叙事药学在心血管药学门诊中的应用

Application of narrative pharmacy in cardiovascular pharmacy clinic

目的探讨临床药师通过叙事药学管理对心血管疾病合并负面情绪患者的用药依从性、负面情绪及生活质量的影响。方法选取2023年2-8月武汉市第一医院心血管药学门诊就诊的49例有用药问题伴负面情绪的患者作为研究对象,在传统药学管理基础上,于患者就诊时及治疗2周时对患者加用叙事药学的模式进行管理。记录患者药物咨询相关问题、药物种类,对患者就诊时及管理1个月随访时的不良反应、血压及血脂、依从性、抑郁和焦虑状态、生活质量、患者满意度等变化进行比较。结果采用叙事药学管理模式的49例患者涉及114个药物相关咨询问题;与就诊时比较,管理1个月后患者服药种类显著减少[4.00(2.00,6.00)种vs.3.00(1.50,5.00)种,P<0.05],不良反应发生率显著下降(32.65%vs.2.04%,P<0.001),血压及血脂达标率显著升高(30.61%vs.95.92%,P<0.001),患者用药依从性显著提高[(3.94±2.44)分vs.(6.78±2.07)分,P<0.01],抑郁评分显著降低[3.00(2.00,4.50)分vs.2.00(0.00,3.00)分,P<0.001],焦虑评分显著降低[3.00(2.00,4.50)分vs.1.00(0.00,2.00)分,P<0.001],生活质量评分显著提高[22.00(19.00,22.00)分vs.23.00(23.00,24.50)分,P<0.01],满意度调查中患者的满意总占比稍有提高(91.84%vs.97.96%,P>0.05)。结论叙事药学应用于心血管药学门诊,能够提高患者依从性,减少药物不良反应,加强药物治疗有效性,避免药物相互作用,有效改善患者焦虑抑郁情绪,最终提高患者生活质量。

OBJECTIVE To explore the effects of narrative pharmacy management on medication compliance,negative emotions,and quality of life in patients with cardiovascular disease complicated with negative emotions.METHODS A total of 49 patients with drug use problems and negative emotions attending the cardiovascular pharmacy clinic of Wuhan First Hospital from February to August 2023 were selected as the study objects,narrative pharmacy model was applied for patient management during their visits;pharmaceutical care and emotional management were performed after 2 weeks of treatment and a follow-up visit was conducted to evaluate and record the management effect one month later.RESULTS Adopting a narrative pharmacy management model,49 patients were involved in 114 drug related consultation questions.Compared with the visit,after one month of management,the number of medication types taken by patients significantly decreased[4.00(2.00,6.00)vs.3.00(1.50,5.00),P<0.05],the incidence of adverse reactions significantly decreased(32.65%vs.2.04%,P<0.001),the rate of blood pressure and lipid compliance significantly increased(30.61%vs.95.92%,P<0.001),and the score of the patient’s medication compliance significantly improved[(3.94±2.44)vs.(6.78±2.07),P<0.01].The depression score significantly decreased[3.00(2.00,4.50)vs.2.00(0.00,3.00),P<0.001],the anxiety score significantly reduced[3.00(2.00,4.50)vs.1.00(0.00,2.00),P<0.001],quality of life score was significantly improved[22.00(19.00,22.00)vs.23.00(23.00,24.50),P<0.01].In the satisfaction survey,there was a slight increase in the overall satisfaction proportion(91.84%vs.97.96%,P>0.05).CONCLUSIONS The application of narrative pharmacy in cardiovascular pharmacy clinic can improve patient compliance,reduce adverse drug reactions,enhance the effectiveness of drug treatment,avoid drug interactions,effectively improve the anxiety and depression,and ultimately improve the quality of life.