区域中心医院与社区医院临床药师协同管理门诊高血压患者的效果研究

Study on effect of cooperative management of outpatient hypertension patients by clinical pharmacists in regional central hospital and community hospital

目的通过区域中心医院临床药师与社区临床药师协同管理的模式,提高门诊高血压患者的用药依从性、血压达标率以及解决患者的药物相关问题。方法上海市浦东医院临床药师收集2020年6月至2020年8月来医院就诊的符合纳入和排除标准的高血压患者信息,录入慢性病管理系统,对应的社区临床药师和/或中心医院药师进入慢性病管理系统,对患者进行2个月一次的随访、干预,全程共6个月,评估患者前后的依从性(Morisky评分)、血压达标率以及药物相关问题(欧洲药学监护联盟分类系统)。结果总共入组高血压患者65例,失访0例。随访期间,患者的依从性评分持续提高;第2个月随访时的血压达标率较入组时显著增高,第4个月随访时的血压达标率较第2个月显著提高,有统计学意义(P<0.05);共发现药物相关问题58例次,提出干预方案92条,最终解决药物相关问题45例次。结论采用中心医院和社区临床药师的协同管理模式对高血压患者进行慢性病管理,可以高效提高患者依从性、提高患者血压达标率以及解决患者的药物相关问题,体现临床药师价值,该经验值得推广。

Objective Through the cooperative management mode of clinical pharmacists in regional central hospital and community clinical pharmacists,to improve the medication compliance and the blood pressure compliance rate of outpatients with hypertension and to address their drug-related problems.Methods The information of outpatients with hypertension meeting inclusion and exclusion criteria was collected and recorded by clinical pharmacists in regional central hospital through chronic disease management system(applet),then the medication compliance(by Morisky score),the success rate of hypertension,and drug-related problems(by Pharmaceutical Care Network Europe classification system).The patients was assessed by the clinical pharmacists of the corresponding communities and regional central hospital through the applet every 2 months for a total of three times.Result A total of 65 patients were enrolled and no patients were lost to follow-up.During the follow-up,the patients’compliance score continued to improve;The blood pressure compliance rate at the second month follow-up was higher than that at the enrollment,and the blood pressure compliance rate at the fourth month follow-up was significantly higher than that at the second month(P<0.05);A total of 58 cases of drug-related problems were found,92 intervention plans were proposed,and 45 cases of drug-related problems were finally solved.Conclusion The cooperative management mode of the clinical pharmacists in regional central hospital and community healthcare centers for chronic disease management of hypertension patients could effectively improve patient compliance,improve the blood pressure compliance rate and solve drug-related problems of patients,which reflected the value of clinical pharmacists.This experience is worthy of promotion.