珠海儿童支气管哮喘的药学服务模式效果研究

Role of Pharmacy Service Modality on Childhood Asthma in Zhuhai City

目的本研究旨在观察临床药学服务对于儿童支气管哮喘的改善情况。方法进行了一项随机双盲对照研究,比较传统发药模式和临床药学服务模式的影响。90例支气管哮喘患儿入组,年龄在2-12 a,经临床医生确诊为支气管哮喘后,随机分为传统发药模式组和临床药学服务模式组,主要观察2组患儿不同时间点用药依从性、就诊次数和例数以及哮喘控制情况。结果传统发药模式组中依从性评分量表中≥30分在1个月、3个月和6个月分别为31%、29%和33%;相比药学服务组达到了76%（P=0.002）、85%（P=0.000 1）和94%（P=0.000 2）。药物服务组患儿的就诊次数和例数都明显降低,特别是7-12个月,与传统发药模式比有明显的统计学差异（P=0.002;P=0.024）;在哮喘控制上,儿童哮喘控制测试量表显示,传统发药模式组中评分≥30分的患者比例在1-3个月内为27%,4-6个月为31%,7-12个月为30%;相比药学服务模式组达到了53%（P=0.028）、82%（P=0.001）和92%（P=0.0002）。临床医生和简易肺功能检测中,传统发药模式组中完全控制的患儿比例、1、3和6个月分别为53%、66%和65%,相比药学服务组分别为70%（P=0.020）,85%（P=0.026）和90%（P=0.005）。结论在儿童支气管哮喘中开展药学服务,有助于改善患儿的病情,使哮喘得到较好的控制,这一服务模式可以长期开展,以此降低和控制儿童支气管哮喘的发病。

Objective To evaluate whether a clinical pharmacy intervention could improve the management of Childhood asthma in Zhuhai City. Methods A double-blind randomized controlled trial in the hospital between Jun 1,2012 and May31,2013 was conducted. Participants aged 2-12 years with asthma,were randomly assigned（ 1 ∶1）,by a computerized system to receive a clinical pharmacy intervention pattern or a regular drug dispensing pattern. The primary outcome was a change in treatment compliance,visit frequency and case number and the rates of asthma exacerbation. Results 90 participants were randomly divided into the clinical pharmacy intervention group（ active group,n = 44） and regular drug dispensing group（ control group,n = 46）; all participants completed follow-up to month 12. At month 1,3 and 6,the rates of scores at 30 points or more（ evaluated by treatment compliance test scale） were higher in patients in the clinical pharmacy intervention group than in those in the control group（ at month 1,31% vs 76%,P = 0. 002; at month 3,29%vs 85%,P = 0. 000 1; and at month 6,33% vs 94%,P = 0. 000 2）. Compared to those in control group,patient＇s visit frequency and case number were more significantly reduced in the clinical pharmacy intervention group,especially during the last 3 month（ P = 0. 002,P = 0. 024）. In control of asthma,total control rates of asthma,according to the scores 30 points or more evaluated by Children Asthma Control Test Scale,were higher in patients in the clinical pharmacy intervention group than in those of the control group（ during the first 3 month,27% vs 53%,P = 0. 028; during the second 3 month,30% vs 82%,P = 0. 001; and during the last 6 months,31% vs 92%,P = 0. 000 2）; by the evaluation of clinician and brief pulmonary function test,total control rates of asthma were also higher in patients in the active group than in those in the control group（ during the first 3 month,53% vs 70%,P = 0. 020; during the second 3 month,66%vs 85%,P = 0. 026; and during the last 6 months,65% vs 90%,P = 0. 005）. Conclusion Clinical pharmacy intervention is modestly more effective than regular drug dispensing pattern,especially for reducing the rates of total control of asthma.The intervention could be implanted in the clinic setting. Future study is warranted in much more childhood chronic disease.