药师应用智能药盒改善2型糖尿病患者药物治疗管理的效果及影响因素分析

Analysis of influencing factors and the effects of using smart medicine kits by pharmacists to improve the outcomes of medication therapy management in patients with type 2 diabetes mellitus

目的评价药师应用智能药盒对既往用药依从性不佳的2型糖尿病(T2DM)患者进行药物治疗管理(MTM)的效果。方法纳入2022年6月至2022年7月在三级医疗机构就诊,且8条目Morisky用药依从性量表(MMAS-8)评分小于6分的T2DM患者,随机分为观察组和对照组。药师对观察组应用智能药盒进行MTM,对照组常规MTM。随访第10周和第20周时比较两组患者的依从性、空腹血糖(FBG)和糖化血红蛋白(HbA1c)的改善情况。结果最终纳入受试者61例,观察组28例,对照组33例,随访过程中观察组和对照组MMAS-8评分平均提高(2.04±1.33)和(1.00±1.53)分,均较基线改善明显(P<0.05),且观察组MMAS-8评分显著高于对照组(P<0.05)。观察组的HbA1c在入组时为(6.41%±1.18%),在第20周时下降至(5.98%±0.68%),随访前后HbA1c下降明显(P<0.05)。亚组分析显示,药师应用智能药盒进行MTM对在职或无陪护的患者具有更明显的依从性提高和血糖指标改善作用。结论药师应用智能药盒进行MTM能显著提升T2DM患者用药依从性,并能降低患者的HbA1c水平。

Objective To evaluate the effects of medication therapy management(MTM)by pharmacists using smart medicine kits for type 2 diabetes mellitus(T2DM)patients with poor drug adherence.Methods T2DM patients who were admitted to the tertiary hospital from June 2022 to July 2022 with scores of 8-item Morisky medication adherence scale(MMAS-8)lower than 6 were recruited.Pharmacists applied smart medicine kits for MTM in the observation group and applied routine MTM in the control group.Medication adherence,fasting blood glucose(FBG),and hemoglobin A1c(HbA1c)in both groups of patients were recorded in the 10th and 20th week of the follow-up period.Results A total of 61 patients were recruited and randomly divided into the observation group(n=28)and the control group(n=33).During the follow-up period,the MMAS-8 scores of the observation and control groups increased by(2.04±1.33)and(1.00±1.53),respectively,showing significant improvement compared to baseline(P<0.05).Besides,the MMAS-8 score of the observation group was significantly higher than that of the control group(P<0.05).At baseline,the HbA1c of the observation group was(6.41%±1.18%),which decreased to(5.98%±0.68%)in the 20th week(P<0.05).Subgroup analysis showed that pharmacists using smart medicine kits for MTM ameliorated medication adherence and blood glucose control more significantly in patients who were employed or had no caregivers.Conclusion The application of smart medicine kits by pharmacists for MTM can improve medication adherence and decrease the HbA1c levels of T2DM patients.