门诊慢性肾脏病患者治疗药物管理研究

Medication therapy management for outpatients with chronic kidney disease

目的：基于慢病管理模式对门诊慢性肾脏病（chronic kidney disease,CKD）患者的治疗药物进行管理,以期提高药物治疗的安全性和有效性。方法：在已构建的慢病管理模式指导下,肾内科临床药师与临床医师组成治疗团队,对2015年5月至2015年10月在北京大学第三医院肾脏内科门诊就诊的CKD患者进行治疗药物管理,记录患者人口学信息、疾病诊断、实验室检查指标和药物重整清单,评估患者药物相关问题（medication-related problems,MRPs）,用SPSS 21.0对数据进行统计分析。结果：研究共纳入116例患者,男性64例,平均年龄（62±16.9）岁（范围：18~88岁）。CKD3期48%,CKD4期29%,CKD5期23%。91例（78%）患者合并高血压,29例（25%）患者合并糖尿病,62例（53%）患者合并高尿酸血症。每例患者平均服用药物（4.5±2.6）种（范围：1~13种）,≥5种的患者有59例（51%）,药物种类包括降压药、降糖药、心血管系统药物、降尿酸药、纠正肾性贫血及肾性骨病的药物以及肾脏保守治疗药物。临床药师通过评估共发现药物相关问题65个,涉及药物安全、有效、适宜和顺应性。结论：门诊CKD患者合并疾病和用药均比较复杂,临床药师基于慢病管理模式能够对患者进行有效的药物治疗管理。

Objective： To administrate the drug application for outpatients with chronic kidney disease（ CKD） based on Chronic Disease Management Model,in order to improve the safety and effectiveness of drug therapy. Methods： For CKD patients who visited Peking University Third Hospital Renal Division from May 2015 to October 2015,clinical pharmacists together with the clinician in Department of Nephrology administrated patients＇ drug therapy,and filled their medication records including patient demographic information,disease diagnosis,laboratory parameters,and Medication Reconciliation list. Patients＇ medication-related problems（ MRPs）were assessed in Chronic Disease Management Model guidance,and SPSS 21. 0 was used for statistical analysis.Results： Totally 116 patients were included in the study. Sixty-two were male; mean age was（ 62 ± 16. 9） years（ range 18 ~ 88 years）. Forty-eight percent of the patients had stage 3 CKD,29% stage 4,and 23% stage 5.Ninety-one patients（ 78%） had hypertension; 29 patients（ 25%） had diabetes mellitus; 62 patients（ 53%） had hyperuricemia. The average number of drugs used per patient was（ 4. 5 ± 2. 6） species（ range 1 ~ 13 species）,and 59 patients（ 51%） took more than five species including drugs for hypertension,cardiovascular disease,hyperuricemia,renal anemia and renal bone disease. Sixty-five medication-related problems were found,involving drug safety,effectiveness,suitability,and compliance. Conclusion： Treatment of outpatients with chronic kidney disease is complicated,clinical pharmacist can administrate the drug application for outpatients effectively based onChronic Disease Management Model.