老年2型糖尿病患者医院-家庭过渡期用药偏差的调查研究

Research on the condition of medication discrepancy in hospital-family transitional period in elderly patients with type 2 diabetes mellitus

目的分析老年2型糖尿病患者在医院-家庭过渡期内用药偏差的发生率、偏差类型、偏差原因及其影响因素,并探讨医院-家庭过渡期用药偏差对血糖的影响。方法选取2019年3月—10月在兰州市某三级甲等医院内分泌科接受住院治疗后预出院的332例老年2型糖尿病患者为调查对象,出院前收集患者的基线资料,出院后1周内,采用糖尿病自我管理活动量表、服药依从性量表及中文版用药偏差评估工具等,以电话随访的方式对患者进行调查。记录患者出院后第6~7天空腹血糖和早餐后2 h的血糖值。并通过Logistic回归确定患者用药偏差的影响因素。采用独立样本t检验分析患者用药偏差与血糖之间的关系。结果 332例患者出院后1周内用药偏差发生率为79.5%;最主要的偏差类型为"服药种类减少";患者源性用药偏差发生原因占比较高,其中最常见的原因为"症状好转而加药或减药";最常见的医源性用药偏差发生原因为"医护人员出院药物教育不完整或不准确,致患者自行猜测服药"。Logistic回归分析结果显示,服药依从性量表得分、医嘱药物数量及糖尿病自我管理活动量表得分是用药偏差的影响因素。与无用药偏差的患者相比,发生用药偏差的老年2型糖尿病患者的空腹血糖值和餐后2 h血糖值更高,差异有统计学意义(P<0.05)。结论老年2型糖尿病患者在出院后1周内用药偏差发生率较高,护理人员应重视老年2型糖尿病患者的用药偏差管理工作,积极地与药剂师、医生进行沟通合作,做好患者及其家属的出院药物指导,确保患者用药安全和血糖稳定。

Objective To evaluate the incidence,types,causes and influential factors of medication discrepancy in hospital-family transitional period in elderly patients with Type 2 Diabetes;to explore the effects of medication discrepancy in hospital-family transitional period on blood concentration. Methods 332 patients with Type 2 Diabetes discharged from a tertiary hospital in Lanzhou city from March to October 2019 were selected. A baseline survey was conducted before discharge. A week after the discharge,Summary of Diabetes Self-Care Activity(SDSCA),Morisky Medication Adherence Scale with Eight-Item(MMAS-8) and the Chinese Version of the Medication Discrepancy Tool(MDT) were used to evaluate the patients by telephone follow-up. The fasting blood glucose and postprandial 2 h blood glucose were recorded. Binomial logistic regression analysis was run to identify the risk factors of medication discrepancy in hospital-family transitional period. The independent sample t test was used to analyze the relationship between the medication discrepancy and the blood glucose. Results The incidence of medication discrepancy in 332 patients within a week after discharge was 79.5%. The main type of discrepancy was the decrease in the types of medication. The results of Binomial logistic regression analysis showed medication discrepancy was affected by medication compliance,quantity of prescribed drugs and the diabetes self-management score. Compared with the patients without medication discrepancy,the fasting and 2 h postprandial blood glucose values of elderly Type 2 Diabetes patients with medication discrepancy were higher,and the difference was statistically significant(P <0.05). Conclusion In the early post-hospital period,the incidence of medication discrepancy is higher in elderly patients with Type 2 Diabetes,and medication discrepancy can have adverse effects on blood glucose level of patients. Therefore,nurses should pay more attention to the management of medication discrepancy in elderly patients with Type 2 Diabetes,actively communicate and cooperate with pharmacists and doctors,and provide guidance for patients and their families on discharge medication,so as to ensure the safety of medication and the stability of blood glucose.