Purdue University College of Pharmacy, Indianapolis, Indiana, United States of America.
Eskenazi Health, Indianapolis, Indiana, United States of America.
PLoS One. 2023 Mar 15;18(3):e0282940. doi: 10.1371/journal.pone.0282940. eCollection 2023.
Reductions in hemoglobin A1c (HbA1C) have been associated with improved cardiovascular outcomes and savings in medical expenditures. One public health approach has involved pharmacists within primary care settings. The objective was to assess change in HbA1C from baseline after 3-5 months of follow up in pharmacist-managed cardiovascular risk reduction (CVRR) clinics.
This retrospective cohort chart review occurred in eight pharmacist-managed CVRR federally qualified health clinics (FQHC) in Indiana, United States. Data were collected from patients seen by a CVRR pharmacist within the timeframe of January 1, 2015 through February 28, 2020. Data collected include: demographic characteristics and clinical markers between baseline and follow-up. HbA1C from baseline after 3 to 5 months was assessed with pared t-tests analysis. Other clinical variables were assessed and additional analysis were performed at 6-8 months. Additional results are reported between 9 months and 36 months of follow up.
The primary outcome evaluation included 445 patients. Over 36 months of evaluation, 3,803 encounters were described. Compared to baseline, HbA1C was reduced by 1.6% (95%CI -1.8, -1.4, p<0.01) after 3-5 months of CVRR care. Reductions in HbA1C persisted at 6-8 months with a reduction of 1.8% ([95%CI -2.0, -1.5] p<0.01). The follow-up losses were 29.5% at 3-5 months and 93.2% at 33-36 months.
Our study augments the existing literature by demonstrating the health improvement of pharmacist-managed CVRR clinics. The great proportion of loss to follow-up is a limitation of this study to be considered. Additional studies exploring the expansion of similar models may amplify the public health impact of pharmacist-managed CVRR services in primary care sites.
血红蛋白 A1c（HbA1C）的降低与心血管结局的改善和医疗支出的节省有关。一种公共卫生方法涉及初级保健环境中的药剂师。目的是评估在经过 3-5 个月的随访后，由药剂师管理的心血管风险降低（CVRR）诊所中 HbA1C 从基线开始的变化。
这是在美国印第安纳州的八家由药剂师管理的 CVRR 合格的联邦健康诊所（FQHC）中进行的回顾性队列图表审查。数据是从 2015 年 1 月 1 日至 2020 年 2 月 28 日期间在 CVRR 药剂师处就诊的患者中收集的。收集的数据包括：基线和随访时的人口统计学特征和临床标志物。使用配对 t 检验分析评估在 3 至 5 个月后从基线开始的 HbA1C。评估了其他临床变量，并在 6-8 个月时进行了额外分析。在 36 个月的随访中报告了其他结果。
主要结果评估包括 445 名患者。在 36 个月的评估期间，共描述了 3803 次就诊。与基线相比，CVRR 护理后 3-5 个月 HbA1C 降低了 1.6%（95%CI -1.8，-1.4，p<0.01）。在 6-8 个月时，HbA1C 持续降低，降低了 1.8%（[95%CI -2.0，-1.5]，p<0.01）。在 3-5 个月时，随访损失为 29.5%，在 33-36 个月时，随访损失为 93.2%。
我们的研究通过证明由药剂师管理的 CVRR 诊所的健康改善，补充了现有文献。随访损失的很大比例是这项研究的一个局限性。探索类似模型扩展的额外研究可能会放大药剂师管理的 CVRR 服务在初级保健场所的公共卫生影响。
