慢病患者药物治疗管理服务模式的构建与实践

Construction and practice of medication therapy management service mode in patients with chronic disease

目的探讨临床药师为老年慢病患者提供慢性疾病药物治疗管理(MTM)服务模式。方法以镇江市第一人民医院2018年1月4个相关科室收治的240例住院患者为研究对象,依据随机数字表法将患者分为MTM组和对照组,每组各120例,并对MTM组实施MTM服务。比较2组患者入院初期、出院后1、3、6、12个月的治疗目标达成率、依从性达标率、再入院率、不良反应发生率和用药相关性问题的数量,评估MTM的实施效果。结果MTM组治疗目标达成率在出院后6个月为86.7%、12个月为80.0%,与对照组相比有明显提高,差异有统计学意义(P<0.05);MTM组患者依从性达标率在出院后3个月为80.0%、6个月为75.0%、12个月为68.3%,与对照组相比明显提高,差异有统计学意义(P<0.05);再次入院率、不良反应发生率和药物相关性问题与对照组相比亦明显下降,差异有统计学意义(P<0.05)。结论通过对老年慢病患者实施MTM,可以提高患者用药的安全性、有效性和依从性。

Objective To explore the mode of medication therapy management(MTM)service of clinical pharmacists for elderly patient with chronic disease.Methods 240 inpatients in four relevant departments of Zhenjiang First People’s Hospital in January 2018 were included.According to the random number table method,they were divided into MTM group and the control group,120 cases in each group.The MTM group received MTM service provided by the clinical pharmacists.The achievement of treatment objectives,patients adherence,readmission and incidence of adverse drug reactions(ADR)as well as the amount of drug-related problems were compared between two groups at initial period of admission and 1,3,6,12 months after discharge.Results The treatment goal achievement rate in MTM group was 86.7%at 6 months and 80.0%at 12 months after discharge,significantly higher than the control group(P<0.05).The compliance rate in MTM group was significantly improved compared with the control group,which was 80.0%at 3 months,75.0%at 6 months and 68.3%at 12 months after discharge(P<0.05).The readmission rate,the incidence of adverse reactions and drug-related problems also decreased significantly(P<0.05).Conclusion MTM can improve the safety,effectiveness and adherence of patients with chronic diseases.