Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
Pharmacy Services, Renfrewshire Health and Social Care Partnership, NHS Greater Glasgow and Clyde, Renfrew, United Kingdom.
Fam Pract. 2024 Feb 28;41(1):41-49. doi: 10.1093/fampra/cmad120.
People with severe mental health illness die prematurely, often due to preventable cardiometabolic disease, which can be exacerbated by antipsychotic medicines that are effective for treating mental illness. Literature demonstrates that physical health monitoring, as recommended in guidelines, for people receiving antipsychotics is substandard. Therefore, we aimed to scope the potential of a general practice clinical pharmacist (GPCP)-led multidisciplinary intervention optimising adherence to cardiometabolic monitoring guidelines and delivering polypharmacy reviews.
Prospective intervention scoping study in three urban general practices; one usual care, two intervention. Patients 18-65 years old prescribed oral antipsychotics were identified from records, and invited for cardiometabolic monitoring and GPCP medication review, from January to December 2022. Interventions and onward referrals were recorded and collated. Anonymised pre- and post-review data were analysed, and actions were graded for clinical importance.
In total 1.5% (210/14,159) of patients aged 18-65 years met inclusion criteria; usual care practice (n = 58); and intervention practices (n = 152). From baseline, the usual care practice achieved an absolute 7% increase in the cardiometabolic monitoring care bundle (glucose/glycosylated haemoglobin, lipids, blood pressure plus body mass index) versus 19-58% in the intervention practices. Two-thirds (92/152) of patients participated in medication reviews, requiring pharmacological and/or non-pharmacological clinical actions. The majority of actions were graded as moderate importance. Seven percentage of patients were identified as new pre-diabetic/diabetic and 6% were at high risk of cardiovascular disease requiring statin initiation.
A pharmacist-led multidisciplinary general practice-based approach may be effective at optimising cardiometabolic monitoring; identifying and treating diabetic and cardiovascular risk factors.
严重精神疾病患者的寿命往往较短，这通常是由于可预防的心血管代谢疾病所致，而治疗精神疾病的抗精神病药物可能会使这些疾病恶化。文献表明，接受抗精神病药物治疗的患者的身体健康监测（如指南所建议的那样）并不完善。因此，我们旨在评估由全科临床药剂师（GPCP）主导的多学科干预措施优化心血管代谢监测指南的依从性和进行多药物治疗审查的潜力。
在三个城市的全科实践中进行前瞻性干预范围研究；一个是常规护理，两个是干预。从 2022 年 1 月至 12 月，从记录中确定了 18-65 岁服用口服抗精神病药物的患者，并邀请他们进行心血管代谢监测和 GPCP 药物审查。记录并整理了干预措施和后续转诊情况。对匿名的审查前后数据进行了分析，并对临床重要性进行了分级。
共有 1.5%（210/14159）的 18-65 岁患者符合纳入标准；常规护理实践（n=58）；和干预实践（n=152）。从基线开始，常规护理实践的心血管代谢监测护理包（血糖/糖化血红蛋白、血脂、血压加体重指数）的绝对增加了 7%，而干预实践的增加了 19-58%。三分之二（92/152）的患者参与了药物审查，需要进行药理学和/或非药理学的临床操作。大多数操作被评为中度重要性。有 7%的患者被确定为新的糖尿病前期/糖尿病患者，有 6%的患者有发生心血管疾病的高风险，需要开始使用他汀类药物。
由药剂师主导的多学科全科实践方法可能是优化心血管代谢监测的有效方法；可以识别和治疗糖尿病和心血管危险因素。
