心房細動患者の管理における薬剤師の役割:体系的レビューとメタ解析
Fernanda S Tonin1, Ross T Tsuyuki2, Fernando Fernandez-Llimos3
1Pharmacy and Pharmaceutical Technology Department, Social and Legal Pharmacy Section, University of Granada, Granada, Spain.
まとめ
薬剤師による介入は,治療期間を延長し,出血や脳卒中のリスクを減らすことで,心房細動 (AF) の管理を改善します. AFのケアにおける薬剤師の役割を最適化するために,さらに質の高い研究が必要です.
科学分野:
- 心臓病科
- 薬理学について
- 医療サービス研究
背景:
- 薬剤師主導の介入は様々な状態のために確立されていますが,心房細動 (AF) の管理におけるその役割はよく定義されていません.
- この研究では,薬剤師が AFの治療に与える貢献に関する証拠を体系的に検討しています.
研究 の 目的:
- 薬剤師主導の介入が心房細動の管理に与える影響に関する既存の証拠を統合する.
- AFケアにおける薬剤師の関与に関連する臨床的,プロセス,および人文的成果を評価する.
主な方法:
- PubMed,Scopus,Web of Scienceのデータベースを使用して,体系的なレビューが行われました.
- 含まれていた研究は,ランダム化試験,非ランダム化試験,およびコホート試験でした.
- RoB 2.0とROBINS- Iを用いて試験の質を評価し,GRADEによってエビデンスが格付けされた.
主要な成果:
- 11,428人の参加者を含む17件の研究が分析され,そのほとんどは非ランダム化試験またはコホート研究であった.
- 薬剤師による介入により,治療期間が有意に改善され (SMD 0. 35),大出血事件 (RR 0. 76) と脳卒中 (RR 0. 65) が減少した.
- 適切な処方率 (RR 1.36) が増加したが,他の結果は有意な違いを示さなかった.証拠の質は低いから中等であった.
結論:
- 薬剤師主導の介入は,心房細動患者の主要な臨床およびプロセスアウトカムを改善する効果を示しています.
- AF管理における薬剤師の役割をさらに洗練し,最適化するために,明確に定義された介入を伴う高品質のランダム化比較試験が必要である.
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