药学监护路径管理模式在慢性阻塞性肺疾病患者慢病管理中的应用与评价

Application and Evaluation of Pharmaceutical Care Pathway Management Model in Chronic Obstructive Pulmonary Disease Patients

目的探究药学监护路径管理模式在慢性阻塞性肺疾病(COPD)患者慢病管理(CDM)中的有效性与可实施性,为临床药师参与COPD患者CDM提供参考。方法选取2018年1—6月徐州医科大学附属连云港医院呼吸与危重症医学科住院COPD患者210例,随机分为对照组和治疗组各105例。对照组患者给予常规临床诊疗,治疗组患者纳入COPD药学监护路径管理。对比分析两组患者入院前、出院前、随访期吸入制剂使用评分、用药依从性评分、肺功能指标、急性加重/住院次数、临床有效控制率、药品不良反应(ADR)发生率。结果实施COPD药学监护路径管理后,治疗组患者吸入制剂使用评分、用药依从性评分、出院后12个月第一秒用力呼气容积百分比(FEV 1%)、临床有效控制率均显著高于本组入院前和对照组同期,差异有统计学意义(P<0.01,P<0.05)。出院后12个月,治疗组患者急性加重/住院次数、ADR发生率显著少于对照组,差异有统计学意义(P<0.05)。结论COPD药学监护路径管理模式体现了临床药师工作内容,量化了工作价值,可为临床药师参与COPD患者CDM提供参考。

Objective To evaluate the effectiveness of the pharmaceutical care pathway management model in patients of chronic obstructive pulmonary disease(COPD),and to provide a reference for clinical pharmacists to participate in the chronic disease management(CDM)of COPD patients.Methods A total of 210 patients with COPD who met the requirements of the department of respiratory and critical care medicine from January to June 2018 in the Xuzhou Medical University Affiliated Hospital of Lianyungang were randomly divided into control group and observation group,105 patients in each group,respectively.Patients in the control group received routine treatment by doctors and nurses.Patients in the observation group were monitored and managed by clinical pharmacists according to the COPD pharmaceutical care pathway.Analysis and comparison were conducted at three time points(before in-patient,before discharge and follow-up period)including inhalation preparation use score,medication compliance score,pulmonary function index,acute aggravation/hospitalization frequency,clinical effective control rate,and adverse drug reactions(ADR)incidence between the patients in the two groups.Results After the implementation of COPD pharmaceutical care path management,the inhalation preparation use score,medication compliance score,percentage of forced expiratory volume in the first second at 12 months after discharge(FEV 1%),and clinical effective control rate of patients in the observation group were all higher than those of the same group before in-hospital and the control group after the implementation of the pharmaceutical care pathway;the differences were statistically significant(P<0.01,P<0.05).In the 12th month after discharge,acute aggravation/hospitalization frequency and ADR incidence of patients in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusion The management mode of COPD pharmaceutical care pathway reflects the work content and the work value of clinical pharmacists.This paper provided a reference for clinical pharmacists to participate in the CDM of COPD patients.