“合作药物治疗管理”模式在化疗所致恶心呕吐规范化管理中的应用与评价

Application and Evaluation of“Collaborative Drug Therapy Management”Model in Standardized Management of Chemotherapy Induced Nausea and Vomiting

目的:通过参与化疗所致恶心呕吐(chemotherapy induced nausea and vomiting,CINV)规范化治疗病房的创建,探索临床药师应用"合作药物治疗管理(collaborative drug therapy management,CDTM)"工作模式在CINV规范化管理中的作用。方法:2019年8月,福建省立医院(以下简称"我院")开始构建以临床药师为主导的CDTM化疗患者无恶心呕吐管理工作模式,对首次接受化疗患者的CINV进行全面管理,通过建档、制订个体化止吐方案,提供药学监护、用药教育等方式,参与患者CINV的治疗。收集2019年6—12月就诊于我院肿瘤内科患者的信息,比较CDTM模式实施前后肿瘤化疗患者CINV发生情况。结果:共纳入130例初诊为肿瘤首次接受化疗的患者,其中CDTM模式实施前(2019年6—7月)34例,CDTM模式实施后(2019年8—12月)96例。与CDTM模式实施前比较,临床药师采用CDTM模式后,患者的CINV总发生率和严重程度均明显降低,差异均有统计学意义(P<0.05),特别是高中度致吐风险患者的CINV发生率明显降低;另外,患者的呕吐功能性生活指数明显提高,差异有统计学意义(P<0.05)。结论:临床药师通过CDTM工作模式,可在CINV规范化治疗过程中发挥积极的作用,值得推广。

OBJECTIVE:By participating into the establishment of standardized treatment ward for chemotherapy induced nausea and vomiting(CINV),to explore the role of clinical pharmacists in the standardized management of CINV under the collobaorative drug therapy management(CDTM)work model.METHODS:In Aug.2019,Fujian Provincial Hospital(hereinafter referred to as"our hospital")established the working mode of non-nausea and vomiting management for patients with CDTM chemotherapy led by clinical pharmacists.A clinical pharmacist-led CINV was constructed and patients receiving chemotherapy for the first time was managed in an all-round way.Pharmacist participates in the treatment of CINV by establishing archives and individualized antiemetic programs,pharmacological monitoring and medication education.Information of patients in the department of oncology of our hospital from Jun.to Dec.2019 were collected,and the occurrence of CINV in cancer chemotherapy patients were compared before and after the implementation of the CDTM model.RESULTS:A total of 130 newly diagnosed patients with the first chemotherapy were enrolled,including 34 patients before the implementation of CDTM model(from Jun.to Jul.2019)and 96 patients after the implementation of CDTM model(from Aug.to Dec.2019).Compared with before the implementation of CDTM model,after the application of CDTM model by clinical pharmacists,the overall incidence and severity of CINV in patients decreased significantly,and the difference was statistically significant(P<0.05),in particular,the incidence of CINV in patients with high and moderate risk of emetogenesis decreased significantly.In addition,the functional vomiting life index of the patients increased significantly,and the difference was statistically significant(P<0.05).CONCLUSIONS:Clinical pharmacists can play an active role in the standardized treatment of CINV through the CDTM work model,which is worthy of promotion.