双向转诊模式下慢性心脑血管疾病患者出院后用药差异调查研究

Study on the difference of drug use in patients with chronic cardiovascular and cerebrovascular diseases after discharge under the two-way referral model

目的:调查双向转诊模式下慢性心脑血管疾病患者出院后用药差异发生率及相关影响因素,为完善转诊双方临床药物管理、减少出院后用药差异的发生提供依据。方法:采用改良版用药差异调查评估工具(MTD)对下转社区管理的302例出院后4~5周的高血压、冠心病、脑卒中患者进行电话或面对面随访,了解患者用药差异发生情况、类型及原因,并进行相关因素评价。结果:用药差异发生率34.4%,以停止服用药物最为常见。其中,患者源性用药差异发生率81.8%,医源性用药差异发生率18.2%,用药差异发生与出院后取药地点、患脑卒中及合并≥2种慢性疾病相关。结论:基层医疗机构应重视出院患者用药教育,进一步完善双向转诊医院间药品目录的统一,规范下转制度和技术指导,建议在慢性疾病患者出院4~5周后、病情及治疗方案相对稳定后下转社区取药,以减少出院后用药差异的发生。

Objective：To explore the incidence and related factors of the difference of drug use in patients with chronic cardiovascular and cerebrovascular diseases after discharge under the two-way referral model,to provide a basis for improving the clinical drug management of the two sides of the referral and reducing the difference of drug use after discharge.Methods：Using the improved version difference survey and evaluation tool（MTD）,we conducted telephone or face-to-face follow-up for 302 cases of hypertension,coronary heart disease and stroke after discharge for community to 4 to 5 weeks after discharge,to understand the occurrence,type and cause of the difference in drug use,and to evaluate the related factors.Results：The rate of difference in drug use was 34.4%,and the most common case was to stop taking drugs.Among them,the incidence of drug difference in patients was81.8%,and the incidence of iatrogenic drug difference was 18.2%,the difference in drug use was related to the drug taking place after discharge,stroke and two or more chronic diseases.Conclusion：The basic level medical institutions should pay attention to drug education for discharged patients,and further improve the integration of two way referral hospital drug list,standardize the down transfer system and technical guidance,we suggest that patients with chronic diseases can be taken in the community at 4 to5 weeks after discharge and relatively stable condition and treatment plan to reduce the difference in the drug use after discharge.