全科门诊共病长处方临床效果的评价研究

Evaluation on clinical effect of long-term multiple diseases prescription in general clinic

目的探究全科门诊共病长处方用药行为的临床效果及影响因素。方法选取2023年1月至2024年2月我院就诊的老年慢性病共病患者80例为研究对象。统计全科门诊开具共病长处方后患者3个月内的用药不合理情况,将存在不合理用药行为的患者纳入不合理组(13例),将无不合理用药行为的患者纳入合理组(67例)。对比两组患者的长处方临床疗效、药物不良反应(恶心呕吐、头晕、腹泻、皮疹)和生活质量[生活质量综合评定量表(GQOL-74)]。使用单因素分析可能影响长处方的用药不合理的危险因素,再使用多因素logistic回归分析共病长处方的用药不合理的独立危险因素。结果合理组患者的长处方临床有效率高于不合理组(P<0.05);合理组患者药物不良反应发生率低于不合理组(P<0.05);用药后,两组患者的GQOL-74评分较用药前均有所提升(P<0.05),且合理组患者的GQOL-74评分高于不合理组(P<0.05)。经单因素分析,两组患者的文化程度、用药依从性、用药知-信-行情况、每日用药次数、用药种数和既往药物不良反应史存在显著差异(P<0.05);多因素logistic回归分析结果显示,患者的用药知-信-行情况、用药依从性是共病长处方的用药不合理的独立危险因素(P<0.05)。结论全科门诊共病长处方可提高老年慢性病患者的生活质量,但不合理用药行为会严重影响临床治疗效果,增加药物不良反应的发生率,其中患者的用药知-信-行情况、用药依从性是导致不合理用药行为的主要影响因素。

Objective To explore clinical effect and influencing factors of long-term multiple diseases prescription in general clinic.Methods A total of 80 elderly patients with chronic diseases in the hospital were enrolled as the research objects between January 2023 and February 2024.The irrational medication of patients within 3 months after the application of long-term multiple diseases prescription in general clinic was statistically analyzed.According to presence or absence of irrational medication,patients were divided into the irrational group(13 cases)and the rational group(67 cases).The clinical curative effect of long-term prescription,adverse drug reactions(nausea and vomiting,dizziness,diarrhea,rash)and quality of life[Generic Quality of Life Inventory-74(GQOL-74)]were compared between the two groups.The possible influencing factors of irrational medication were analyzed by univariate analysis,and independent risk factors of irrational medication were analyzed by multivariate Logistic regression analysis.Results The clinical response rate of long-term prescription in the rational group was higher than that in the irrational group(P<0.05),and incidence of adverse drug reactions was lower than that in the irrational group(P<0.05).After medication,GQOL-74 scores were increased in the both groups(P<0.05),which were higher in the rational group than the irrational group(P<0.05).Univariate analysis showed that there were significant differences in education level,medication compliance,medication knowledge-attitude-practice,daily medication frequency,medication types and past history of adverse drug reactions between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that medication knowledge-attitude-practice and medication compliance were independent risk factors of irrational medication in long-term multiple diseases prescriptions(P<0.05).Conclusion The long-term multiple diseases prescription in general clinic can improve quality of life in elderly patients with chronic diseases.However,irrational medication will seriously affect clinical curative effect and increase incidence of adverse drug reactions.Medication knowledge-attitude-practice and medication compliance are the main influencing factors of irrational medication.