药物治疗管理服务对急性缺血性脑卒中患者依从性及预后影响的研究

Effects of medication therapy management service on medication compliance and prognosis of patients with acute ischemic stroke

目的通过随机对照试验,探寻与分析药物治疗管理(MTM)服务对急性缺血性脑卒中(以下简称脑卒中)患者依从性及预后的影响。方法对北京某三甲医院2018年5月至2019年7月的脑卒中患者进行MTM服务,共纳入134例患者,MTM组66例,对照组68例,整理并记录患者的一般情况、疾病、用药情况,通过Morisky调查问卷,记录患者依从性基线及改变情况,同时记录服务前后患者美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分与日常生活能力评分(Activities of daily living,ADL)情况,分析药师干预对患者依从性及疾病预后的影响。结果两组在平均年龄、伴发疾病、初始用药品种方面差异均无统计学意义。Morisky评分:MTM组服务前后分别为(4.90±1.36)分、(5.68±1.19)分,对照组分别为(4.74±1.64)分、(4.79±1.75)分,P=0.01;NIHSS评分:MTM组服务前后分别为(2.83±3.12)分、(1.35±1.66)分,对照组分别为(3.01±3.47)分、(2.29±3.29)分,P=0.03;ADL评分:MTM组服务前后分别为(83.48±18.35)分、(91.44±12.18)分,对照组分别为(79.85±24.12)分、(84.33±23.47)分,P=0.03。两组服务前Morisky评分、NIHSS评分、ADL评分比较差异均无统计学意义(P>0.05),服务后评分比较差异有统计学意义(P<0.05)。结论临床药师开展MTM服务,能够提高患者的依从性,对合理用药、改善患者生活方式、改善脑卒中患者的疾病预后均具有积极意义。

Objective To explore and analyze the effect of medication therapy management(MTM)service on compliance and prognosis of patients with acute ischemic stroke(hereinafter referred to as stroke)through a randomized controlled trial.Methods A total of 134 stroke patients treated from May 2018 to July 2019 in a tertiary A hospital in Beijing were included to receive the MTM service,including 66 patients in the MTM group and 68 in the control group.The general situation,disease and medication of the patients were sorted out and recorded.The baseline and change of patient′s compliance were recorded through the Morisky questionnaire.At the same time,the scores of the National Institute of Health Stroke Scale(NIHSS)and the activities of daily living(ADL)of the patients before and after the service were recorded,and the effects of pharmacist intervention on patient′s compliance and prognosis were analyzed.Results There was no significant difference between the two groups in the mean age,concomitant diseases or initial drug varieties.Morisky score of MTM group before and after service was 4.90±1.36 and 5.68±1.19,respectively;in control group it was 4.74±1.64 and 4.79±1.75,respectively(P=0.01).NIHSS score of MTM group before and after service was 2.83±3.12 and 1.35±1.66,respectively;in control group it was 3.01±3.47 and 2.29±3.29,respectively(P=0.03).The ADL score of MTM group before and after service was 83.48±18.35 and 91.44±12.18,respectively;in control group it was 79.85±24.12 and 84.33±23.47,respectively(P=0.03).There was no significant difference in Morisky score,NIHSS score or ADL score between the two groups before the service(P>0.05),but there was significant difference after the service(P<0.05).Conclusion Clinical pharmacist′s MTM service can improve the patient′s compliance,and has positive significance in rational drug use,improving the patient′s lifestyle and improving the disease prognosis of stroke patients.