个性化教育干预提高老年冠心病患者家庭用药安全性的研究

Study on the improvement of safety of family self-medication in elderly patients with coronary heart disease interfered with individualized education

目的探讨社区护士开展用药安全教育干预，对确保非住院老年冠心病患者正确、有效和安全用药的效果。方法随机整群抽取在沙井街道20个社康服务中心建档的老年冠心病患者120例作为干预对象。采用自行设计的《老年冠心病患者用药相关知识、信念、行为状况调查表》在教育干预前、后对干预对象进行调查、评估和分析。根据认识水平的差异，选用多种形式对入选患者进行个性化用药教育干预。结果与干预前比较，干预后患者对用药知识掌握程度的9项指标差异有统计学意义（P〈0．01）；在用药行为方面，教育干预后患者用药时关注药物的安全性、能按医生要求的用药次数服药、心绞痛发作时能正确应用急救药物、自己从不随意更换药物4项行为正确率显著提高（P〈0．01）；收缩压及舒张压均降低（P〈0．01）；干预后第3个月及第6个月药物不良反应例次数减少。结论社区护士有效的教育干预可以提高冠心病患者的自我保健能力，增加患者的用药知识，促进其树立正确的用药信念，建立良好的遵医用药行为，是保障该群体用药有效性和安全性的有力措施。

Objective To discuss effect of intervention with the education of medication safety by community nurses on ensuring rightness, effectiveness and security of medication in non-patient elderly patients with coronary heart disease （CHD）. Methods 120 elderly patients with CHD were given educational intervention extracted with random cluster sampling from the patients whose files were established in 20 community health centers in Shajing subdistrict. Investigation, evaluation and analysis were made with self- designed ＂questionnaire on the knowledge, belief and behavior of medication in the elderly patients with CHD＂ pre and post-intervention. The medical intervention was performed with individualized education and a variety of forms according to individual cognitive level. Results 9 indexes in the aspect of the mastery degree of patients＇ medication knowledge were differed between pre and post-intervention significantly （ P 〈 0. O1 ）, The accuracy rates of 4 medication behaviors, including the patients＇ attention paid to medication safty, the patients＇ compliance with the medication times prescribed by doctors, the rightness of using emergency drugs by the patients during angina attack and the self-changing drugs by the patients, were promoted significangly （ P 〈 0. 01 ）. The systolic and the diastolic pressures decreased significantly. The number and the times of adverse drug reaction decreased significantly. Conclusions The effective education intervention developed by community nurses improve the abilities of self health care, increase medication knowledge, promote setting up belief of correct medication, establish medication beaviors of compliance with doctors in the patients with CHD. The intervention is a strong measure of ensuring the effectiveness and safety of medication in the population.