医联体药师团队协作建立慢性气道疾病患者长期用药安全评估管理模式的实践

Practice of Management Mode of Long-term Medication Safety Assessment for Chronic Airway Disease Patients Established by Pharmacists Team of Medical Consortium

目的:为药师参与慢病管理提供参考。方法:选取在我院及某医联体所辖5家社区卫生服务中心就诊且符合入选标准的259例慢性气道疾病患者(包括哮喘和慢性阻塞性肺疾病患者),对其进行由我院临床药师带动并指导社区药师共同参与的长期用药安全评估管理,该管理模式主要包括用药安全综合评估与风险分级管理、追踪随访与用药指导、全程化处方审核、建立共享数据库等,实施1年后通过对相关组别的相关指标进行评分评估其效果。结果:实施该管理模式1年后,与实施前比较,高风险组和低风险组患者安全用药认知能力评分分别由(4.49±1.26)和(7.31±1.01)分提高至(5.40±1.56)和(7.44±0.91)分;患者用药依从性评分分别由(4.96±1.21)和(7.08±1.24)分提高至(6.66±1.08)和(7.38±0.98)分;哮喘患者疾病控制测试(ACT)评分分别由(16.15±2.58)和(21.15±1.03)分提高至(16.80±2.57)和(21.64±1.55)分;慢性阻塞性肺疾病患者疾病控制测试(CAT)评分分别由(25.51±4.07)和(14.90±3.95)分降至(24.20±3.96)和(13.80±4.08)分;药师对不合理处方的有效辨识率和干预率分别由3.6%和1.4%提高至9.4%和7.6%,以上差异比较均具有统计学意义(P<0.05)。结论:药师协作团队参与慢性气道疾病患者长期用药安全评估的管理模式可提高慢性气道疾病患者用药认知能力和用药依从性、改善患者疾病控制效果、提升药师对临床不合理用药的辨识和干预能力。

OBJECTIVE： To provide reference for pharmacists to participate in the management of chronic disease. METHODS：A total of 259 patients with chronic airway disease [included asthma and chronic obstructive pulmonary disease （COPD）] met the inclusion criteria were selected from our hospital and 5 community health care centers of medical consortium. These patients received medication safety assessment management,which was led by clinical pharmacists of our hospital with the participation of community pharmacists,including medication safety comprehensive evaluation and risk classification management,follow-up and medication guidance, integrated prescriptions checking, establishment of shared database. 1 years after the implementation,the effectiveness were evaluated by score the relatived indicators in related groups. RESULTS：After a year of the management mode practice,compared with before intervention,the patients’safety medication cognitive ability score in high-risk and low-risk group increased from（4.49±1.26）and（7.31±1.01）to（5.40±1.56）and（7.44±0.91）;medication adherence score increased from（4.96±1.21）and（7.08±1.24）to（6.66±1.08）and（7.38±0.98）;ACT score from asthma patients increased from （16.15±2.58）and（21.15±1.03）to（16.80±2.57）and（21.64±1.55）;CAT score from COPD patients decreased from（25.51± 4.07） and （14.90 ± 3.95） to （24.20 ± 3.96） and （13.80 ± 4.08）;the rate of irrational prescription effective identification and intervention by pharmacists increased from 3.6% and 1.4% to 9.4% and 7.6% ,respectively. All the differences above were statistically significant （P〈0.05）. CONCLUSIONS：The participation of pharmacists in long-term medication safety assessment management for chronic airway disease patients can improve patients’safety medication cognitive ability,medication adherence,disease control and the pharmacists’ability of irrational drug use identification and intervention.