高血压中的药物坚持:一个集群随机临床试验
Saul Blecker1,2, Devin M Mann1,2,3, Tiffany R Martinez1
1Department of Population Health, NYU Grossman School of Medicine, New York, New York.
JAMA cardiology
|July 9, 2025
概括
使用电子健康记录和团队护理的多组件干预措施并没有改善高血压患者的药物坚持. 这种方法未能显著增加覆盖天数 (PDC) 的比例或改善血压控制.
科学领域:
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
- 临床药房 临床药房
背景情况:
- 药物不服药影响了近一半的高血压患者,并且经常被忽视.
- 电子健康记录 (EHR) -药房数据链接为评估遵守提供了可扩展的解决方案.
- 识别和解决坚持障碍对于管理不受控制的高血压至关重要.
研究的目的:
- 为了评估多组分干预对不受控制的高血压和药物不服药.
- 这项干预措施将EHR药房数据与以团队为基础的护理整合在一起,以解决坚持障碍.
- 为了确定这种干预措施是否能改善药物坚持和血压控制.
主要方法:
- 一个务实的,双臂集群随机试验 (TEAMLET) 涉及10个初级保健站点.
- 包括没有控制的高血压和低药物坚持的成年人 (覆盖日数比例[PDC] <80%).
- 干预组接受了不遵守的自动识别,障碍查,临床决策支持和遵守讨论;对照组接受了通常的护理.
主要成果:
- 包括1726名患者;平均基线PDC为33.2%.
- 两组之间从基线到12个月的PDC变化没有显著差异 (干预:18.5%与对照:18.2%).
- 没有观察到血压变化或达到≥80%PDC的患者比例的显著差异.
结论:
- TEAMLET干预,结合EHR技术和团队护理,并没有改善抗高血压药物的服药能力.
- 自动识别和以团队为基础的护理策略并没有导致坚持或血压的显著改善.
- 需要进一步的研究来确定有效的策略,以改善高血压管理中的药物坚持.
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