基于药物治疗管理的服务模式对社区老年高血压患者的干预效果分析

Intervention Effects of Service Model Based on Medication Therapy Management on Elderly Patients with Hypertension in Community

目的:评价基于药物治疗管理(medication therapy management,MTM)的药学服务方式在老年高血压患者管理中的应用效果。方法:设计随机、对照研究,从2017年12月至2019年6月签约社区筛查出有高血压疾病的90例老年患者,将其分为干预组和对照组各45例,干预组患者接受MTM相关服务,对照组患者接受常规用药指导。6个月后,比较两组患者血压控制水平、用药依从性、用药偏差及患者满意度的变化。结果:随访期间对照组失访1例(死亡1例),最终纳入研究的干预组患者共45例,对照组患者共44例。在干预组与对照组患者初始血压差异无统计学意义(P>0.05)的前提下,干预组患者实施MTM后,收缩压和舒张压均较干预前明显降低,差异有统计学意义(t(收)=-3.628,t(舒)=-3.302;P<0.001);对照组6个月后的血压水平控制不明显,与干预前的差异无统计学意义(P>0.05)。干预组患者的用药依从性明显高于对照组,差异有统计学意义(P<0.05);干预组患者用法与用量、联合用药不合理、重复用药、药物疗效不佳和不良反应等用药偏差发生率均明显低于对照组,差异均有统计学意义(P<0.05);干预组患者对药学服务的满意度也明显高于对照组,差异有统计学意义(P<0.05)。结论:实施基于MTM的药物服务模式,可改善社区老年高血压患者血压控制水平,提高药物治疗的安全性、有效性和患者的满意度。

OBJECTIVE:To evaluate the intervention effects of service model based on medication therapy management(MTM)on elderly patients with hypertension in community.METHODS:A randomized,controlled study was designed to screen 90 elderly patients with hypertension from the contracted community from Dec.2017 to Jun.2019,all patients were divided into the intervention group and the control group,with 45 cases in each group.The intervention group received MTM-related services,and the control group was given routine medication instructions.Changes in blood pressure control level,medication compliance,medication deviation,and patient satisfaction were evaluated after 6 months.RESULTS:During the follow-up period,1 case in the control group was lost to follow-up(1 case died),a total of 45 patients in the intervention group and 44 cases in the control group were included in the study.Under the premise that there was no significant difference in initial blood pressure between the intervention group and the control group(P>0.05),the systolic and diastolic blood pressure of the intervention group after MTM was significantly lower than before intervention,and the difference was statistically significant(t(SBP)=-3.628,t(DBP)=-3.302;P<0.001);the blood pressure level of the control group was not significantly controlled after 6 months,and the difference was not statistically significant(P>0.05).The medication compliance of the intervention group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).The incidence of medication deviation in the intervention group such as usage and dosage,irrational drug combination,repeated medication,poor drug efficacy,and adverse drug reactions was significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The satisfaction of patients in the intervention group to pharmaceutical services was significantly higher than that of the control group,the difference was statistically significant(P<0.05).CONCLUSIONS:The implementation of MTM service can improve the blood pressure control level of elderly hypertensive patients in the community,and improve the safety,effectiveness and patient satisfaction.