儿科临床药师对吸入性糖皮质激素类药物应用的临床综合评价

Clinical Comprehensive Evaluation on the Application of Inhaled Corticosteroids by Pediatric Clinical Pharmacists

目的:调研儿科临床药师对吸入性糖皮质激素(inhaled corticosteroids,ICS)应用的临床综合评价。方法:本研究于2019年10月对全国12个省份的102名儿科临床药师进行问卷调查,收集基本信息、药物评价、剂型评价及依从性评价等资料,采用描述性统计方法进行数据分析。结果:在药物评价方面,儿科临床药师认为布地奈德优于倍氯米松和氟替卡松。在剂型评价方面,压力定量气雾剂(无储物罐)最易被家长或患儿掌握[综合分数(comprehensive score,CS)为2.86分];其次为雾化器、干粉吸入器(都宝装置)、压力定量气雾剂(加储物罐)以及干粉吸入器(准纳器),其CS分别为2.59、2.26、2.05以及1.54分。在吸入装置培训方面,53.92%(55/102)的儿科临床药师已开展吸入设备使用培训,46.08%(47/102)的儿科临床药师未进行培训。儿科临床药师对患儿实际用药占医嘱用药比例的评价结果显示,29人(占28.43%)认为该比例<50%,30人(占29.41%)认为该比例为50%~<75%,35人(占34.31%)认为该比例为75%~<100%,仅8人(占7.84%)认为该比例达100%。患儿不配合治疗、担心长期用药的不良反应和病情好转后停药为未完全遵医嘱的前3位原因。结论:儿科临床药师应加强对家长或患儿吸入设备使用的培训,选择家长或患儿更容易掌握的吸入设备,进一步提高对患儿及家长坚持长期治疗的依从性。

OBJECTIVE:To investigate the clinical comprehensive evaluation on the application of inhaled corticosteroids(ICS)by pediatric clinical pharmacists.METHODS:This study had conducted a questionnaire survey on 102 pediatric clinical pharmacists from 12 provinces across the country in Oct.2019,data of general information,drug evaluation,dosage form evaluation and compliance evaluation were collected and analyzed by adopting descriptive statistical method.RESULTS:In terms of drug evaluation,pediatric clinical pharmacists believed that budesonide was superior to beclomethasone and fluticasone.In terms of dosage form evaluation,pressure quantitative aerosol(without storage tank)was the most easily mastered by parents or children[with the comprehensive score(CS)was 2.86 scores];followed by atomizer,dry-powder inhaler(turbuhaler),pressure quantitative aerosol(with storage tank)and dry-powder inhaler(accuhaler),with the CS were respectively 2.59,2.26,2.05 and 1.54 scores.In terms of inhalation device training,53.92%(55/102)of pediatric clinical pharmacists had carried out training on the use of inhalation device,while the rest 46.08%(47/102)had not been trained.The evaluation results of pediatric clinical pharmacists on the proportion of children’s actual medications accounted for the prescribed medications indicated that 29 persons(28.43%)considered the proportion to be less than 50%,30 persons(29.41%)considered the proportion to be 50%-<75%and 35 persons(34.31%)considered the proportion to be 75%-<100%,only 8 persons(7.84%)considered the proportion to be 100%.The top 3 reasons of not fully complying with the medical orders were respective children who do not cooperate with treatment,worry about the adverse drug reactions of long-term medication and drug withdrawal after condition improved.CONCLUSIONS:Pediatric clinical pharmacists should strengthen training on the use of inhalation devices for parents or children,choose inhalation devices that are easier for parents or children to master,so as to further improve the compliance to long-term treatment for children and parents.