研究表明,作为多学科护理的一部分,接受直接药剂师输入的心力衰竭(HF)患者具有更好的临床结果。这项研究评估/比较了两个多学科诊所之间在有和没有药剂师直接参与的情况下,针对慢性HF患者的指南指导药物治疗(GDMT)的处方实践差异。
慢性HF患者的回顾性审核,在2005年3月至2017年1月之间向两个多学科门诊诊所进行了介绍;多学科门诊咨询服务(MACS)与综合药剂师护理模式和一般心脏病学心力衰竭服务(GCHFS)诊所,没有药剂师的积极参与。
MACS门诊患者明显年龄较大(80vs.73年,p<.001),更有可能是女性(p<.001),并且收缩压明显较高(123vs.112mmHg,p<.001)和舒张压(67vs.60mmHg,p<.05)与GCHF临床患者相比的血压。此外,MACS门诊患者表现出更多的多重用药和更高的多种合并症患病率.这两个诊所的GDMT处方率相似,并且在HFrEF中实现了血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)的最大耐受剂量。然而,MACS诊所的HFpEF患者更有可能服用ACEI/ARB(70.5%vs.56.2%,p=0.0314)比GCHFS患者。同时患有HFrEF和HFpEF(MACS诊所)的患者服用β受体阻滞剂和盐皮质激素受体拮抗剂的可能性显着降低。在MACS诊所的慢性心房颤动(AF)中使用地高辛在HFrEF患者中明显更高(82.5%vs.58.5%,p=0.004),但房颤抗凝的人数(27.1%vs.48.0%,p=0.002)和处方利尿剂(84.0%vs.94.5%,p=0.022)在MACS诊所就诊的HFpEF患者中明显较低。年龄,心率,收缩压(SBP),贫血,慢性肾功能衰竭,在多元二元逻辑回归中,其他合并症是GDMT利用的主要重要预测因素。
在药剂师参与的多学科团队中,发现某些药物的处方率较低。仔细考虑人口统计学和临床特征,使用药物的禁忌症,多药,潜在的合并症是实现最佳实践所必需的。
Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of
guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics-with and without the direct involvement of a pharmacist.
A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist.
MACS clinic patients were significantly older (80 vs. 73 years, p < .001), more likely to be female (p < .001), and had significantly higher systolic (123 vs. 112 mmHg, p < .001) and diastolic (67 vs. 60 mmHg, p < .05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression.
Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.