基于分级管理的静脉血栓栓塞症患者全程化抗凝管理模式的建立与评价

Establishment and Evaluation of Integrated and Hierarchical Anticoagulation Management Mode for Patients with Venous Thromboembolism

目的:建立基于分级管理的静脉血栓栓塞症患者全程化抗凝管理模式(Integrated and hierarchical anticoagulation management mode for patients with venous thromboembolism,VTE-IHAM),并评价实践效果。方法:以文献计量学的方法建立VTE-IHAM。纳入2020年5月至2020年9月于南京大学医学院附属鼓楼医院住院的深静脉血栓(Deep venous thrombosis,DVT)患者,临床药师使用VTE-IHAM对患者进行抗凝治疗管理,并随访3个月,对抗凝质量和药师工作量进行分析。结果:建立了一套完整的VTE-IHAM,模式中包括分级管理和全程化管理两部分。共纳入98例DVT患者,与无差别监护管理模式相比,VTE-IHAM管理的患者在血栓栓塞和出血发生率方面无显著性差异;但是临床药师对每位患者的查房次数(5.0±2.6 vs 10.4±4.4,P<0.001)和总计管理时间(74.3±43.0 min vs 137.2±67.2 min,P<0.001)显著减少。结论:临床药师建立的VTE-IHAM,能够识别抗凝治疗高风险患者,规范工作流程和内容,提高了药师工作效率。

Objective:To establish an integrated and hierarchical anticoagulation management mode for patients with venous thromboembolism(VTE-IHAM),and evaluate its practical effects.Methods:The method of bibliometrics was used to establish VTE-IHAM.Patients with deep vein thrombosis(DVT)were enrolled,who were hospitalized in the Drum Tower Hospital Affiliated to Nanjing University Medical School from May 2020 to September 2020.Clinical pharmacists used VTE-IHAM to manage patients in anticoagulation therapy and followed up for three months.The quality of anticoagulation treatment and the workload of pharmacists were analyzed.Results:VTE-IHAM was established including a hierarchical management mode and an integrated management mode.A total of 98 DVT patients were enrolled.Compared with patients managed by the undifferentiated mode,patients managed by VTE-IHAM showed no significant difference in the incidence of thromboembolism and bleeding,while their number of ward rounds[(5.0±2.6)vs(10.4±4.4),P<0.001)]and total management time[(74.3±43.0)min vs(137.2±67.2)min,P<0.001]per patient by clinical pharmacists were significantly reduced.Conclusion:VTE-IHAM established by clinical pharmacists can identify high-risk patients in anticoagulant therapy,standardize the work process and content,and improve the work efficiency of pharmacists.