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Physician-pharmacist collaborative management in patients after percutaneous coronary intervention: a retrospective
Qingxia Zhang1, Haofan Su2, Boyu Li3
1Department of Pharmacy, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China.
Insights
Physician-Pharmacist Collaborative Management (PPCM) improved cardiovascular risk factor control in patients post-percutaneous coronary intervention (PCI). This model enhanced medication adherence and goal achievement compared to usual care.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Percutaneous coronary intervention (PCI) requires ongoing management of cardiovascular risk factors.
- Optimizing medication adherence and achieving therapeutic goals are critical post-PCI.
- The role of collaborative models in post-procedural care needs further evaluation.
Purpose of the Study:
- To evaluate the effectiveness of a Physician-Pharmacist Collaborative Management (PPCM) model.
- To assess PPCM's impact on risk factor control in patients after PCI.
- To compare PPCM with usual care (UC) in a post-PCI population.
Main Methods:
- Retrospective cohort study of patients undergoing PCI.
- Comparison between patients in a Complex Coronary Interventions Medication Therapy Management (CCI-MTM) clinic (PPCM group) and physician-only cardiology clinic (UC group).
- Propensity score matching (PSM) used to control for confounding bias, with 6-month follow-up.
Main Results:
- PPCM group showed significantly higher rates of achieving LDL-C and heart rate goals (73.8% vs 41.0% and 14.8% vs 4.1%, respectively).
- Median time to achieve goal LDL-C was shorter in the PPCM group (31 days vs 126 days).
- Higher utilization of beta-blockers and ACEIs/ARBs observed in the PPCM group, with no significant difference in adverse drug events.
Conclusions:
- The PPCM model significantly improved cardiovascular risk factor control post-PCI.
- Pharmacist-led collaborative management enhances the use of preventive medications.
- PPCM is an effective strategy for optimizing care in patients following PCI.
Aim:
Evaluate the effect of the Physician-Pharmacist Collaborative Management (PPCM) practice model in patients after percutaneous coronary intervention (PCI).
Method:
A retrospective cohort study was conducted in post-PCI patients. The study enrolled patients who underwent PCI at our hospital from May 1, 2018, to January 31, 2020. Patients were divided into two groups: the PPCM group if they utilized the Complex Coronary Interventions Medication Therapy Management (CCI-MTM) clinic and the usual care (UC) group if they used the physician-only cardiology clinic. Patients had clinic visits monthly, and data were analyzed after 6-months of follow-up. A propensity score matching (PSM) method was used to control confounding bias between groups.
Results:
A total of 727 patients met the inclusion criteria, including 67 patients in the PPCM group and 660 patients in the UC group. Using the 1:2 nearest neighbor matching method, 61 pairs were successfully matched; this included 61 patients in the PPCM group and 122 patients in the UC group. The proportion of patients reaching both LDL-C (73.8% versus 41.0%, P < 0.001) and heart rate (14.8% versus 4.1%, P = 0.007) goals in the PPCM was higher compared to the UC group. The median time to achieving the goal LDL-C was shorter in the PPCM group (31 days versus 126 days, P = 0.001). The utilization rates of [Formula: see text]-receptor blockers (73.8% versus 56.6%, P = 0.005) and ACEIs or ARBs (72.1% versus 56.6%, P = 0.018) were higher in the PPCM group compared to the UC group. There was no significant difference in adverse drug events between the two groups (P > 0.05). All recommendations to resolve drug-related problems were accepted by the physicians and patients.
Conclusion:
The pharmaceutical care provided by the pharmacist in the PPCM clinic improved risk factor control and increased the utilization of preventive drugs in post-PCI patients.
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