闭环管理在老年肺结核患者安全用药中的应用

Application of closed-loop management in safe drug administration among elderly tuberculosis patients

目的分析闭环管理在老年肺结核患者安全用药管理中的应用效果。方法收集2017年1月1日至2017年12月30日在陕西省结核病防治院治疗的302例老年结核病患者(对照组),调查患者在治疗过程中各种错误服药情况。纳入2018年1月1日至2018年12月30日治疗的老年肺结核患者295例(观察组)。根据对照组错误服药情况对观察组患者实施闭环管理,包括建立老年肺结核患者安全服药管理要求并实施管理,评价安全服药管理实施的效果,分析安全服药管理存在问题,并进行问题的整改和跟踪。比较两组患者的服药正确率、药物不良反应的发生率和检出率。结果观察组患者的服药正确率为95.60%(282/295),高于对照组的74.83%(226/302),差异有统计学意义(χ^2=50.694,P=0.000);观察组药物不良反应的发生率为38.64%(114/295),对照组为42.72%(129/302),两组比较差异无统计学意义(χ^2=1.025,P=0.311);观察组药物不良反应的检出率为92.11%(105/114),高于对照组的76.74%(99/129),差异有统计学意义(χ^2=10.599,P=0.001)。结论闭环管理能提高老年肺结核患者的正确服药率,对药物不良反应的发生率没有影响,但能提高药物不良反应的检出率,提高老年肺结核患者服药的安全性。

Objective To analyze the application effect of using closed-loop management for safe drug administration among elderly tuberculosis patients.Methods Three hundred and two elderly patients with pulmonary tuberculosis treated in Shaanxi Provincial Tuberculosis Hospital from January 1,2017 to December 30,2017 were enrolled as control group,for whom situation of medication non-compliance in the course of treatment were investigated.295 elderly patients with pulmonary tuberculosis treated from January 1,2018 to December 30,2018 were enrolled as observation group.Closed-loop management was implemented on the observation group to correct those medication non-compliances found in the control group which included establishing drug safety management protocol and implementing management,evaluating the effect of the implementation,analyzing problems existing during the safe medication management process,and rectifying and tracking problems found.The compliance of taking medicine,the incidence and detection rate of adverse drug reactions were compared between those two groups.Results In observation group,95.60%(282/295)patients took medicine timely,and the detection rate of adverse drug reactions was 92.11%(105/114),both of them were higher than that in control group(medicine taking correctness 74.83%(226/302),detection rate 76.74%(99/129)).Those differences were statistically significant(χ^2=50.694,10.599,P=0.000,0.001).The difference of the incidence of adverse drug reactions rate in two group was not statistically significant(observation group 38.64%(114/295),control group 42.72%(129/302),χ^2=1.025,P=0.311).Conclusion Closed-loop management can improve the compliance of medicine taking.It has no effect on the incidence of adverse drug reactions but can improve the detection rate,and increase the safety of medication among elderly patients with pulmonary tuberculosis.