临床药师参与慢性心力衰竭疾病管理的效果评价

Effects Evaluation of Clinical Pharmacists Participating in Disease Management of Chronic Heart Failure

目的:评价临床药师参与慢性心力衰竭(CHF)疾病管理的效果。方法:选择2013年1月-2014年12月于我院心血管内科住院治疗的CHF患者180例,按照随机数字表法分为对照组和药师管理组,各90例。对照组患者给予常规治疗,药师管理组患者在此基础上,由临床药师提供药学监护、心理疏导、用药教育和为期6个月的出院随访等个体化药学服务。比较入院和出院时两组患者综合自护能力,比较出院6个月内两组患者再住院和病死情况,比较入院和出院6个月后两组患者美国纽约心脏病学会(NYHA)心功能分级、左室射血分数(LVEF)、血浆N末端脑钠肽前体(NT-pro BNP)水平及其生活质量。结果:入院时,两组患者对疾病相关知识的了解、自理能力、用药依从性评分和综合自护能力总分比较,差异均无统计学意义(P>0.05);出院时,两组患者各项评分和总分均优于入院时,且药师管理组明显优于同期对照组,差异均有统计学意义(P<0.05)。出院6个月内,药师管理组患者的再住院率明显低于对照组,差异具有统计学意义(P<0.05);而两组患者病死率比较,差异无统计学意义(P>0.05)。入院时,两组患者NYHA心功能分级、LVEF和血浆NT-pro BNP水平比较,差异均无统计学意义(P>0.05);出院6个月后,药师管理组患者的上述3个指标,对照组患者的NYHA心功能分级和血浆NT-pro BNP水平均较入院时明显改善,且药师管理组患者NYHA心功能分级、LVEF和血浆NT-pro BNP水平均明显优于同期对照组,差异均有统计学意义(P<0.05)。入院时,两组患者的社会限制、情绪、症状评分和生活质量总分比较,差异均无统计学意义(P>0.05);出院6个月后,两组患者的各项评分和总分均优于入院时,且药师管理组明显优于同期对照组,差异均有统计学意义(P<0.05)。结论:临床药师参与CHF疾病管理可提高患者的综合自护能力,降低患者的再住院率,改善患者的心功能,提高患者的生活质量。

OBJECTIVE：To evaluate the effects of clinical pharmacists participating in disease management of chronic heart failure（CHF）. METHODS：A total of 180 CHF inpatients selected from cardiovascular medicine department of our hospital during Jan. 2013 to Dec. 2014 were divided into control group and pharmacist management group according to random number table,with 90 cases in each group. The control group was given routine treatment. The pharmacist management group additionally received indi-vidualized pharmaceutical care,such as pharmaceutical monitoring,psychological counseling,medication education and 6-month follow-up. The comprehensive self-care ability of the 2 groups were compared on admission and on discharge;re-hospitalization and mortality were compared between 2 groups within 6 months after discharged;the patients’NYHA classification,LVEF,plas-ma level of NT-proBNP and quality of life were compared between 2 groups on admission and 6 months after discharge. RE-SULTS：There was no statistical significance in the cognition of patients to disease,self-care ability,medication compliance score and total comprehensive self-care ability score between 2 groups on admission （P〉0.05）. Each score and total score of 2 groups were better on discharge than on admission,and the pharmacist management group was better than control group,with statistical significance（P〈0.05）. Within 6 months after discharge,re-hospitalization rate of pharmacist management group was significantly lower than that of control group,with statistical significance （P〈0.05）. There was no statistical significance in mortality rate be-tween 2 groups （P〉0.05）. There was no statistical significance in NYHA classification,LVEF,plasma level of NT-proBNP be-tween 2 groups on admission（P〉0.05）. 6 months after discharge,the above 3 indexes of pharmacist management group as well as NYHA classification and plasma level of NT-proBNP of control group were improved significantly compared to on admission;NYHA classification,LVEF and plasma level of NT-proBNP of pharmacist management group were better than those of control group at corresponding period,with statistical significance （P〈0.05）. There was no statistical significance in social limit,mood, symptom score and total score of life quality between 2 groups on admission（P〉0.05）. 6 months after discharge,each score and total score of 2 groups were all better than on admission,and the pharmacist management group was better than control group, with statistical significance （P〈0.05）. CONCLUSIONS：The participation of clinical pharmacists in the disease management of CHF can significantly improve comprehensive self-care ability,decrease re-hospitalization rate,ameliorate cardiac function and en-hance the quality of life.