脑梗死患者基于药物治疗管理的药学查房模式探索

Pharmaceutical ward round based on medication therapy management in patients with cerebral infarction

目的探索可操作性强、内容规范化、患者受众面广的药学查房模式。方法选择本院神经内科2018年9月1日至2018年11月30日符合条件的缺血性脑卒中患者进行药学查房,根据事先设计好的“患者药物治疗管理记录表”及方法进行问诊、药学监护、用药教育和回访,分析数据并进一步改进药学查房模式。结果接受药学查房的137人中,入院前明确有慢性病诊断的108人,有长期服药史的101人,有自行停药、减量或换药行为的35人,没有人听说过临床药师。在院期间及出院后半年内电话回访分别收集患者提问78人次(56.9%)和41人次(29.9%),问题201条和63条,分别纠正错误用药方法和理念49人次(35.8%)和21人次(12.1%),问题115条和43条。患者最关心的问题分别是药物用法用量(21.2%)、用药方案或药物选择(20.5%)、药物不良反应(14.8%),患者存在最常见错误用药方法及理念分别是慢性病相关问题(38.0%)、药物不良反应(15.8%)、中成药(11.4%)。结论通过有目的、有条理的引导式提问,可以明显增强药患互动,新的药学查房模式适用性强、值得推广。大众对临床药师的了解有待加强,慢性病宣教是药师工作很好的切入点。

Objective To explore a pharmaceutical ward round model with strong operability,standardized content and patients friendliness.Methods From September 1st,2018 to November 30th,2018,eligible patients with ischemic stroke in the Neurology Department of our hospital were selected for the pharmaceutical ward round.According to the pre-designed“patient medication therapy management record form”and methods,we conducted inquiry,pharmaceutical care,medical education and revisit,analyzed the data and improved the pharmaceutical ward round model.Results Among the 137 who had the pharmaceutical ward round,108 had definite diagnosis of chronic diseases before the admission,101 had long-term medication history,and 35 stopped,reduced or changed drugs by themselves.None heard of clinical pharmacists.During the hospital stay and half a year after the discharge,78 question times(56.9%)and 41 question times(29.9%)were collected by phone;201 items and 63 items were asked.Totally 49 wrong medication methods and ideas were corrected(35.8%)and 21 questions(12.1%),115 questions and 43 questions were corrected,respectively.The most concerned problems of patients were drug usage and dosage(21.2%),medication plan or drug selection(20.5%),and adverse drug reactions(14.8%).The most common wrong medication methods and concepts of patients were chronic disease-related problems(38.0%),adverse drug reactions(15.8%),and Chinese patent medicine(11.4%).Conclusion Through purposeful and methodological guidance,the interaction between patients and pharmacists is enhanced obviously,and the new pharmaceutical ward round model is practicable and worth popularizing.Public understanding of clinical pharmacists needs to be improved and chronic disease education is a good starting point.