呼吸与危重症医学科咳喘药学门诊的建设实践与效果评价

Evaluation of the practice and effect of building a cough and asthma pharmacy clinic in the Department of PCCM

目的 回顾性总结呼吸与危重症医学科(PCCM)咳喘药学门诊实践成果,与综合药学门诊进行成效对比,评估其药学服务价值,为其他医疗机构药学门诊的规划建设提供参考。方法 选取黄石市中心医院药学综合门诊2020年11月至2021年5月及PCCM咳喘药学门诊2021年11月至2022年5月就诊的哮喘病例,通过药学门诊病人用药评估指导单、病人吸入装置操作评定表,对比评价药学综合门诊和PCCM药学门诊的药学服务效果。结果 以药学综合门诊哮喘病人为对照组,PCCM咳喘药学门诊哮喘病人为干预组,病人自我用药情况评估,在知晓用药原因、用法用量、不良反应应对措施、药物相互作用方面,首次就诊:对照组为92例(64.8%)、109例(76.8%)、87例(61.3%)、85例(59.9%),干预组为90例(65.2%)、107例(77.5%)、83例(60.1%)、80例(58.0%),两组差异无统计学意义(P>0.05),复诊或随诊时:对照组为118例(83.1%)、114例(80.3%)、98例(69.0%)、94例(66.2%),干预组为132例(95.7%)、128例(92.8%)、123例(89.1%)、120例(87.0%),干预组改善情况优于对照组(P<0.05);哮喘控制测试(ACT)评分,在良好控制、控制不佳方面,首次就诊:对照组为21例(14.8%)、121例(85.2%),干预组为19例(13.8%)、119例(86.2%),两组差异无统计学意义(P>0.05),复诊或随诊时:对照组为88例(62.0%)、46例(32.4%),干预组为105例(76.1%)、8例(5.8%),干预组改善情况优于对照组(P<0.05);吸入制剂药师指导前后测评,在操作一般、操作不佳方面,药师指导前:对照组为82例(60.3%)、32例(23.5%),干预组为81例(62.3%)、29例(22.3%),两组差异无统计学意义(P>0.05),药师指导后:对照组为76例(55.9%)、18例(13.2%),干预组为30例(23.1%)、2例(1.5%),干预组改善情况优于对照组(P<0.05)。结论 PCCM药学门诊与综合药学门诊相比,在哮喘病人的药物知识教育、吸入装置操作、哮喘控制效果等方面能够发挥出更好的药学服务作用,对其他医疗机构规划建设药学门诊具有一定的借鉴及参考意义。

Objective To retrospectively summarize the practice results of the Pulmonary and Critical Care Medicine(PCCM)cough and asthma pharmacy clinic,compare the effectiveness with comprehensive pharmacy clinics,evaluate the value of its pharmacy servic⁃es,and provide a reference for the planning and construction of pharmacy clinics in other medical institutions.Methods Asthma pa⁃tients who visited the comprehensive pharmacy clinic of Huangshi Central Hospital from November 2020 to May 2021 and the PCCM cough and asthma pharmacy clinic from November 2021 to May 2022 were selected.The effectiveness of pharmacy services in the com⁃prehensive pharmacy clinic and PCCM pharmacy clinic was evaluated comparatively by using the patient medication assessment in⁃struction sheet and the patient inhalation device operation rating form in the pharmacy clinic.Results Asthma patients in the compre⁃hensive pharmacy clinic were used as the control group and the asthma patients in the PCCM cough and asthma pharmacy clinic were used as the intervention group.Patients were assessed for self-medication in terms of knowing the cause of medication,usage,adverse reaction response,and drug interaction at the first visit:92 cases(64.8%),109 cases(76.8%),87 cases(61.3%),and 85 cases(59.9%)in the control group,and 90 cases(65.2%),107(77.5%),83 cases(60.1%),and 80 cases(58.0%)in the intervention group,and the dif⁃ferences between the two groups were not statistically significant(P>0.05).At the time of return or follow-up,there were 118 cases(83.1%),114 cases(80.3%),98 cases(69.0%),and 94 cases(66.2%)in the control group,and 132 cases(95.7%),128 cases(92.8%),123 cases(89.1%),and 120 cases(87.0%)in the intervention group,and the intervention group showed better improvement than the control group(P<0.05).The Asthma Control Test(ACT)score,in terms of good control and poor control,at the first consultation was 21 cases(14.8%)and 121 cases(85.2%)in the control group and 19 cases(13.8%)and 119 cases(86.2%)in the intervention group,and the difference between the two groups was not statistically significant(P>0.05).At the time of return or follow-up,there were 88 cases(62.0%)and 46 cases(32.4%)in the control group,and 105 cases(76.1%)and 8 cases(5.8%)in the intervention group,and the im⁃provement in the intervention group was better than that in the control group(P<0.05).In terms of general and poor operation,before pharmacist guidance,there were 82 cases(60.3%)and 32 cases(23.5%)in the control group and 81 cases(62.3%)and 29 cases(22.3%)in the intervention group,and the difference between the two groups was not statistically significant(P>0.05).After pharmacist guidance,there were 76 cases(55.9%)and 18 cases(18 cases)in the control group,18 cases(13.2%)in the control group and 30 cases(23.1%)and 2 cases(1.5%)in the intervention group,and the improvement in the intervention group was better than that in the control group(P<0.05).Conclusion Compared with comprehensive pharmacy clinics,PCCM pharmacy clinics can play a better role in phar⁃macy services in terms of drug knowledge education,inhalation device operation,and cough control effect for asthma patients,which is a reference and significance for other medical institutions to plan and build pharmacy clinics.