区域中心医院与社区医院临床药师协同管理门诊糖尿病病人效果分析

Effect of cooperative management of outpatient diabetes patients by clinical pharmacists in regional central hospital and community hospital

目的通过区域中心医院临床药师与社区卫生服务中心临床药师协同管理的模式,提高门诊糖尿病病人的用药依从性、血糖达标率以及解决病人的药物相关问题。方法收集前来中心医院及社区就诊的符合纳入和排除标准的糖尿病病人信息,录入慢病管理系统(小程序),对应的社区药师和(或)中心医院药师进入慢病管理系统,每两个月对病人进行随访、干预,全程共6个月,评估病人干预前后用药依从性(Morisky评分)、血糖达标率以及药物相关问题(欧洲药学监护联盟分类系统)。结果共入组糖尿病病人132人,失访4人。随访期间,病人的平均依从性评分依次提高0.34、0.09和0.20;第2个月随访时的血糖达标率较入组时,第4个月较第2个月都有显著提高(P<0.05);共解发现药物相关问题145例次,提出干预方案220条,最终解决或部分解决药物相关问题115例次。结论采用中心医院药师和社区药师的协同管理模式对糖尿病病人进行慢病管理,可以高效提高病人依从性、提高病人血糖达标率以及解决病人的药物相关问题,体现临床药师价值,该经验值得推广。

Objective Through the mode of collaborative management between clinical pharmacists in regional central hospital and community hospital,to improve the medication compliance and the blood glucose compliance rate of outpatients with diabetes and to address their drug-related problems.Methods The information of outpatients with diabetes meeting inclusion and exclusion criteria was collected and recorded by clinical pharmacists in regional central hospital through chronic disease management system(applet),then the medication compliance(by Morisky score),the blood glucose compliance rate,and drug-related problems(by Pharmaceutical Care Network Europe classification system)of the patients were assessed by the clinical pharmacists of the corresponding communities and regional central hospital through the applet every 2 months for a total of three times.Results A total of 132 patients were enrolled and 4 patients were lost to follow-up.During the follow-up,the mean compliance scores of patients increased by 0.34,0.09,and 0.20,respectively;the blood glucose compliance rate at the second month follow-up was higher than that at the enrollment,and the blood glucose compliance rate at the fourth month follow-up was significantly higher than that at the second month(P<0.05);a total of 145 drugrelated problems were found,220 intervention plans were proposed,and 115 drug-related problems were finally fully or partly solved.Conclusions The mode of collaborative management between the clinical pharmacists in regional central hospital and community healthcare centers for chronic disease management of diabetes patients could effectively improve patient compliance,improve the blood glucose compliance rate and solve drug-related problems of patients,which reflected the value of clinical pharmacists.This experience is worthy of promotion.