基于综合药物管理评价的老年患者药物相关问题的药学服务模式探索

Study on pharmaceutical care model for drug-related problems in elderly patients based on comprehensive medication management review

目的 基于综合药物管理评价(CMMR)探索应对老年患者药物相关问题(DRPs)的药学服务模式,并观察该模式下的药学服务效果。方法 参考澳大利亚CMMR指南,建立老年患者药学服务新模式:临床药师通过保健医生转诊、患者或其照护者主动咨询等途径来接诊;出诊采取面诊和电话访谈相结合的方式;并采取门诊复诊、电话随访、预约上门指导等形式了解保健医生或患者对DRPs的处置情况。在该模式下,通过横断面调查老年患者DRPs的发生现状及分类,通过自身前后对照,从住院率、药品不良反应(ADR)发生率、用药依从性、用药数量、血脂水平等方面评价药学服务效果。结果 在本研究中,形成了以患者为中心,评估-干预-再评估的闭环药学服务模式。调查结果发现,317例研究对象中,有203例(64.0%)发生了DRPs,平均每人发生DRPs 1.03(0~7)例次。采用所建立的药学服务模式干预后,与干预前对比,虽然用药数量由2.00(0.00,3.00)种增至2.00(1.00,3.00)种,但患者低密度脂蛋白胆固醇水平由3.48(2.58,4.29) mmol/L下降至3.11(2.29,3.81) mmol/L(P<0.05);患者1年内住院率、1年内ADR发生率、用药依从性评分变化无统计学意义(P>0.05)。结论 基于CMMR的药学服务模式能有效甄别并管理老年患者的DRPs,降低患者血脂水平。

OBJECTIVE To explore the pharmaceutical care model for elderly patients with drug-related problems(DRPs) based on the comprehensive medication management review(CMMR),and to observe the effect of pharmaceutical care under the model.METHODS The pharmaceutical care new model for elderly patients was established by concerning CMMR guidelines in Australia.In other words,clinical pharmacists receive medical care through referral by health practitioners and active consultation by patients or their caregivers.Visits were made by a combination of face-to-face and telephone interviews.Follow-up was carried out in the form of outpatient follow-up,telephone follow-up,appointment,and home guidance to know about the treatment of DRPs by healthcare practitioners or patients.Under this model,the occurrence status and classification of DRPs in elderly patients were studied through cross-sectional investigation.The effect of pharmaceutical care was evaluated from the aspects of hospitalization rate,adverse drug reaction(ADR) incidence,medication compliance,the number of medications,blood lipid level,etc.,through self-before-after comparison.RESULTS In this study,a patient-centered,evaluation-intervention-reevaluation closed-loop pharmaceutical care model was formed.Among 317 study subjects,the average number of DRPs was 1.03(0-7) cases.Compared before and after the intervention,the number of drug types increased from 2.00(0.00,3.00) to 2.00(1.00,3.00),but the level of low-density lipoprotein cholesterin in patients decreased from 3.48(2.58,4.29) mmol/L to 3.11(2.29,3.81) mmol/L(P<0.05).There was no statistical significance in hospitalization rate,ADR incidence within or medication compliance.CONCLUSIONS CMMR-based pharmaceutical care model can effectively identify and manage the patients' DRPs and reduce the level of blood lipid.