临床药师参与华法林抗凝教育对肺栓塞患者认知度的影响

Impact of clinical pharmacists participating in warfarin anticoagulation education on cognition of patients with pulmonary embolism

目的:比较临床药师参与和未参与华法林标准化教育对肺栓塞患者华法林抗凝认知度的影响的差异。方法:采用回顾性队列研究分析2017年1月至2019年5月就诊于北京朝阳医院呼吸科住院的确诊肺血栓栓塞(pulmonary thromboembolism, PTE)年龄大于18岁的患者,服用华法林≥3个月,且国际标准化比值(international normalized ratio, INR)控制目标为2.0~3.0。依据此次入院前是否接受过临床药师主导的标准化教育进行分组,分为标准化教育组与非标准化教育组。设计华法林认知度调查问卷,进行信度和效度检测,比较2组患者在抗凝监测、服药注意事项、不良反应发生及处理等方面的认知差异。结果:自行设计的华法林认知度问卷信度良好,Cohen’s kappa值为0.89;效度检验经专家组审议后查验通过。共纳入237例服用华法林的PTE患者,其中标准化教育组113例,非标准化教育组124例。标准化教育组问卷总分平均16.20±1.59,非标准化教育组10.51±4.02;标准化教育组的规律服药患者比例显著高于非标准化教育组。在非标准化教育组中,接受常规医护人员教育患者85例,从未接受教育组39例。结论:临床药师参与PTE患者的华法林抗凝教育能显著提高患者的抗凝认知度,并提高用药依从性。

OBJECTIVE To compare the effectiveness of standard education group(clinical pharmacists’ participation)versus non-standardized education group(no pharmacists’ participation in warfarin education)on awareness of warfarin anticoagulation of patients with pulmonary thromboembolism(PTE).METHODS A retrospective cohort study was performed for analyzing 237 hospitalized PTE patients from January 2017 to May 2019.They took warfarin for over 3 months and the international normalized ratio(INR)of control target was 2.0-3.0.They were divided into two groups of standardized education(n=113)and non-standardized education(n=124)based upon whether or not receiving standard education of clinical pharmacists before admission.A warfarin awareness survey questionnaire was designed and reliability and validity were tested.And inter-group cognitive differences in anticoagulation monitoring, medication precautions, occurrence and management of adverse reactions were compared.RESULTS The self-designed warfarin awareness questionnaire had an excellent reliability with a Cohen’s Kappa value of 0.89;validity test was modified and verified after expert deliberations.The average total score of the questionnaire was(16.20±1.59)in standardized education group and(10.51±4.02)in non-standardized education group;the proportion of regularily medicated patients was significantly higher in standardized education group than that in non-standardized education group.In non-standardized education group, 85 patients received routine medical staff education and 39 patients never did.CONCLUSION The participation of clinical pharmacists in warfarin anticoagulation education of PTE patients can significantly improve the patients’ awareness of anticoagulation and improve medication compliance.