规范化药学服务对AECOPD患者临床治疗的干预效果评价

Evaluation of Intervention Effects of Standardized Pharmaceutical Care on Clinical Treatment of AECOPD Patients

目的:评价规范化药学服务对慢性阻塞性肺疾病急性加重期(AECOPD)患者临床治疗的干预效果。方法:选取2014年9月-2015年3月于我院呼吸内科治疗的AECOPD患者127例,采用随机数字表法分为对照组(63例)和观察组(64例)。对照组患者仅接受传统的医疗服务和药物治疗,观察组患者在对照组基础上,由临床药师参照AECOPD临床药学路径给予规范化的药学服务,并于出院1个月后进行电话随访。比较两组患者住院期间抗菌药物使用情况,住院期间及出院后的用药依从性、药品不良事件(ADE)发生情况、满意度和用药偏差,以及出院后患者对ADE的知晓程度和复诊率。结果:住院期间两组各有1例患者脱落;有33例患者未完成出院后随访。住院期间,观察组患者的用药依从率以及对一般医疗过程和用药指导的总满意度均显著高于对照组,而抗菌药物使用率、抗菌药物联合使用率、使用强度、ADE发生率和用药偏差的比例均显著低于对照组,差异均有统计学意义(P<0.05)。出院后,观察组患者的ADE知晓率以及对用药指导的总满意度均显著高于对照组,ADE发生率显著低于对照组,差异均有统计学意义(P<0.05);而两组患者用药依从率、复诊率和用药偏差的比例比较,差异均无统计学意义(P>0.05)。结论:规范化的药学服务可明显提高住院患者的用药依从性和满意度,有助于抗菌药物的合理使用,可降低ADE的发生率,减少用药偏差,但对出院后患者的用药依从性、复诊率和用药偏差的影响不大。

OBJECTIVE： To evaluate the intervention effects of standardized pharmaceutical care on clinical treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） patients. METHODS： A total of 127 AECOPD patients were collected from respiratory medicine department of our hospital during Sept. 2014-Mar. 2015, and then divided into control group （63 cases） and observation group （64 cases） according to random number table. Control group only received traditional medical service and drug therapy. Observation group was additionally given standardized pharmaceutical care provided by clinical pharmacists according to AECOPD clinical pharmacy pathway on the basis of control group. The patients were followed up 1 month after discharge. The use of antibiotics during hospitalization, medication adherence, the occurrence of ADE, patient satisfaction and medication bias during hospitalization and after discharge, the rates of ADR awareness and return visit after discharge were compared between 2 groups. RESULTS： In both groups, 1 patient withdrew from the study during hospitalitation; 33 patients didn’t complete return visit after discharge. During hospitalization, the rate of medication adherence and the total satisfaction of traditional medical procedures and medication guidance in observation group were significantly higher than control group; the utilization ratio of antibiotics and combined use of antibiotics, AUD, the incidence of ADE, the proportion of medication bias were significantly lower than control group, with statistical significance （P〈0.05）. After discharge, the rate of ADR awareness and the total satisfaction of medication guidance in observation group were significantly higher than control group, and the incidence of ADR was significantly lower than control group, with statistical significance （P〈0.05）. There was no statistical significance in the rate of medication compliance, the rate of return visit, the proportion of medication bias between 2 groups after discharge （P〉0.05）. CONCLUSIONS： The standardized pharmaceutical care can significantly improve medication compliance and satisfaction of inpatients, contribute to rational use of antibiotics, reduce the incidence of ADE and medication bias, but have no significant effect on medication compliance, the rate of return visit and medication bias of discharged patients.