初级卫生保健中低血压治疗的充分性

C. Salom, C. Campabadal, F. Bejarano, N. Marco, L. Castillo, S. Conde, A. Marcos, M. Roch, A. Sanjuan, L. Canadell
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The prescription was validated by the pharmacist and the interventions were proposed to the physician. Results 300 patients were included, aged 68 (11.4) years (157 (52.3%) men), assigned to eight physicians. 44 (14.7%) patients were not adherent, and the therapeutic objective was not reached in 62 (20.7%) patients. 296 (86.5%) interventions were suggested on 342 active principles: change in therapeutic equivalent, 29.4%; intensify the dosage, 27.3%; interrupt the drug, 24.7%; reassess the indication, 9.8%; change the active principle, 7.1%; and reduce the dosage, 1.7%. Interventions involved: atorvastatin, 38.7%; rosuvastatin, 17.7%; fenofibrate, 16.3%; ezetimibe, 15.9%; pitavastatin, 9.2%; lovastatin, 1.1%; and fluvastatin, 1.1%. The final drugs were: atorvastatin, 54.3%; simvastatin, 34.7%; gemfibrozil, 7.5%; and pravastatin, 3.5%. Physicians accepted 289 (97.6%) interventions. At the 2–3 month follow-up, the implementation carried out lowered the percentage of drugs not considered firstline from 27.49% to 22.07% (19.71% reduction). Conclusion and relevance The prescription of hypolipemiant drugs was not in accordance with the recommended standards, possibly due to ignorance of institutional recommendations, magnification in the perception of adverse effects of classic treatments and therapeutic inertia. Review of the prescriptions by the specialist pharmacist was an added value in optimising the treatment of these patients by means of a multidisciplinary team. It will be interesting to analyse the results at the 1 year follow-up when all patients should have received a visit: the changes implemented, control of the lipid profile after the intervention as well as the savings in drug costs. 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引用次数: 0

摘要

背景和重要性基于降脂疗效、安全性、使用经验和成本标准,他汀类药物辛伐他汀、普伐他汀和≥40mg阿托伐他汀以及吉非齐贝特在我国被优先考虑。目的和目的优化初级保健(PH)患者的降脂治疗。材料和方法在PH中心进行了一项前瞻性研究(2020年6月至7月),数据来自ECAP计算机化病历。接受非一线降脂治疗的患者也包括在内。收集人口统计变量(年龄和性别)、患者依从性和治疗效果、涉及的药物和干预措施(建议、接受和实施)的数据。药剂师对处方进行了验证,并向医生提出了干预措施。结果纳入300例患者,年龄68岁(11.4岁),其中男性157例(52.3%),分配给8名医生。未坚持治疗44例(14.7%),未达到治疗目的62例(20.7%)。根据342项有效原则,提出了296项干预措施(86.5%):改变治疗当量,占29.4%;加大剂量,27.3%;中断用药,24.7%;重新评估适应症,9.8%;改变主动原则,7.1%;减少剂量,1.7%。干预措施:阿托伐他汀,38.7%;伐,17.7%;非诺贝特,16.3%;ezetimibe, 15.9%;pitavastatin, 9.2%;洛伐他汀,1.1%;氟伐他汀,1.1%。最终用药为:阿托伐他汀,54.3%;辛伐他汀,34.7%;二甲苯氧庚酸,7.5%;普伐他汀,3.5%。医生接受干预289例(97.6%)。随访2-3个月,实施后非一线用药比例由27.49%降至22.07%,下降19.71%。结论及相关性降压药处方不符合推荐标准,可能是由于忽视机构推荐、放大了对经典疗法不良反应的认知以及治疗惰性所致。专科药剂师对处方的审查是通过多学科团队优化这些患者治疗的附加价值。在1年的随访中,当所有患者都应该接受访问时,分析结果将是有趣的:实施的变化,干预后血脂的控制以及药物成本的节省。参考文献和/或致谢利益冲突无利益冲突
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5PSQ-135 Adequacy of hypolipemiant treatment in primary healthcare
Background and importance Based on the criteria lipid lowering efficacy, safety, experience of use and cost, the statins simvastatin, pravastatin and ≥40 mg atorvastatin, and gemfibrozil fibrate, are prioritised in our territory. Aim and objectives To optimise lipid lowering treatment in primary healthcare (PH) patients. Material and methods A prospective study (June to July 2020) was carried out in a PH centre, with data obtained from the ECAP computerised medical record. Patients on lipid lowering treatment not considered firstline were included. Data were collected for demographic variables (age and sex), patient adherence and therapeutic effectiveness, drugs involved and interventions (proposal, acceptance and implementation). The prescription was validated by the pharmacist and the interventions were proposed to the physician. Results 300 patients were included, aged 68 (11.4) years (157 (52.3%) men), assigned to eight physicians. 44 (14.7%) patients were not adherent, and the therapeutic objective was not reached in 62 (20.7%) patients. 296 (86.5%) interventions were suggested on 342 active principles: change in therapeutic equivalent, 29.4%; intensify the dosage, 27.3%; interrupt the drug, 24.7%; reassess the indication, 9.8%; change the active principle, 7.1%; and reduce the dosage, 1.7%. Interventions involved: atorvastatin, 38.7%; rosuvastatin, 17.7%; fenofibrate, 16.3%; ezetimibe, 15.9%; pitavastatin, 9.2%; lovastatin, 1.1%; and fluvastatin, 1.1%. The final drugs were: atorvastatin, 54.3%; simvastatin, 34.7%; gemfibrozil, 7.5%; and pravastatin, 3.5%. Physicians accepted 289 (97.6%) interventions. At the 2–3 month follow-up, the implementation carried out lowered the percentage of drugs not considered firstline from 27.49% to 22.07% (19.71% reduction). Conclusion and relevance The prescription of hypolipemiant drugs was not in accordance with the recommended standards, possibly due to ignorance of institutional recommendations, magnification in the perception of adverse effects of classic treatments and therapeutic inertia. Review of the prescriptions by the specialist pharmacist was an added value in optimising the treatment of these patients by means of a multidisciplinary team. It will be interesting to analyse the results at the 1 year follow-up when all patients should have received a visit: the changes implemented, control of the lipid profile after the intervention as well as the savings in drug costs. References and/or acknowledgements Conflict of interest No conflict of interest
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