对老年2型糖尿病患者实施药物重整的效果观察

Observation on the effect of medication reconciliation implementation for patients with type 2 diabetes

目的通过对老年2型糖尿病患者实施药物重整,探讨以临床药师为主导的药物重整服务在防范用药偏差中的作用。方法以2018年1-6月内分泌科新入的65岁以上的2型糖尿病患者为研究对象。临床药师在患者入院的24 h内获取用药清单,与现行医嘱比较,发现用药偏差,并对其开展药物重整服务。结果共有213例患者纳入研究。共发现用药偏差94条,用药偏差发生率为25.82%。发生频次最高的用药偏差类型为漏服,占比45.74%。患者用药种数与用药偏差的发生率之间呈现强相关(OR=1.19,95%CI 1.10~1.29,P<0.001)。结论用药偏差在老年2型糖尿病患者中的发生率较高,以药师为主导的药物重整服务能够有效发现和防范用药偏差,保障患者在医疗单元间转换的安全性。

AIM To determine the effect of a medication reconciliation program performed by pharmacists on patients with type 2 diabetes over 65 years old in preventing medication errors. METHODS Patients were included when they were 65 years old and with type 2 diabetes in endocrine department from January to June 2018. A best possible medication history(BPMH) was constructed within 24 h after hospital admission, then the BPMH was compared to admission orders prescribed by physicians to detect unintentional medication discrepancies.RESULTS Totally 213 patients were included. Overall, 94 unintentional medication discrepancies were identified. The overall rate of unintentional medication discrepancies was 25.82%. The most common type of unintentional medication discrepancies were the omissive,which accounted for 45.74%. Increased number of preadmission medications(OR=1.19,95%CI 1.10-1.29,P<0.001) was found to the strongest predictor of unintentional medication discrepancies. CONCLUSION There are high incidences of unintentional medication discrepancies in patients with type 2 diabetes over 65 years old. The pharmacist-led medication reconciliation programs are important in both detection and prevention of unintentional medication discrepancies, and it is a promising strategy for patient transition safe.