门诊患者中药汤剂煎服常见问题及对策研究

Study on the Common Problems and Countermeasures of Traditional Chinese Medicine Decoction in Outpatients

目的:调查门诊患者家庭人工煎煮中药汤剂过程中出现的常见问题,归纳分析原因并探讨解决对策,提高药师药学服务水平,保证煎药质量。方法:选取2019年5月~2020年3月在本院门诊草药房取自煎中药的800例患者作为调查对象,排除不配合者79例、沟通不畅者8例、自煎转代煎者65例、回访不接电话者143例,最终纳入505例。先通过现场沟通对患者煎服操作进行调查、干预及评估,再通过电话回访评估干预后情况,并采用Wilcoxon符号秩和检验对比药师干预前和干预后患者中药汤剂煎服知识改善情况,分析误区产生的原因,提出适当的解决对策。结果:干预后的患者煎药操作评分和服用事项评分均高于干预前,有统计学差异(P <0.001);205条煎服疑问中,特殊处理药物、用法用量和煎煮时间占比较高,分别为26.34%、23.41%、20.49%;112条煎服误区中,特殊处理药物和煎煮时间占比较高,分别为27.68%和21.43%;人、药品、环境为引起煎服问题的三大因素。结论:门诊患者煎服中药不规范问题长期客观存在,应建立煎药数据库,促进药师精确指导患者个性化煎服中药。

Objective:To investigate the common problems in the manual boil process of traditional Chinese medicine decoction at home for outpatients,summarize and analyze the reasons and explore solutions to improve the pharmaceutical service level of pharmacist and ensure the quality of the decoction.Methods:From May 2019 to March 2020,800 patients who got traditional Chinese herbal medicine from the herbal medicine room of hospital and chose to boil the medicine by themselves were included in the study.79 cases were excluded because of non-cooperation,8 cases of poor communication,65 cases of changing into boil-service provided method,and 143 cases of unanswered phone call during returned visit.Thus,505 cases were finally included in the study.First,investigator carried out investigation,intervention and evaluation of the boil process through on-site communication.Then,return visit by phone was used to evaluate the effects after the intervention.Wilcoxon symbol rank test was carried out to compare the improvement of the patient’s knowledge of the TCM decoction before and after pharmacist intervention.The causes of misunderstanding and appropriate countermeasures were analyzed and suggested.Results:The scores of decoction operation and knowledge concerning taking method of patients after intervention were higher than those before intervention,with statistical difference(P<0.001).Among the 205 questions,the proportion of questions concerning special processed drugs,using method and quantity of drugs,boil time were higher,accounting for 26.34%,23.41%,and 20.49%,respectively.Among the 112 errors about decoction,the proportion of errors concerning special processed drugs and boiling time is higher,accounting for 27.68%and21.43%respectively.People,medicines and environment are the three major factors that cause decoction problems.Conclusion:The irregularity of the TCM decoction processed by patients themselves has existed for a long time.A database of decoctions should be established to promote the precise guidance of pharmacist for personalized decoction of TCM.