医疗联合体老年患者多学科诊疗中药物治疗管理模式实践与效果

Practice and Effect of the Medication Therapy Management Model in Geriatric Multidisciplinary Diagnosis and Treatment Under the Background of the Medical Consortium

目的探讨医疗联合体(简称医联体)背景下药物治疗管理(MTM)模式在老年患者多学科诊疗(MDT)中的应用效果。方法选取上海市静安区中心医院老年多病诊治专家联合门诊2019年1月1日至2020年12月31日服务的患者39例,通过询问病史及用药史、评估药物治疗问题(包括适应证、有效性、安全性、依从性)、现场联合会诊、患者教育及随访的方式提供MTM服务,并从总体服务情况、患者就诊来源、疾病分布、药物治疗相关问题(MRPs)、服务效果等方面进行分析和总结。结果 39例患者中,平均年龄(73.07±7.64)岁,平均患病种类(5.10±1.47)种,疾病排序依次为高血压、糖尿病、脑血管疾病和冠状动脉粥样硬化性心脏病;64.10%(25/39)的患者来自社区医院转诊;平均服药种数(9.23±3.70)种;89.74%(35/39)的患者有药物调整诉求;共发现MRPs 196例次,解决182例次;患者主动回访率为38.46%,疾病控制改善率为100.00%,患者满意度为100.00%。不必要的药物治疗、需要增加药物治疗、无效药物及依从性不佳居23项MRPs的前4位。结论该院初步建立了医联体背景下老年患者MDT中的MTM工作模式,能充分发挥药师的作用,提供优质的药学服务,改善药物治疗效果,保障老年患者安全、有效用药。

Objective To investigate the application effect of medication therapy management(MTM)mode in geriatric multidisciplinary diagnosis and treatment(MDT)under the background of the medical consortium.Methods A total 39 patients served by the expert joint outpatient clinic for geriatric MDT in the Jing'an District Central Hospital from January 1st,2019 to December 31st,2020 were selected.MTM services were provided by pharmacists through inquiring about disease and medication history,evaluating medication problems(including indications,effectiveness,safety and compliance),on-site joint consultation,patient education and follow-up.The overall service results,the source of patients,distribution of disease,medication-related problems(MRPs),service outcomes and other aspects were analyzed and summarized.Results The average age of 39 patients was(73.07±7.64)years,and the average number of chronic diseases was(5.10±1.47)kinds with the order of hypertension,diabetes,cerebrovascular disease and coronary heart disease,64.10%(25/39)of the patients were referred from community hospitals,the average number of drugs taken by patients was(9.23±3.70)kinds,89.74%(35/39)of the patients had drug adjustment demands,196 cases of MRPs were found and 182 cases of MRPs were solved.The patient-initiated follow-up was 38.46%,the improvement rate of disease control was 100.00%,and the patients'satisfaction rate was 100.00%.Unnecessary medication,need to increase medication,ineffective drugs and poor compliance were the top four causes amng the 23 kinds of MRPs.Conclusion Our hospital has initially established an MTM service model in the MDT for elderly patients under the background of the medical consortium,which can give full play to the role of pharmacists,provide high-quality pharmaceutical care,improve medication outcomes and ensure safe and effective medication for elderly patients.