基于药物治疗管理和欧洲药学监护联盟分类系统对老年慢性病患者开展持续性药学监护实践

Practice and exploration of continuous pharmaceutical care for elderly patients with chronic diseases based on MTM and PCNE classification system

目的大量治疗药物带来的用药风险直接影响着老年人群的生命质量,文章旨在通过评价基于药物治疗管理(MTM)和欧洲药学监护联盟(PCNE)分类系统的持续性药学监护模式对老年慢性病患者药物治疗的影响,探索适合老年慢病患者的药学服务模式。方法选取2020年6月至2020年12月期间在东部战区总医院接受住院治疗的慢性病患者158例作为研究对象,随机分为对照组和药学监护组,其中对照组79例,药学监护组79例。对照组接受“医-护”传统医疗服务模式的治疗,药学监护组接受传统医疗模式和持续性药学监护服务。药师采用PCNE系统从分类、发生原因、干预层面、接受情况和最终状态类别5个层面对药学监护组已存在或潜在的药物相关问题(DRPs)进行分析记录,观察两组患者在人院、出院3个月、出院6个月时用药依从性和生活质量评分变化。结果药学监护组共发现92个DRPs,其中有关治疗效果的问题55个(59.78%),发生原因有48个(52.17%)与药物选择相关,针对医师层面的干预有84个(91.30%),药师提出的全部干预中被接受并完全或部分执行的有87个(94.57%),最终全部解决的DRPs有63个(68.48%);在患者出院3个月、6个月进行随访时,药学监护组的总依从数和生活质量评分均明显高于同时期的对照组(P<0.01)。结论基于MTM和PCNE分类系统对老年慢性病患者开展的持续性药学监护实践,可以全面发现、系统评估并及时解决DRPs,显著提高用药依从性,为患者带来更好的生活质量。

Objective The risk of drug caused by a large number of therapeutic drugs has a direct impact on the quality of life of the elderly.The purpose of this paper is to evaluate the effect of continuous pharmaceutical care model based on medication therapy management(MTM)and pharmaceutical care network Europe(PCNE)classification system on drug treatment in elderly patients with chronic diseases,and to explore a pharmaceutical care model suitable for elderly patients with chronic diseases.Methods A total of 158 patients with chronic diseases who were hospitalized in our hospital from June 2020 to December 2020 were randomly divided into control group and pharmaceutical care group.There were 79 cases in the control group and 79 cases in the pharmaceutical care group.The control group was treated with"physician-nurse"traditional medical service mode.The pharmaceutical care group was treated with traditional medical model and continuous pharmaceutical care.Pharmacists used the PCNE system to analyze and record the existing or potential DRPs in the pharmaceutical care group from five aspects:problems,causes,intervention,acceptance and outcomes.The changes of drug compliance and quality of life scores of patients in the two groups were observed at hospitalization,3 months after discharge and 6 months after discharge.Results 92 DRPs were found in the pharmaceutical care group,among which 55 problems(59.78%)were related to the effectiveness of treatment.There were 48 causes(52.17%)related to drug selection,and 84 interventions(91.30%)were aimed at the physician level.Of all the interventions proposed by pharmacists,87 were accepted and fully or partially implemented(94.57%).Finally,63 DRPs were solved.When the patients were followed up for 3 months and 6 months after discharge,the total drug compliance and quality of life scores in the pharmaceutical care group were significantly higher than those in the control group at the same time(P<0.01).Conclusion The practice of continuous pharmaceutical care for elderly patients with chronic diseases based on MTM and PCNE classification system can comprehensively discover,systematically evaluate and solve DRPs in time,significantly improve drug compliance and bring better quality of life for patients.