医师-临床药师协作抗凝管理服务在瓣膜病型心房颤动患者中的应用

Anticoagulation management by physician-clinical pharmacist team for patients with valvular atrial fibrillation

目的探讨医师-临床药师协作抗凝管理在瓣膜病型心房颤动(房颤)患者华法林抗凝中的应用价值。方法以2014年1月至2016年12月在临沂市人民医院心内科住院应用华法林抗凝治疗、出院6个月内仍持续治疗并完成随访的瓣膜病型房颤患者172例为研究对象,采用随机数字表法将患者分为对照组(85例)和研究组(87例)。对照组患者就诊于心内科门诊并接受华法林剂量调整;研究组患者接受医师-临床药师协作的华法林抗凝管理。比较两组患者的国际标准化比值(INR)达标率、华法林剂量稳定患者比例、抗凝药物知识、服药信念、服药依从性等。结果两组患者年龄、性别构成、体重、烟酒嗜好、瓣膜病类型、合并疾病、入院INR、入院时抗凝知识评分、入院时服药信念评分、入院时服药依从性评分等差异均无统计学意义(均P>0.05)。干预后,研究组患者INR达标率[52.17%(191/368)比41.02%(121/295),χ2=8.178,P=0.004]、华法林剂量稳定患者比例[74.71%(65/87)比56.47%(48/85),χ2=6.349,P=0.012]、抗凝药物知识评分[(11.03±2.25)分比(10.08±1.86)分,t=3.018,P=0.003]、服药信念得分[(12.23±2.07)分比(11.67±1.48)分,t=2.042,P=0.043]、服药依从性评分[(7.36±0.89)分比(7.04±1.10)分,t=2.112,P=0.036]均高于对照组。结论医师-临床药师协作抗凝管理团队,可以提高抗凝管理水平,提高患者的华法林抗凝知识,增强患者的服药信念,提高患者的服药依从性,提高华法林抗凝达标率和稳定性。

Objective To evaluate the effectiveness of anticoagulation management by physician-clinical pharmacist team for patients with valvular atrial fibrillation. Methods One hundred and seventytwo patients with valvular atrial fibrillation received warfarin therapy for anticoagulation duringhospitalization in Linyi People′s Hospital from January 2014 to December 2016, the patients continued toreceive warfarin therapy for>6 months after discharge. The patients were randomly assigned in two groups:the anticoagulation management was given by physician - clinical pharmacist team in 87 cases (trial group),while the dosage of wargarin was adjusted in outpatient department by physicians alone in 85 cases (controlgroup). The goal attainment rate of international normalized ratio (INR), the proportion of patients with astable warfarin dose, knowledge of anticoagulants, belief of medication, medication compliance werecompared between two groups.Results There were no significant differences in age, sex, body weight,smoking and drinking habits, valvular disease type, comorbidities; and the initial INR, knowledge ofanticoagulants,belief of medication and medication compliance at admission between two groups (all P>0.05). The goal attainment rate of INR (52.17% vs. 41.02%,χ 2 =8.178,P=0.004), the proportion of patientswith a stable dose of warfarin (74.71% vs. 56.47%,χ 2 =6.349,P=0.012), the knowledge of anticoagulants(11.03±2.25 vs. 10.08±1.86, t=3.018, P=0.003), the belief of medication[(12.23±2.07) vs.(11.67±1.48), t=2.042,P=0.043], and the medication compliance[(7.36±0.89) vs. (7.04±1.10), t=2.112 8, P=0.036] in thetrial group were significantly higher than those in control group. Conclusion Anticoagulation managementby physician -clinical pharmacist team can improve the management level of anticoagulation and theknowledge of anticoagulans,enhance the medication belief,improve the goal attainment rate of INR and thecompliance rate of medication in patients with valvular atrial fibrillation.