Pharmacists on primary care teams: Effect on antihypertensive medication management in patients with type 2 diabetes

被引：10
作者：
Omran, Dima [1 ]
Majumdar, Sumit R. [2 ]
Johnson, Jeffrey A. [3 ]
Tsuyuki, Ross T. [2 ]
Lewanczuk, Richard Z. [2 ]
Guirguis, Lisa M. [1 ]
Makowsky, Mark [1 ]
Simpson, Scot H. [1 ]
机构：
[1] Univ Alberta, Fac Pharm & Pharmaceut Sci, Edmonton, AB T6G 1C9, Canada
[2] Univ Alberta, Fac Med & Dent, Dept Med, Edmonton, AB T6G 1C9, Canada
[3] Univ Alberta, Sch Publ Hlth, Edmonton, AB T6G 1C9, Canada
来源：
JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION | 2015年 / 55卷 / 03期
基金：
加拿大健康研究院;
关键词：
BLOOD-PRESSURE CONTROL; RANDOMIZED-TRIAL; ADDING PHARMACISTS; RISK; ADHERENCE; MELLITUS; DISEASE; INTENSIFICATION; HYPERTENSION; METAANALYSIS;
D O I：
10.1331/JAPhA.2015.14225
中图分类号：
R9 [药学];
学科分类号：
1007 ;
摘要：
Objective: To identify which activities produced a significant improvement in blood pressure control in patients with type 2 diabetes when pharmacists were added to primary care teams. Methods: This prespecified, secondary analysis evaluated medication management data from a randomized controlled trial. The primary outcome was a change in treatment, defined as addition, dosage increase, or switching of an antihypertensive medication during the 1-year study period. The secondary outcome was a change in antihypertensive medication adherence using the medication possession ratio (MPR). Results: The 200 evaluable trial patients had a mean age of 59 (SD, 11) years, 44% were men, and mean blood pressure was 130 (SD, 16)/74 (SD, 10) mm Hg at baseline. Treatment changes occurred in 45 (42%) of 107 patients in the intervention group and 24 (26%) of 93 patients in the control group (RR, 1.63; 95% CI, 1.08-2.46). Addition of a new medication was the most common type of change, occurring in 34 (32%) patients in the intervention group and 17 (18%) patients in the control group (P = 0.029). Adherence to antihypertensive medication was high at baseline (MPR, 93%). Although medication adherence improved in the intervention group (MPR, 97%) and declined in the control group (MPR, 91%), the difference between groups was not significant (P = 0.21). Conclusion: The observed improvement in blood pressure control when pharmacists were added to primary care teams was likely achieved through antihypertensive treatment changes and not through improvements in antihypertensive medication adherence.
引用
收藏
页码：265 / 268
页数：4
相关论文
共 17 条
[1]   National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants [J].
Danaei, Goodarz ;
Finucane, Mariel M. ;
Lu, Yuan ;
Singh, Gitanjali M. ;
Cowan, Melanie J. ;
Paciorek, Christopher J. ;
Lin, John K. ;
Farzadfar, Farshad ;
Khang, Young-Ho ;
Stevens, Gretchen A. ;
Rao, Mayuree ;
Ali, Mohammed K. ;
Riley, Leanne M. ;
Robinson, Carolyn A. ;
Ezzati, Majid .
LANCET, 2011, 378 (9785) :31-40
[2]   Detailed Treatment Algorithms for Effective Nurse- and Pharmacist-Directed Diabetes Care A Personal Approach [J].
Davidson, Mayer B. .
DIABETES EDUCATOR, 2009, 35 (01) :61-71
[3]   Trends in Death Rates Among US Adults With and Without Diabetes Between 1997 and 2006 Findings from the National Health Interview Survey [J].
Gregg, Edward W. ;
Cheng, Yiling J. ;
Saydah, Sharon ;
Cowie, Catherine ;
Garfield, Sanford ;
Geiss, Linda ;
Barker, Lawrence .
DIABETES CARE, 2012, 35 (06) :1252-1257
[4]   Improving Blood Pressure Control Through a Clinical Pharmacist Outreach Program in Patients With Diabetes Mellitus in 2 High-Performing Health Systems The Adherence and Intensification of Medications Cluster Randomized, Controlled Pragmatic Trial [J].
Heisler, Michele ;
Hofer, Timothy P. ;
Schmittdiel, Julie A. ;
Selby, Joe V. ;
Klamerus, Mandi L. ;
Bosworth, Hayden B. ;
Bermann, Martin ;
Kerr, Eve A. .
CIRCULATION, 2012, 125 (23) :2863-+
[5]   Adding pharmacists to primary care teams reduces predicted long-term risk of cardiovascular events in Type 2 diabetic patients without established cardiovascular disease: results from a randomized trial [J].
Ladhani, N. N. ;
Majumdar, S. R. ;
Johnson, J. A. ;
Tsuyuki, R. T. ;
Lewanczuk, R. Z. ;
Spooner, R. ;
Simpson, S. H. .
DIABETIC MEDICINE, 2012, 29 (11) :1433-1439
[6]   Type 2 Diabetes Mellitus Management in Canada: Is It Improving? [J].
Leiter, Lawrence A. ;
Berard, Lori ;
Bowering, C. Keith ;
Cheng, Alice Y. ;
Dawson, Keith G. ;
Ekoe, Jean-Marie ;
Fournier, Carl ;
Goldin, Lianne ;
Harris, Stewart B. ;
Lin, Peter ;
Ransom, Thomas ;
Tan, Mary ;
Teoh, Hwee ;
Tsuyuki, Ross T. ;
Whitham, Dana ;
Woo, Vincent ;
Yale, Jean-Francois ;
Langer, Anatoly .
CANADIAN JOURNAL OF DIABETES, 2013, 37 (02) :82-89
[7]   A Randomized Trial of the Effect of Community Pharmacist and Nurse Care on Improving Blood Pressure Management in Patients With Diabetes Mellitus Study of Cardiovascular Risk Intervention by Pharmacists- Hypertension (SCRIP-HTN) [J].
McLean, Donna L. ;
McAlister, Finlay A. ;
Johnson, Jeffery A. ;
King, Kathryn M. ;
Makowsky, Mark J. ;
Jones, Charlotte A. ;
Tsuyuki, Ross T. .
ARCHIVES OF INTERNAL MEDICINE, 2008, 168 (21) :2355-2361
[8]   Treatment and blood pressure control in 47,964 people with diabetes and hypertension: A systematic review of observational studies [J].
McLean, Donna L. ;
Simpson, Scot H. ;
McAlister, Finlay A. ;
Tsuyuki, Ross T. .
CANADIAN JOURNAL OF CARDIOLOGY, 2006, 22 (10) :855-860
[9]   Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis [J].
Morgado, Manuel P. ;
Morgado, Sandra R. ;
Mendes, Liliana C. ;
Pereira, Luisa J. ;
Castelo-Branco, Miguel .
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2011, 68 (03) :241-253
[10]   Clinical inertia [J].
Phillips, LS ;
Branch, WT ;
Cook, CB ;
Doyle, JP ;
El-Kebbi, IM ;
Gallina, DL ;
Miller, CD ;
Ziemer, DC ;
Barnes, CS .
ANNALS OF INTERNAL MEDICINE, 2001, 135 (09) :825-834
12