实施临床药学服务路径干预COPD患者药物治疗效果调查分析

Investigation and analysis on the effect of drug administration on the treatment of COPD patients with clinical pharmacy service pathway

目的医院临床药师通过对观察组COPD患者实施临床药学服务路径,对比分析干预后观察组和对照组的药物治疗效果,为进一步建立并推广COPD等慢性疾病的医院临床药学服务模式提供可行的方法及依据。方法将2016年4月-2017年2月入院的156例AECO PD患者分为观察组和对照组各78例,对观察组实施临床药学服务路径,收集统计所有患者基本信息、用药医嘱、用药情况,并进行疾病自我评估,出院后随访两组患者的用药依从性,AECOPD发作次数、药物不良事件发生次数,疾病自我评价等具体内容,进行统计并对比分析。结果患者用药依从性按量表评分进行统计,评分在13~16分之间,住院期间观察组47例(60.26%)明显高于对照组19例(24.36%),出院后1月随访观察组18(23.08%)也高于对照组7(8.97%)。出院1月后CAT问卷评分在21~40分之间,观察组52例较对照组66例明显较低,这与临床药师对观察组患者开展用药教育有关。观察组78名患者出院后继续遵医嘱使用吸入制剂70例(89.74%),使用含糖皮质激素吸入剂漱口率67例(95.71%),明显高于对照组51例(67.95%)和32例(62.74%)。对照组有37例(47.44%)的患者AECOPD发作次数≥1次,22例(28.21%)的患者因疾病反复再次入院,发生可疑药品不良反应有9例(11.54%),均明显高于观察组7例(8.97%)、6例(7.69%)和3例(3.84%)。对照组有28例(35.90%)的患者疾病情况自我评估认为病情较1月前严重,用药依从性评分量表提示这些患者的用药依从性评分基本在8分以下,用药依从性不好。结论医院临床药师通过对入院的COPD患者实施临床药学服务路径,可以提高患者对疾病情况的自我认知和用药依从性,提高生活质量,减少AECOPD的次数及入院率,从而节约利用有限的卫生资源。因此,医院临床药师对COPD等临床慢性疾病患者的全程药物治疗管理实施临床药学服务路径是有效可行的,具有积极重要的临床意义。

Objective To observe the clinical pharmacological service pathways of COPD patients in the observation group and to analyze the therapeutic effect of the observation group and the control group after intervention. To further establish and promote the hospital clinical pharmacy service mode such as COPD and other chronic diseases Provide a viable method and basis. Methods A total of 156 patients with AECOPD who were enrolled from April 2016 to February 2017 were divided into the observation group and the control group.78 patients were enrolled in the observation group. All the patients were collected. All the patients were collected. And the self-assessment of the disease, the follow-up of the two groups of patients after follow-up medication, AECOPD episodes, the number of adverse drug events, disease self-evaluation and other specific content, and comparative analysis. Results The compliance of the patients was statistically analyzed by the scale. The score was between 13 and 16, and 47 cases（60.26%） in the observation group were significantly higher than that of the control group（24.36%）. Group 18（23.08%） was also higher than that of the control group 7（8.97%）. The CAT score was 21~40 points after discharge in January, and 52 cases in the observation group were significantly lower than that of the control group,which may be related to the clinical pharmacists＇ education in the observation group. In the observation group, 78 patients（90.71%） were treated with inhalation rate of glucose corticosteroid inhalant, which was significantly higher than that of the control group（67.95%） and 32（62.74%）. In the control group, 37 patients（47.44%） had AECOPD episodes ≥1 times and 22 patients（28.21%） had 9 cases（11.54%） of suspected adverse drug reactions due to repeated hospitalizations. 7 cases（8.97%）, 6 cases（7.69%） and 3 cases（3.84%）. In the control group, 28 patients（35.90%） showed that the disease was more serious than the previous month. The compliance index of the medication showed that the compliance score of these patients was less than 8 points, and the medication compliance was not good. Conclusion Hospital clinical pharmacists can improve the self-awareness and medication compliance of patients with disease, improve the quality of life, reduce the number of AECOPD and the admission rate, thus saving the use of limited health through the implementation of clinical pharmacy service pathways in patients with COPD admitted to hospital Resources. Therefore, the hospital clinical pharmacists on COPD and other clinical chronic diseases in patients with full drug treatment management of clinical pharmacy service path is effective and feasible, which has a very important clinical significance.