以药物治疗管理为核心的社会药房糖尿病管理实践研究

Diabetes Management Practice Research Centered on Medication Therapy Management

目的了解社会药房开展糖尿病管理的现状、成效和存在的问题,并提出改进建议。方法采用观察和访谈的方法了解河北省容城镇某社会药房糖尿病管理模式和现状,回顾性分析2型糖尿病患者的用药档案和服务记录,评估社会药房开展糖尿病管理的成效和存在的问题。结果社会药房提供的是以药物治疗管理为核心的糖尿病管理服务。2018年9月至12月,共有119例2型糖尿病患者完整接受糖尿病管理服务;共发现189种药物相关问题,人均1.59种;共进行221次干预,人均1.85次;干预前后,患者的空腹血糖值基本保持不变,餐后2 h血糖值略有下降(由11.8 mmol/L降至11.4 mmol/L);干预后总体血糖达标率偏低(20.16%),血糖达标人数无明显变化(P>0.05),饮食和运动达标人数上升(P<0.05),饮食达标人数偏低(39.50%)。结论社会药房糖尿病管理服务对于患者用药合理性和安全性及饮食、运动控制有积极意义,可通过构建执业药师专科化制度,增设药事服务费,制订执业药师与医师协作指导规范,加强对执业药师跨学科知识的培训及设计合适的薪酬模型,确保社会药房糖尿病管理服务的有效性和可持续性。

Objective To understand the current situation,effectiveness and existing problems of diabetes management in community pharmacy and put forward suggestions and measures for improvement.Methods The model and current situation of diabetes management were understood through interviews and observations,and the data of diabetes management were retrospectively analyzed,the effectiveness and existing problems were evaluated.Results This community pharmacy provided diabetes management services centered on medication therapy management(MTM).A total of 119 patients with type 2 diabetes mellitus were fully involved in diabetes management services from September 2018 to December 2018.A total of 189 drug-related problems were found,with an average of 1.59 per person.A total of 221 interventions were performed diabetes,with an average of 1.85 interventions per person.Before and after participating in the diabetes management service,the fasting blood glucose level of the patient remained basically unchanged,and 2 h postprandial glucose level decreased slightly from 11.8 mmol/L to 11.4 mmol/L.The overall blood glucose compliance rate was low(20.16%),and there was no significant change in the number of blood glucose compliances(P>0.05).The number of diet and exercise compliances increased,and there were significant differences before and after the intervention(P<0.05).The number of diet compliances was low(39.50%).Conclusion Diabetes management service has positive significance for patient rationality and safety,as well as diet and exercise control.It can establish licensed pharmacist specialization system,establish pharmaceutical services fee,develop a practice pharmacist and physician collaboration guidance,strengthen the training of licensed pharmacists’interdisciplinary knowledge and design appropriate compensation models to ensure the effectiveness and sustainability of social pharmacy diabetes management services.