Nkemdirim Okere Arinze, Balogun Aliyah, Smith Angela, Stevens Jade
College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA.
Int J Cardiol Cardiovasc Risk Prev. 2023 Aug 22;19:200206. doi: 10.1016/j.ijcrp.2023.200206. eCollection 2023 Dec.
Cardiovascular disease is the leading cause of death globally. Despite the effectiveness of lifestyle changes and recommended therapeutics, access to primary care and treatments to improve cardiovascular risk-factors (CRFs) remains challenging. Pharmacists and telehealth services have been proposed as potential solutions to overcome these barriers.
PubMed, OVID, and CINAHL databases were searched from January 2006 to March 2023. The primary outcomes were changes from baseline in systolic/diastolic blood pressure, glycated hemoglobin (A1c), cholesterol levels, and adherence to any patient counseling. Only studies conducted in the United States and Canada were included in the review.
Of 110 screened bibliographic records, 14 studies were included in the review. The pharmacist-led telehealth interventions included medication therapy management, medication reviews, and counseling on lifestyle changes. Nine studies reported significant improvements with intervention, 7 studies on CRFs and 2 studies on medication adherence at the 12-month follow-up, when pharmacist-led telehealth services were compared to usual care or historical data (p < 0.05).
This scoping review provides evidence for continued support to the development and implementation of pharmacist-led telehealth services in primary cardiovascular care. The findings suggest that pharmacist-led telehealth interventions can improve cardiovascular outcomes and adherence to drug and non-drug therapy among patients with CRFs. However, because of lack of published randomized clinical studies on patients with CRFs residing in underserved communities, future directions in research should focus on exploring the implementation of pharmacist-led telehealth services in rural or underserved communities, utilizing various payment models to enhance accessibility and feasibility.
心血管疾病是全球主要的死亡原因。尽管生活方式改变和推荐的治疗方法有效,但获得初级保健和改善心血管危险因素(CRF)的治疗仍然具有挑战性。药剂师和远程医疗服务被提议作为克服这些障碍的潜在解决方案。
检索了2006年1月至2023年3月的PubMed、OVID和CINAHL数据库。主要结局是收缩压/舒张压、糖化血红蛋白(A1c)、胆固醇水平相对于基线的变化,以及对任何患者咨询的依从性。纳入综述的仅为在美国和加拿大进行的研究。
在筛选的110篇文献记录中,有14项研究纳入综述。药剂师主导的远程医疗干预包括药物治疗管理、药物审查以及生活方式改变咨询。9项研究报告称干预后有显著改善,在12个月随访时,与常规护理或历史数据相比,7项关于CRF的研究和2项关于药物依从性的研究显示药剂师主导的远程医疗服务有显著改善(p<0.05)。
本范围综述为继续支持药剂师主导的远程医疗服务在心血管初级保健中的开发和实施提供了证据。研究结果表明,药剂师主导的远程医疗干预可以改善心血管结局,并提高CRF患者对药物和非药物治疗的依从性。然而,由于缺乏关于居住在服务不足社区的CRF患者的已发表随机临床研究,未来的研究方向应侧重于探索药剂师主导的远程医疗服务在农村或服务不足社区的实施情况,利用各种支付模式提高可及性和可行性。