临床药师在痛风管理中工作模式与效果评价的探讨

Working mode and outcome evaluation of clinical pharmacists during gout management

目的:探讨临床药师在基层医院痛风患者管理中的工作模式与效果。方法:选取某院110例痛风反复发作再次入院的患者作为研究对象,临床药师进行为期6个月的用药指导和健康管理,包括住院期间、出院时以及出院后6个月的药学监护、用药教育、健康宣教、生活方式指导和干预。监测患者干预前及干预后第3,6个月血尿酸水平及痛风复发情况,并通过问卷调查的形式,了解患者干预前后痛风相关知识知晓率及自我管理依从性改变情况。结果:最终全部完成资料收集的患者有93人。干预第3,6个月,患者血尿酸达标率分别为54.84%和73.12%,痛风相关知识知晓达标率分别是61.29%和81.72%,均较干预前(分别是3.23%和21.51%)明显升高(P<0.001);干预后6个月内痛风发作率为24.73%,较干预前(40.86%)明显降低(P<0.05);干预后,患者自我管理依从性总分以及合理饮食、遵医用药、主动就医与随访这3个维度的评分较干预前均明显升高(P<0.001),但规律运动、控制体质量依从性评分升高不明显(P>0.05)。结论:临床药师参与基层医院痛风患者的管理,可提高患者对痛风的认知水平,增强自我管理依从性,提高尿酸达标率,降低复发率,对于痛风及其伴发疾病的防治具有重要意义。

OBJECTIVE To explore the working mode and outcome evaluation of clinical pharmacists during management of gout patients at grass-root hospitals.METHODS A total of 110 re-hospitalized recurrent gout patients were selected as study subjects.Clinical pharmacists practiced medication guidance and health management for 6 months,including pharmaceutical care,medication tutorial,health education,lifestyle guidance and intervention during hospitalization,at discharge and 6 months post-discharge.The serum level of uric acid and the recurrence of gout were monitored before intervention and at Months 3 and 6 after intervention and changes in gout awareness rate and self-management compliance before and after intervention were examined by a questionnaire.RESULTS Among them,93 patients finally completed data collection.At Months 3 and 6 after intervention,the compliance rates of blood uric acid were 54.84%and 73.12%and the compliance rates of gout knowledge 61.29%and 81.72%respectively.Both were significantly higher than those before intervention(3.23%and 21.51%respectively)(P<0.001).The gout flare-up rate within 6 months after intervention was 24.73%.It was significantly lower than that before intervention(40.86%)(P<0.05).After intervention,the total score of self-management compliance,the scores of reasonable diet,compliance with drug dosing,active medical treatment and follow-ups were significantly higher than those before intervention(P<0.001),However,the regular exercise and weight control compliance scores were not significantly elevated(P>0.05).CONCLUSION The participation of pharmacists in the management of gout patients at grass-root hospitals can improve patient cognitive level of gout,enhance self-management compliance,improve uric acid compliance rate and reduce recurrence rate.All these measures are vital for preventing and treating gout and its associated diseases.