临床药师主导的慢病管理在184例缺血性脑卒中患者中的效果评价

Evaluation of Clinical Pharmacist-led Chronic Disease Management in 184 Patients with Ischemic Stroke

目的:评价临床药师主导的缺血性脑卒中患者管理的效果,为慢病管理提供参考。方法:前瞻性纳入2018年5-8月在河北医科大学第一医院神经内科住院治疗的184例缺血性脑卒中患者,采用随机数字表法分为对照组(92例)和干预组(92例),对照组不实施临床药师干预,干预组以临床药师为主导对患者进行住院期间药学监护、出院时用药教育、出院后药学随访等慢病管理措施;考察两组患者出院6个月时的用药(使用抗血小板药、降压药、降糖药和降脂药)依从性良好率及血压、血糖[糖化血红蛋白(HbA1c)]、血脂[低密度脂蛋白(LDL-C)]等缺血性脑卒中二级预防控制指标的达标率,考察两组患者出院6个月时的药品不良反应发生率及再住院率。结果:最终干预组与对照组统计患者数分别为84、82例。出院6个月时,干预组使用抗血小板药的用药依从性良好率为96.43%,高于对照组的95.13%,但差异无统计学意义;干预组使用降压药、降糖药和降脂药的用药依从性良好率分别为92.86%、91.67%和77.38%,高于对照组的78.57%、69.70%和60.98%,差异有统计学意义(P<0.05);干预组血压指标的达标率为89.29%,高于对照组的76.79%,但差异无统计学意义;干预组HbA1C和LDL-C指标的达标率分别为80.56%和66.67%,高于对照组的57.58%和48.78%,差异有统计学意义(P<0.05);干预组药品不良反应发生率为15.48%,低于对照组的20.73%,但差异无统计学意义;干预组再住院率为7.14%,低于对照组的17.86%,差异具有统计学意义(P<0.05)。结论:以临床药师为主导对缺血性脑卒中患者进行管理,可提高患者的用药依从性,提高缺血性脑卒中二级预防控制指标的达标率,降低再住院率。

OBJECTIVE:To evaluate the effects of clinical pharmacist-led ischemic stroke management,and to provide reference for chronic disease management.METHODS:Totally 184 patients with ischemic stroke who were hospitalized in neurology department of the First Hospital of Hebei Medical University from May to August 2018 were included prospectively,and then divided into control group(92 cases)and intervention group(92 cases)by random number method.Control group did not receive clinical pharmacist intervention.In the intervention group,clinical pharmacists were the leader in the pharmaceutical care during the hospitalization,the medication education at discharge,and pharmacy follow-up after discharge.The rate of medication compliance(antiplatelet drugs,antihypertensive drugs,hypoglycemic drugs and lipid-lowering drugs)and the rate of secondary prevention and control indicators of ischemic stroke,such as blood pressure,blood glucose[glycated hemoglobin(HbA1 c)]and blood lipid[low-density lipoprotein cholesterol(LDL-C)]were investigated between 2 groups at 6 months after discharge.The incidence of adverse drug reaction and the rate of rehospitalization were compared between 2 groups at 6 months after discharge.RESULTS:The number of patients in the intervention group and the control group was 84 and 82,respectively.At 6 months after discharge,the compliance rate of antiplatelet drugs in the intervention group was 96.43%,which was higher than 95.13% of control group,but the difference was not statistically significant.The good compliance rates of antihypertensive drugs,hypoglycemic drugs and lipid-lowering drugs in the intervention group were 92.86%,91.67% and 77.38%,which were higher than 78.57%,69.70% and 60.98 % of control group,with statistical significance(P<0.05).The qualified rate of index of blood pressure was 89.29% in intervention group,which was higher than 76.79% of control group,but the difference was not statistically significant.The qualified rates of HbA,c and LDL-C in the intervention group were 80.56% and 66.67%,which were higher than 57.58% and 48.785 of control group,with statistical significance(P<0.05).The incidence of total adverse drug reactions in the intervention group was 15.48%,which was lower than 20.73% of control group,but the difference was not statistically significant.The total rehospitalization rate in the intervention group was 7.14%,which was lower than 17.86% of control group,the difference was statistically significant(P<0.05).CONCLUSIONS:The management of ischemic stroke patients with clinical pharmacists as the leading factor can improve the patient’ s medication compliance,improve the qualified rate of secondary prevention and control indicators of ischemic stroke,and reduce the rate of rehospitalization.