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首页> 外文期刊>Journal of managed care pharmacy : >Lipid levels and use of lipid-lowering drugs for patients in pharmacist-managed lipid clinics versus usual care in 2 VA Medical Centers.
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Lipid levels and use of lipid-lowering drugs for patients in pharmacist-managed lipid clinics versus usual care in 2 VA Medical Centers.

机译：脂质水平和使用脂降低药物用于药剂师管理的脂质诊所的患者对2 VA医疗中心的常规护理。

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OBJECTIVE: The objective of this study was to assess the effectiveness of pharmacist- managed dyslipidemia clinics at 2 Veterans Affairs medical centers since the release of the 2001 National Cholesterol Education Panel Adult Treatment Panel III (NCEP ATP III) guideline compared with the usual care (UC) provided by other health care professionals in the same setting. METHODS: Analysis was performed through retrospective chart review of patients with a diagnosis of dyslipidemia who received care in either the Amarillo or Lubbock, Texas, pharmacist-managed lipid clinics (LCs) or UC from a primary care physician. Data from medical charts were abstracted for dates of service from July 2001 to December 2003 for 115 patients selected randomly from LC rolls matched with 115 patients with a diagnosis of dyslipidemia selected randomly from UC. All patients had to have had at least 3 visits with the LC or 3 visits in UC with a billing code of dyslipidemia; they were followed for at least 6 months after an initial visit in July 2001 or thereafter and were enrolled in the VA health care system for at least 1 year. Baseline lipid values were available for LC but not UC patients. Cholesterol target goals were determined according to NCEP ATP III guideline. RESULTS: After an average of 21.6 months of follow-up, the proportion of patients in the LC group that attained goal level increased from 45.2% at baseline to 82.6% for total cholesterol (TC) and from 36.5% at baseline to 64.3% for lowdensity lipoprotein cholesterol (LDL-C [P <0.001 for both comparisons]). There was an average 24.5 mg/dL absolute reduction (relative reduction, 19.4%) in LDL-C along with significant improvements in the other lipid levels (P <0.001 for TC and LDL-C, P = 0.007 for triglycerides [TGs]) with the exception of highdensity lipoprotein cholesterol (HDL-C), which declined from 40.0 mg/dL to 36.3 mg/dL (P <0.001). A total of 50 patients (43.5%) were on lipid-lowering pharmacotherapy at baseline versus 108 patients (93.9%) at follow-up. Compared with UC, LC patients were more likely to have achieved goal LDL-C (64.3% vs. 15.7% for UC, P <0.001) and TC (82.6% vs. 40.9%, P <0.001), but there was no difference in the proportion of patients at TG goal for LC (65.2%) compared with UC (52.2%, P = 0.061) or at HDL-C goal (23.5% for LC vs. 33.0% for UC, P = 0.143). A higher proportion of LC patients (93.9%) used lipid-lowering agents compared with UC patients (24.3%, P <0.001). Subanalysis of patients on a lipid-lowering agent found that a significantly higher proportion (85.2%) in the LC group were at goal total cholesterol compared with 60.7% for UC (P = 0.012) and at goal LDL-C (66.7% for LC vs. 39.3% for UC, P = 0.016). However, a lower proportion were at goal HDL-C for LC (21.3%) versus 42.9% for UC (P = 0.043). Overall, only 11 LC patients (9.6%) attained goal levels for all 4 serum lipid values by the end of follow-up versus 2 UC patients (1.7%, P = 0.019). CONCLUSIONS: Nearly two thirds of patients diagnosed with dyslipidemia and enrolled in a pharmacist-managed LC had LDL-C levels at or below NCEP ATP III target goal compared with 16% of dyslipidemia patients who received UC from their primary care provider. The pharmacist-managed LC patients were also twice as likely (83 vs. 41%) to have attained the TC target goal, but there was no difference between the 2 groups in the proportion of patients who attained either TG or HDL-C target goals. Only 9.6% of LC patients were at goal for all 4 individual lipid measures at the end of follow-up.
机译：目的：本研究的目的是评估2001年国家胆固醇教育小组成人治疗委员会III（NCEP ATP III）指南的2001年国家胆固醇教育小组成人治疗委员会（NCEP ATP III）指南以来药剂师管理血脂血症诊所的有效性。与通常的护理（ UC）由其他医疗保健专业人员提供相同的环境。方法：通过回顾性的患者进行分析，对患者进行诊断，患有血脂血症的诊断，他们从初级保健医生那里接受了Amarillo或Lubbock，Texas，药剂师管理的脂质诊所（LCS）或UC的护理。来自医疗图表的数据从2001年7月到2003年7月，从LC卷与115例患者随机选择的115名患者从UC中随机选择的血脂血症进行诊断，为2003年12月到2003年12月。所有患者必须至少有3次访问液相同调失据或3次访问血脂血症的结算代码;他们在2001年7月或此后初次访问后至少6个月，并在VA卫生保健系统中纳入至少1年。基线脂质值可用于LC但不是UC患者。根据NCEP ATP III指南确定胆固醇目标目标。结果：平均后续21.6个月后，LC集团患者的比例达到目标水平从基线的45.2％增加到总胆固醇（TC）的82.6％，基准36.5％至64.3％低密度脂蛋白胆固醇（LDL-C [P <0.001，两者均相比]）。 LDL-C平均含有24.5mg / dl绝对还原（相对减少，19.4％），其它脂质水平的显着改善（用于Tc和LDL-C的P <0.001，P = 0.007用于甘油三酯[TGS]）除高密度脂蛋白胆固醇（HDL-C）外，其从40.0mg / d1下降至36.3mg / dl（p <0.001）。总共50名患者（43.5％）在基线降低脂质药物治疗，随访时，108名患者（93.9％）。与UC相比，LC患者更有可能实现LDL-C的目标（UC，P <0.001）和TC（82.6％对40.9％，P <0.001），但没有差异在与UC（52.2％，p = 0.061）或HDL-C目标的患者的患者的比例为LC（65.2％）（65.2％，P = 0.061）（LC对33.0％的23.5％，P = 0.143）。与UC患者相比，LC患者（93.9％）使用脂降低剂的比例较高（93.9％）（24.3％，P <0.001）。在降脂剂上患者的细胞分析发现，LC组中的显着比例（85.2％）为Gent总胆固醇，而UC的60.7％（P = 0.012）和目标LDL-C（LC为66.7％）对UC的3.39.3％，P = 0.016）。然而，较低的比例为LC-C的目标HDL-C（21.3％）对UC的42.9％（P = 0.043）。总体而言，只有11名LC患者（9.6％）在随访结束时，只有4例血清脂质值达到目标水平（1.7％，P = 0.019）。结论：近三分之二的患者被诊断出患有血脂血症并注册的药剂师管理的LC在NCEP ATP III目标目标中或低于NCEP ATP III目标目标的LDL-C水平，而16％的血脂血症患者从其初级保健提供者接到过腹期性的患者。药剂师管理的LC患者也是达到TC目标目标的可能性（83与41％）的两倍（83 vs.41％），但是2组在达到TG或HDL-C目标目标的患者的比例中没有差异。只有9.6％的LC患者在随访结束时为所有4个单独的脂质措施目标。

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