运用PCNE分类系统对COPD和脑卒中患者进行药学监护的前瞻性队列研究

A prospective study of pharmaceutical care in patients with COPD and stroke on the PCNE classification system

目的:本研究是中国临床药师首次将欧洲医药保健网分类系统(PCNE)应用于COPD和脑卒中患者的药学监护,探索解决药物相关问题(DRPs)的闭环管理模式(发现问题-分析问题-解决问题-评价结果)。方法:前瞻性收集某院2017年8月1日—2017年11月11日诊断为COPD或脑卒中住院患者,随机分为简单反馈组和药师主导的信息干预组(简称信息干预组),依据PCNE分类,分析DRPs的数量、问题类别、原因、干预、转归和涉及药物等因素的差异。结果:(1)纳入病例791例(简单反馈组379例,信息干预组412例);(2)DRPs发生数:信息干预组125例,简单反馈组25例,两组有显著性差异(P<0.01)。DRPs易发生于肝、肾功能不全(41.6%)及住院天数>15 d(26.5%)患者;(3)DRPs问题主要涉及治疗安全性(71个)和治疗有效性(46个);原因主要为药物选择错误(80个);药师干预中:医生层面147个(118个为药师主动干预);药物层面131个;患者层面30个。干预接受率92.6%,其中88.1%干预完全执行。(4)DRPs涉及药物主要为质子泵抑制剂和辅助用药。结论:建立在信息系统基础上的PCNE分类系统可帮助临床药师更有效地发现COPD和脑卒中患者的DRPs,实现药学服务数据系统化的收集、分类、归纳和评估,有助于药学监护记录的标准化和规范化,也将为DRPs数据库建设提供模块化管理思路。

OBJECTIVE To explore the closed-loop management model of ＂problem discovery-problem analysis-problem solving-evaluation results＂ when dealing with drug-related problems（DRPs）in patients with COPD and stroke on Pharmaceutical Care Network Europe（PCNE）classification system used by Chinese clinical pharmacists for the first time.METHODS A prospective trial was conducted in hospitalized patients with COPD or stroke from August 1 to November 11,2017.Patients were randomized into two groups：the simple feedback group and the pharmacist-led information intervention group（information intervention group）.The assessment of quantity,problem categories,causes,interventions,outcomes of DRPs was based on the PCNE classification.RESULTS Totally 791 cases（379 in the simple feedback group and 412 in the information intervention group）were enrolled,and 125 and 25 DRPs were identified in the information intervention group and simple feedback group,respectively（P〈0.01）.Data showed that DRPs were more likely to occur in patients with liver or renal insufficiency（41.6%）and hospitalized for〉15 d（26.5%）.DRPs were mostly related to treatment safety（n=71）and efficacy（n=46）.DRPs were mainly caused by drug selection（80）.The interventions were at prescriber（n=147）,drug（n=131）,and patient（n=30）levels.At the prescriber level,there were 118 active interventions by pharmacists.The acceptance rate of the intervention proposals reached 92.6%,including 88.1% that were fully implemented.Drugs associated with DRPs were proton pump inhibitors and auxiliary drugs.CONCLUSION The PCNE classification system based on the information system can help clinical pharmacists to more effectively identify DRPs in patients with COPD and stroke,and realize the systematic collection,classification,induction and evaluation of pharmaceutical service data,which is conducive to the standardization and normalization of pharmaceutical monitoring records,and will also provide modular management ideas for the construction of DRPs database.