在医疗服务不足的心力衰竭人群中实施远程医疗主导的心力衰竭药物治疗方案优化诊所
Journal of the American Pharmacists Association : JAPhA
|December 16, 2024
概括
远程医疗心力衰竭 (HF) 诊所改善了指导方针导向医疗疗 (GDMT) 在专业心脏病服务中的使用. 初级保健机构需要进一步支持,以实现最佳的高频率药物管理.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 数字健康数字健康
背景情况:
- 针对心力衰竭 (HF) 的低最佳指南导向医学治疗 (GDMT) 在农村初级保健机构中很普遍.
- 在阿巴拉契亚山脉的农村地区,HF护理的健康差异很大.
- 多学科远程医疗诊所旨在改善农村HF患者获得专业护理的机会.
研究的目的:
- 为了评估远程医疗为主导的高频率药物优化诊所的影响.
- 评估心脏病学和初级保健服务中GDMT使用的变化.
主要方法:
- 试点研究:多中心前性队列,6个月后续.
- 包括18岁以上的患有HF且射出分数减少或轻微减少的患者.
- 远程医疗每2-4周一次;主要结果:使用所有4个GDMT类.
主要成果:
- 与一般心脏病学相比,HF心脏病学服务显示,所有4种GDMT药物的使用数量较高 (46%与9%在基线,高达52%与18%在6个月).
- 个人使用GDMT药物 (ARNI,MRA,SGLT2I) 在高频心脏病服务中也较高.
- 初级保健机构在整体GDMT使用中没有显著变化,ARNI和β-阻断剂的数值增加,但MRA的数量下降.
结论:
- 多学科远程医疗方法有效地优化了GDMT在专业的高频服务中.
- 初级保健和一般心脏病学需要额外的支持,以启动GDMT,持久性 (MRA,SGLT2I),和剂量定位.
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