临床药师干预糖尿病老年患者用药依从性的效果分析

Analysis on the Effect of Clinical Pharmacist Intervening Drug Compli-ance in Aged Patients with Diabetes Mellitus

目的探讨增加临床药师干预后糖尿病老年患者用药依从性的改善情况和临床疗效，为提高糖尿病患者的用药依从性提供新思路。方法选择2014年1—3月在惠州市第六人民医院糖尿病专科门诊就诊的糖尿病老年患者90例作为研究对象，随机分为3组，每组各30例，其中DM—a组仅进行临床医师的常规治疗，DM—b组在进行常规治疗的同时对患者本人和家属进行干预，DM—c组在DM—b组的基础上增加临床药师药学服务干预。DM—b和DM—c组患者在第一次就诊时就开始实施干预，在就诊半年后监测并记录三组患者空腹血糖（FPG）及餐后2h血糖（2hPG）、糖化血红蛋白（HbA。）指标，并对用药依从性、患者满意度调查，观察干预期间不良反应（ADR）发生情况。结果三组患者均能顺利完成整个疗程。DM—c组患者分别与DM—a组和DM-b组患者比较，FPG[（7．35±1．21）比（8．66±2．01）、（8．36±1．46）mmoi／L]、2hPG[（11．05±1．30）比（12．88±1．44）、（12．55±1．52）mmol／L]和HbA1c水平[（7．44±0．73）％比（8．62±1．20）％、（8．05±1．15）％]明显降低，用药依从性（88％比69％、76％）显著提高，差异均有统计学意义（P〈0．05）；医疗过程方面的患者满意度三组[（8．01±0．88）比（7．74±0．63）、（7．75±0．65）分]差异无统计学意义（P〉0．05），但是DM—c组的药学指导方面的患者满意度较DM—a组、DM—b组[（8．65±0．64）比（2．88±0．43）、（2．97±0．61）分]显著提高，同时ADR发生率（3．3％比L16．7％、13．3％）显著下降，差异有统计学意义（P〈0．05）。结论临床药师对糖尿病老年门诊患者开展药学咨询干预，能大幅度提高患者用药依从性，最大限度地减少了隐性用药失误的发生，改善药物疗效，成功减轻了患者的经济负担，值得临床上广泛应用。

Objective To explore and analyse the improvement and clinical effect of drug compliance in aged patients with diabetes mellitus after adding clinical pharmacist intervention to provide new ideas for improving drug compliance in aged patients with diabetes mellitus. Methods Ninety elder patients with diabetes mellitus who were treated in the Special Outpatient of Diabetes, Sixth People＇s Hospital of Huizhou from January to March 2014 were selected as research objects. They were divided into three groups randomly, with 30 cases in each group. DM-a group were treated with routine treatment, patients and their family members in DM-b group were intervened while taking routine treatment at the same time, DM-c group were given pharmaceutical careintervention by clinical pharmacist on the basis of DM-b group. Patients in DM-b group and DM-c group were intervened in the first treatment on the basis of voluntary. FPG, 2hPG and HbA1c of the three groups were detected and record after treatment for half a year. Drug compliance and satisfactory degree were investigated, and ADE was observed during intervention period. Results Patients in three groups fulfilled the period of treatment successfully. In DM-c group, compared with patients in DM-a group and DM-b group, FPG [（7.35±1.21） vs （8.66±2.01）, （8.36±1.46） mmol/L], 2hPG [（11.05±1.30） vs （12.88±1.44）, （12.55±1.52） mmol/ L] and HbAlc level [（7.44±0.73）% vs （8.62±1.20）%, （8.05±1.15）%] of patients significantly decreased, the drug compliance significantly increased （88% vs 69%, 76%）, the differences were statistically significant （P 〈 0.05）, patients＇ satisfaction had no difference in terms of the whole medical process [（8.01±0.88） vs （7.74±0.63）, （7.75±0.65） scores], the difference was not statistically significant （P 〉 0.05）, however, patients＇ satisfaction in terms of pharmaceutical guidance significantly improved [（8.65±0.64） vs （2.88±0.43）,（2.97±0.61） scores], and incidence of ADE significantly decreased at the same time （3.3% vs 16.7%, 13.3%）, the differences were statistically significant （P 〈 0.05）. Conclusion Providing Pharmacy consultationintervention for aged patients with diabetes mellitus can significantly improve patients＇ drug compliance,reduce invisible medication errorsin maximum, improve the effectiveness of medicine and relieve patients＇ financial burden and it deserves widespread clinical applications.