社区常见慢性病患者用药整合管理干预效果研究

An Investigation of the Effect of Integrated Drug Management and Intervention on Drug Usage in Community Patients with Chronic Diseases

目的研究整合管理干预对社区常见慢性病患者用药管理的影响。方法 2016年5月—2017年7月,根据纳入与排除标准,选取上海市普陀区长风街道长风社区卫生服务中心(以下简称为中心)慢性病患者242例为研究对象。先调查并记录中心慢性病患者的患病情况(疾病名称、患病种数)和用药种数;随后,在患者知情同意的前提下对其不恰当的用药情况进行整合管理干预,经过3个月及以上的干预,于病情稳定情况下调查患者用药情况(用药种数、用药调整情况及其理由),计算用药种数变化率。结果疾病名称:高血压200例(82.6%),冠心病122例(50.4%),糖尿病63例(26.0%),脑卒中55例(22.7%),骨关节病13例(5.4%),骨质疏松症12例(5.0%),慢性阻塞性肺疾病(COPD)8例(3.3%)。不同性别患者患病种数比较,差异无统计学意义(P>0.05)。80～、≥85岁患者患病种数多于<60、60～岁患者,70～岁患者患病种数多于60～岁患者,80～岁患者患病种数多于65～岁患者(P<0.05)。干预后患者用药种数少于干预前(P<0.05)。用药种数变化率:总体-23.8%,男性-22.4%,女性-25.0%;各类疾病用药种数变化率绝对值从大到小依次为COPD(-45.0%)、脑卒中(-37.9%)、骨质疏松症(-28.6%)、冠心病(-24.0%)、高血压(-21.9%)、骨关节病(-14.3%)、糖尿病(-7.1%)。干预前、后,不同性别患者用药种数比较,差异无统计学意义(P>0.05)。男、女性患者干预后用药种数均少于自身干预前(P<0.05)。高血压、冠心病、脑卒中、糖尿病、COPD患者干预后用药种数少于自身干预前(P<0.05);骨质疏松症、骨关节病患者干预后用药种数与自身干预前比较,差异无统计学意义(P>0.05)。242例患者中,用药种数增加者9例(3.7%),减少者142例(58.7%),无变化者91例(37.6%)。151例用药种数有变化的患者共有206项用药调整,其理由为:病情缓解95项(46.1%),重复用药67项(32.5%),药物不良反应18项(8.8%),不合理用药14项(6.8%),病情需要增加药物12项(5.8%)。结论社区慢性病患者存在着多病共存、用药种数较多的现象,全科医生对患者进行整合管理干预能够调整用药种数,减少重复用药、不合理用药。

ObjectiveTo study the impact of integrated management and intervention on drug usage in community patients with chronic diseases.MethodsFrom May 2016 to July 2017,242 patients with chronic diseases treated in the Changfeng Community Health Care Center,Putuo（hereinafter referred to as the ＂center＂）in Shanghai City who met the study inclusion and exclusion criteria were enrolled in this research.Baseline patient data including diseases and drug usage were recorded.Patients provided informed consent,and inappropriate drug use in these patients was recorded using a management and intervention strategy.After 3 months of intervention,drug usage（the number of administered drugs,drug adjustment and reasons）in the patients was investigated when the patients were stable and compared with the baseline data.ResultsDiseases recorded were as follows：200 cases（82.6%）had hypertension,122 cases（50.4%）had coronary heart disease,63 cases（26.0%）had diabetes,55 cases（22.7%）had stroke,13 cases（5.4%）had osteoarthritis,12 cases（5.0%）had osteoporosis and 8 cases（3.3%）had chronic obstructive pulmonary disease（COPD）.There was no significant difference in the number of diseases between male and female patients（P〉0.05）.Patients aged 80 years and ≥85 years suffered more diseases than patients aged 60 years and 〈60 years,and patients aged 70 years suffered more diseases than patients aged 60 years,patients aged 80 years also had more diseases than patients aged 65 years（P〈0.05）.The number of administered drugs after the intervention was less than the number before the intervention（P〈0.05）.Changes in the number of administered drugs were as follows：overall（-23.8%）,male（-22.4%）,female（-25.0%）;diseases according to their absolute change rates were COPD（-45.0%）,stroke（-37.9%）,osteoporosis（-28.6%）,coronary heart disease（-24.0%）,hypertension（-21.9%）,osteoarthritis（-14.3%）and diabetes（-7.1%）.Before and after intervention,the number of administered drugs in male and female patients were not significantly different（P〉0.05）.The number of administered drugs after the intervention was less than the number before the intervention in both male and female patients（P〈0.05）.The number of administered drugs in patients with hypertension,coronary heart disease,stroke,diabetes or COPD after the intervention was less than the number before the intervention（self-comparison）（P〈0.05）,and both osteoporosis or osteoarthritis showed no significant difference（P〉0.05）.Of the 242 patients,the number of drugs administered increased in 9 cases（3.7%）,the number of drugs administered decreased in 142 cases（58.7%）and no change in the number of drugs administered was observed in 91 cases（37.6%）.Of 151 cases whose administered drugs were changed,there were 206 drug adjustments;the most common reasons for adjustment included：95 items（46.1%）of disease release,67 items（32.5%）of repeat medication,18 items（8.8%）of adverse reactions,14 items（6.8%）of irrational medication,and 12 items（5.8%）of increasing medication due to treatment requirement.ConclusionCommunity patients often have multiple diseases and are administered multiple drugs.Integrated management and intervention can reduce repeat and irrational medications.