一个集群随机试验,以评估大型医疗保健系统初级保健诊所中集中式远程临床药房服务
Korey Kennelty1,2, Christopher S Coffey3, Gail Ardery1
1Department of Pharmacy Practice and Science, College of Pharmacy.
概括
远程心血管风险服务并没有显著改善整体指南的遵守. 然而,它确实显示了对未经控制的患者缩血压的显著降低.
科学领域:
- 心脏病学 心脏病学
- 主要护理是指初级护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 由临床药剂师管理的远程心血管风险服务 (CVRS) 已开发,以支持初级保健团队.
- 这项研究旨在评估CVRS在改善各类初级保健机构遵守指南方面的有效性.
研究的目的:
- 检查远程心血管风险服务 (CVRS) 是否改善了初级保健诊所的准则遵守.
- 评估CVRS对不同患者群体和地理位置的影响.
主要方法:
- 一个集群随机试验,涉及20个美国初级保健诊所,按少数群体的代表性分层.
- 临床被随机分配,接受CVRS干预或通常的护理12个月.
- 主要结局是遵守指南优势 (TGA) 标准,对个别测量和血压控制进行了后期分析.
主要成果:
- 在12个月后,干预 (0.72) 和常规护理 (0.66) 组之间的TGA平均得分没有显著差异 (p=0.10).
- 代表性不足的少数群体的TGA分数没有显著差异 (0.70与0.67,p=0.50).
- 干预组中观察到静脉压的显著降低,这些患者在基线时没有控制血压 (-8.03mmHg,p=0.03).
结论:
- 总体来说,CVRS并没有显著改善对指导方针的遵守,这可能是由于对基线的高度遵守造成的.
- 该服务显示,在高风险,不受控制的患者中降低缩血压有好处.
- 未来的研究应该针对这种远程服务模型的高风险患者,他们的病情不受控制.
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