社区癌痛患者药学服务实施及效果评价

Effects of Pharmaceutical Care in Community Patients with Cancer Pain

目的提高社区癌痛患者疼痛控制达标率,改善患者对癌痛管理的满意度。方法组建由社区公共卫生服务人员、临床药师、社区医生以及追踪药师共同组成的照护团队,对社区癌痛患者开展药学服务,并对照护效果进行追踪评价。结果临床药师为17名中、重度癌痛患者提供药学服务52次,发现药物治疗问题224例,提出药学建议337条。接受药学服务后,患者过去24 h最严重的疼痛程度、最轻微的疼痛程度、平均的疼痛程度由(9.12±1.34),(5.53±1.46)和(7.24±1.99)分下降至(4.71±1.36),(1.18±0.95)和(2.41±1.18)分(P<0.01);用药"高依从性"患者比例由0%升至64.7%(P<0.01)。患者对药学服务能"帮助了解所用药品"、"协助按时用药"、"减少药品不良反应"、"帮助建立正确的用药观念"以及"减少医药花费"的评分依次为(4.35±0.49),(4.53±0.51),(4.00±0.61),(4.29±0.59)和(3.76±0.66)分;患者对"药学服务的方便性"、"药师能力"、"药师态度"、"病情改善"、"提高生活质量"的评分依次为(4.06±0.66)、(4.24±0.44)、(4.20±0.40)、(4.41±0.71)和(4.29±0.47)分。结论社区癌痛患者所面临的药物治疗问题多而复杂。药学服务可以减少药物治疗问题,提高疼痛控制达标率,改善患者对癌痛管理的满意度。患者对药学服务持肯定态度。

OBJECTIVE To improve the control rate of cancer pain and the satisfaction of community patients with cancer pain. METHODS A mukidisciplinary team was built, which included community public health workers, clinical pharmacists, community physicians and tracking pharmacists. Pharmaceutical care was provided to patients with cancer pain in the community, and the effects of pharmaceutical care were evaluated. RESULTS The clinical pharmacists provided 52 times of pharmaceutical care to 17 patients, 224 cases of medication problems were discovered, and 337 pieces of medication suggestions were made. After receiving pharmaceutical care,the scores of the most severe pain,the mild pain and the average pain in the past 24 h decreased from（9. 12 ±1.34）, （5.53 ±1.46 ） and （7. 24 ± 1.99） to （4. 71 ± 1.36）, （ 1. 18 ± 0. 95 ） and （ 2.41 ± 1.18 ） （ P 〈 0. 01 ）, respectively. The percentage of good medication compliance increased from 0% to 64. 7% （P 〈 0.01 ）. The influence of pharmaceutical care on patients included ＂helping understand the drugs＂, ＂ taking medicine on time＂, ＂reducing adverse drug reaction＂ ,＂ establishing correct concept of medication＂ and ＂reducing medical costs＂, which got scores of （4. 35 ± 0.49 ）, （4. 53 ± 0. 51 ）, （4. 00 ±0. 61 ）, （4. 29 ± 0. 59 ）, and （3.76 ± 0. 66）, respectively. For ＂convenience of pharmaceutical care＂ ,＂ pharmacist ability＂, ＂pharmacists＇ attitude＂ ,＂ symptom improve- ment＂ and ＂improvement of the quality of life＂ ,the patients gave scores of （4.06 ±0. 66）, （4. 24 ±0.44）, （4.20 ±0.40）, （4.41 ± 0. 71 ） and （4. 29 ± 0. 47）, respectively. CONCLUSION The problems in the drug treatment in community patients with cancer pain are numerous and complex. Pharmaceutical care can reduce the problems, improve the control rate of cancer pain, and increase the community patients＇ satisfaction on the management of cancer pain. The patients give positive evaluation to the pharmaceutical care.