 14.5% versus 14.8%, and 13.9% versus 9.7%, respectively (all with p<0.05).
Telepharmacy may have a sustained effect for up to 12 months on blood pressure of patients with hypertension. This intervention also improves pharmacists' ability to identify and prevent drug-related problems in community setting.
评估社区药房提供的远程药学服务在高血压管理中的有效性，并考察其对药剂师识别药物相关问题（DRP）能力的影响。
这是一项双臂随机临床试验，在阿联酋的16家社区药房和239例高血压未得到控制的患者中进行，为期12个月。第一组（n = 119）接受远程药学服务，第二组（n = 120）接受传统药学服务。两组均随访12个月。药剂师自行报告研究结果，主要是从基线到12个月随访时收缩压和舒张压的变化。在基线、3、6、9和12个月时测量血压读数。其他结果包括平均知识水平、用药依从性以及DRP发生率和类型。还报告了两组药剂师干预的频率和性质。
在3个月、6个月和9个月随访以及3个月、6个月、9个月和12个月随访时，各研究组间收缩压和舒张压的平均差异均具有统计学意义。详细而言，干预组（IG）收缩压从基线时的145.9 mmHg和对照组（CG）的146.7 mmHg分别降至3个月、6个月、9个月和12个月随访时的124.5 mmHg、123.2 mmHg、123.5 mmHg和124.9 mmHg，而CG组在相应随访时分别为135.9 mmHg、133.8 mmHg、133.7 mmHg和132.4 mmHg。IG组舒张压从基线时的84.3 mmHg和CG组的85.1 mmHg分别降至3个月、6个月、9个月和12个月随访时的77.6 mmHg、76.2 mmHg、76.1 mmHg和77.8 mmHg，而CG组在相应随访时分别为82.3 mmHg、81.5 mmHg、81.5 mmHg和81.9 mmHg。IG组参与者对高血压的用药依从性和知识水平显著提高。干预组和对照组药剂师识别出的DRP发生率和每位患者的DRP数量分别为2.1%对1.0%（p = 0.002）和0.6对0.3（p = 0.001）。IG组和CG组药剂师干预的总数分别为331次和19次。IG组和CG组中与患者教育、停止药物治疗、调整药物剂量以及增加药物治疗相关的药剂师干预比例分别为27.5%对20.9%、15.4%对18.9%、14.5%对14.8%以及13.9%对9.7%（均p<0.05）。
远程药学服务可能对高血压患者的血压产生长达12个月的持续影响。这种干预还提高了药剂师在社区环境中识别和预防药物相关问题的能力。
