Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, 2713, Doha, Qatar.
Heart Hospital, Hamad Medical Corporation, 3050, Doha, Qatar.
Int J Clin Pharm. 2023 Jun;45(3):630-640. doi: 10.1007/s11096-023-01538-4. Epub 2023 Feb 16.
Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity in Qatar and globally.
The primary objective of the study was to evaluate the effectiveness of a structured clinical pharmacist-delivered intervention on all-cause hospitalizations and cardiac-related readmissions in patients with ACS.
A prospective quasi-experimental study was conducted at Heart Hospital in Qatar. Discharged ACS patients were allocated to one of three study arms: (1) an intervention group (received a structured clinical pharmacist-delivered medication reconciliation and counselling at discharge, and two follow-up sessions at 4 weeks and 8 weeks post-discharge), (2) a usual care group (received the general usual care at discharge by clinical pharmacists) or, (3) a control group (discharged during weekends or after clinical pharmacists' working hours). Follow-up sessions for the intervention group were designed to re-educate and counsel patients about their medications, remind them about the importance of medication adherence, and answer any questions they may have. At the hospital, patients were allocated into one of the three groups based on intrinsic and natural allocation procedures. Recruitment of patients took place between March 2016 and December 2017. Data were analyzed based on intention-to-treat principles.
Three hundred seventy-three patients were enrolled in the study (intervention = 111, usual care = 120, control = 142). Unadjusted results showed that the odds of 6-month all-cause hospitalizations were significantly higher among the usual care (OR 2.034; 95% CI: 1.103-3.748, p = 0.023) and the control arms (OR 2.704; 95% CI: 1.456-5.022, p = 0.002) when compared to the intervention arm. Similarly, patients in the usual care arm (OR 2.304; 95% CI: 1.122-4.730, p = 0.023) and the control arm (OR 3.678; 95% CI: 1.802-7.506, p ≤ 0.001) had greater likelihood of cardiac-related readmissions at 6 months. After adjustment, these reductions were only significant for cardiac-related readmissions between control and intervention groups (OR 2.428; 95% CI: 1.116-5.282, p = 0.025).
This study demonstrated the impact of a structured intervention by clinical pharmacists on cardiac-related readmissions at 6 months post-discharge in patients post-ACS. The impact of the intervention on all-cause hospitalization was not significant after adjustment for potential confounders. Large cost-effective studies are required to determine the sustained impact of structured clinical pharmacist-provided interventions in ACS setting.
Clinical Trials: NCT02648243 Registration date: January 7, 2016.
急性冠状动脉综合征（ACS）是卡塔尔和全球范围内导致死亡和发病的主要原因。
本研究的主要目的是评估结构化临床药师提供的干预措施对 ACS 患者全因住院和心脏相关再入院的有效性。
在卡塔尔心脏医院进行了一项前瞻性准实验研究。出院的 ACS 患者被分配到三个研究组之一：（1）干预组（出院时接受结构化临床药师提供的药物重整和咨询，并在出院后 4 周和 8 周进行两次随访），（2）常规护理组（出院时接受临床药师提供的常规护理）或（3）对照组（周末或临床药师工作时间后出院）。干预组的随访旨在重新教育和指导患者有关药物的知识，提醒他们注意药物依从性的重要性，并回答他们可能有的任何问题。在医院，患者根据内在和自然分配程序被分配到三个组之一。患者招募于 2016 年 3 月至 2017 年 12 月进行。数据分析基于意向治疗原则。
共有 373 名患者入组本研究（干预组 111 例，常规护理组 120 例，对照组 142 例）。未调整结果显示，与干预组相比，常规护理组（比值比 2.034；95%置信区间：1.103-3.748，p=0.023）和对照组（比值比 2.704；95%置信区间：1.456-5.022，p=0.002）的 6 个月全因住院的可能性显著更高。同样，常规护理组（比值比 2.304；95%置信区间：1.122-4.730，p=0.023）和对照组（比值比 3.678；95%置信区间：1.802-7.506，p≤0.001）的患者在 6 个月时有更大的心脏相关再入院的可能性。调整后，仅对照组和干预组之间的心脏相关再入院有统计学意义（比值比 2.428；95%置信区间：1.116-5.282，p=0.025）。
本研究表明，临床药师实施的结构化干预措施对 ACS 患者出院后 6 个月的心脏相关再入院有影响。在调整潜在混杂因素后，干预对全因住院的影响不显著。需要进行大规模的成本效益研究，以确定结构化临床药师提供的干预措施在 ACS 环境中的持续影响。
临床试验：NCT02648243 注册日期：2016 年 1 月 7 日。
