Estudio AFPRES-CLMefectividad de un programa de atención farmacéutica comunitaria en pacientes con hipertensión arterial

Abstract

Introduction: The chronicity and aging of the population represent a health, economic and social challenge for the entire world, forcing the necessary transformation of the health system to address it conveniently. The community pharmacy in continuous evolution, through the implementation and development of Professional Assistance Services, can improve the health results of the population, in addition to allowing its adaptation to this new social model. Objective: To determine the effectiveness of the AFPRES-CLM Community Pharmaceutical Care program on the health outcomes of patients with arterial hypertension treated pharmacologically. Material and method: Controlled and randomized study by conglomerates that responds to the CONSORT guidelines carried out in the autonomous community of Castilla-La Mancha (Spain) between January and June 2015. The study population is made up of pharmacologically treated hypertensive patients who attend the community pharmacy and who voluntarily want to participate, excluding patients with secondary arterial hypertension, arrhythmia, pregnancy, who do not want to participate or do not sign the informed consent document. For the calculation of the sample size, studies that measure quality of life were taken into account, which need large samples of patients to detect relevant changes, since these measures are, in general, less sensitive to changes than physiological measures. An estimate of the necessary sample size was also made according to the clinical effectiveness parameter (blood pressure control), obtaining a smaller size than the previous one. The design of this study required a minimum of 240 patients in each group, estimating a rate of loss to follow-up of 20%. The patients were recruited consecutively by the pharmacist and, after signing the informed consent document, their record was sent to the research team that verified the admission criteria, then starting their monitoring depending on whether they were control or intervention. The control pharmacists were trained in the process of recruiting patients and collecting data. The control patient received usual health care at the community pharmacy. For their study, they came at the beginning and end of the observation period. The intervention pharmacists received complementary training, consisting of monthly theoretical-practical clinical sessions in order to be able to individualize each of the pharmaceutical interventions. They were also trained in the action protocol and data collection. The intervention patient went to the pharmacy at least once a month, where they received the AFPRES-CLM Community Pharmaceutical Care Program, consisting of Health Education, Pharmacotherapeutic Follow-up using the Dáder method, and Ambulatory Blood Pressure Monitoring. The main variables were blood pressure control, the use of health resources (hospital admissions, visits to the emergency room, frequency of visits by primary care physicians and specialist physicians) and quality of life (assessed using the SF-36 questionnaire). They were determined in both groups, at the beginning and end of the follow-up period. Results: At the beginning of the follow-up, 63 community pharmacies and 388 patients were recruited, concluding the monitoring of 347 patients. The AFPRES-CLM community program improved blood pressure control (85.8% vs 66.3% p <0.001), decreased the use of emergency services (p = 0.002) and improved the physical component of quality of life , evaluated using the SF-36 questionnaire. 354 negative results of the medication were detected, with 74.9% being resolved satisfactorily, and 330 non-pharmacological pharmaceutical interventions were carried out. 29 ABPM were performed, of which 16 were considered valid, making changes in antihypertensive drug therapy in 6 patients (37,5%). Conclusion: The AFPRES-CLM community pharmaceutical intervention has improved the health outcomes of hypertensive patients undergoing antihypertensive drug treatment, so it can be implemented and generalized in the Community Pharmacy.