Randomized clinical trial of a postdischarge pharmaceutical care program vs. regular follow-up in patients with heart failure
Resumen
Objective: To assess the efficacy of a multifactorial educational
intervention carried out by a pharmacist in patients with heart
failure (HF).
Method: A randomized, prospective, open clinical trial in
patients admitted for HF. The patients assigned to the intervention
group received information about the disease, drug therapy,
diet education, and active telephone follow-up. Visits were completed
at 2, 6, and 12 months. Hospital re-admissions, days of
hospital stay, treatment compliance, satisfaction with the care
received, and quality of life (EuroQol) were evaluated; a financial
study was conducted in order to assess the possible impact of the
program. The intervention was performed by the pharmacy
department in coordination with the cardiology unit.
Results: 134 patients were included, with a mean age of 75
years and a low educational level. The patients of the intervention
group had a higher level of treatment compliance than the
patients in the control group. At 12 months of follow-up, 32.9%
fewer patients in the intervention group were admitted again vs.
the control group. The mean days of hospital stay per patient in
the control group were 9.6 (SD = 18.5) vs. 5.9 (SD = 14.1) in the
intervention group. No differences were recorded in quality of life,
but the intervention group had a higher score in the satisfaction
scale at two months [9.0 (SD = 1.3) versus 8.2 (SD = 1.8) p =
0.026]. Upon adjusting a Cox survival model with the ejection
fraction, the patients in the intervention group had a lower risk of
re-admission (Hazard ratio 0.56; 95% CI: 0.32-0.97). The financial
analysis evidenced savings in hospital costs of € 578 per
patient that were favorable to the intervention group.
Conclusions: Postdischarge pharmaceutical care allows for
reducing the number of new admissions in patients with heart failure,
the total days of hospital stay, and improves treatment compliance
without increasing the costs of care.
intervention carried out by a pharmacist in patients with heart
failure (HF).
Method: A randomized, prospective, open clinical trial in
patients admitted for HF. The patients assigned to the intervention
group received information about the disease, drug therapy,
diet education, and active telephone follow-up. Visits were completed
at 2, 6, and 12 months. Hospital re-admissions, days of
hospital stay, treatment compliance, satisfaction with the care
received, and quality of life (EuroQol) were evaluated; a financial
study was conducted in order to assess the possible impact of the
program. The intervention was performed by the pharmacy
department in coordination with the cardiology unit.
Results: 134 patients were included, with a mean age of 75
years and a low educational level. The patients of the intervention
group had a higher level of treatment compliance than the
patients in the control group. At 12 months of follow-up, 32.9%
fewer patients in the intervention group were admitted again vs.
the control group. The mean days of hospital stay per patient in
the control group were 9.6 (SD = 18.5) vs. 5.9 (SD = 14.1) in the
intervention group. No differences were recorded in quality of life,
but the intervention group had a higher score in the satisfaction
scale at two months [9.0 (SD = 1.3) versus 8.2 (SD = 1.8) p =
0.026]. Upon adjusting a Cox survival model with the ejection
fraction, the patients in the intervention group had a lower risk of
re-admission (Hazard ratio 0.56; 95% CI: 0.32-0.97). The financial
analysis evidenced savings in hospital costs of € 578 per
patient that were favorable to the intervention group.
Conclusions: Postdischarge pharmaceutical care allows for
reducing the number of new admissions in patients with heart failure,
the total days of hospital stay, and improves treatment compliance
without increasing the costs of care.
Palabras clave
Randomized clinical trial. Heart failure. Pharmaceutical care. Treatment compliance. Re-admission. Hospital discharge.
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eISSN: 2171-8695
ISSN-L: 1130-6343
Dep. Legal: M-39835-2012
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