药师与医护人员协作管理对降低心力衰竭医保患者再住院率和医疗费用的影响

Effects of pharmacists and medical staff co-operation on reduction of re-hospitalization and medical expenses of heart failure patients

目的评价药师与医护人员协作管理模式对降低心力衰竭医保患者再住院率和医疗费用的影响。方法建立由心血管专科医生、心血管专业临床药师和心内科护师组成的管理团队,将124例确诊为C期慢性心力衰竭的医保住院患者根据年龄±5年、脑利钠肽(BNP)±100 pg/ml、射血分数±5%、血肌酐±0.5 mg/dl、血压同一分级、是否合并糖尿病6个因素1∶1配对,随机分配接受团队管理组治疗或传统治疗组治疗,评价18个月后两组患者的管理效果。结果与传统治疗组相比,团队管理组患者因心衰再住院率、诊疗的总费用、生活质量、住院费用、药费、住院天数显著低于传统治疗组(均为P<0.01),药物治疗依从性、ACEI/ARB达标率、β受体阻滞剂达标率显著高于传统治疗组(均为P<0.05),全因死亡率、ACEI/ARB使用率、β受体阻滞剂使用率与传统治疗组比较差异无统计学意义(均为P>0.05)。结论药师与医护人员开展协作管理模式在改善心力衰竭医保患者生活质量,降低再入院率和医疗费用等方面效果显著,值得推广应用。

Objective To evaluate the effects of collaboration between pharmacists and medical staff on re-hospitalization rate and medical expenses of heart failure patients. Methods A management team consisting of cardiologists,clinical pharmacists and registered nurses was established. The 124 medicalinsured inpatients with phase C of chronic heart failure,were randomly divided into two groups： team management group and traditional treatment/control group. Team group and control group was 1∶ 1 matched by 6 factors including age（ ± 5y）,BNP（ ± 100 pg/ml）,ejection fraction（ ± 5%）,creatinine（ ± 0. 5mg/dl）,blood pressure of same grade and with or without diabetes. The management effects of two groups were evaluated after 18 months. Results Compare control group,the re-hospitalization for heart failure,total medical cost,quality of life,hospitalization cost,medication cost and days of hospitalization in team group were significantly lower（ all P 0. 05）. Medication adherence,compliance rate of ACEI or ARB and beta blockers in team group was significantly higher than control group（ all P 0. 01）. All-cause mortality,utilization rate of ACEI,ARB and beta blockers were not significantly different between the two groups（ all P 0. 05）. Conclusions The cooperative management model of pharmacists and medical staffs has significant effects on improving the quality of life,reducing insurance expenses and readmission rate in heart failure patients. This mode is worth popularization and application.