药师主导的智能微信群在癫痫患者用药宣教中的效果评价

Evaluation of the medication education effect of smart WeChat group led by pharmacists for patients with epilepsy

目的针对需要长期用药的癫痫患者,研究药师主导的智能微信群的宣教效果以及患者的药学服务需求。方法纳入诊断为癫痫并正在使用抗癫痫药(ASMs)治疗的患者,开展随机对照研究。对患者进行面对面宣教后,随机分为普通宣教组和智能微信群宣教组,后者进入微信群,群内提供每日的文字宣教内容和每周的视频科普,并有1名药师和2名医师负责回答患者提问,另有关键字匹配自动回复功能,例如输入相应数字自动回复门诊预约链接、私聊咨询链接、更多科普文章链接等。随访3个月后,在整体人群和各个亚组中比较癫痫发作、依从性和用药知识掌握情况。药师负责收集群内所有患者的提问并分类。结果普通宣教组和智能微信群宣教组各纳入患者64例,随访后的无癫痫发作率、高依从率、知识问卷>30分者分别为49%和63%(P=0.128)、38%和47%(P=0.427)、20%和34%(P=0.085),差异均无统计学意义。经亚组分析,在癫痫发作方面,年龄<60岁和高中学历的患者中,经过智能微信群宣教后,无癫痫发作率显著高于普通宣教组(OR=2.67,95%CI:1.12~6.34和OR=4.42,95%CI:1.21~16.12);依从性方面,智能微信群宣教组中服用多种ASMs的患者的依从性显著高于普通宣教组(OR=3.40,95%CI:1.07~10.77);知识问卷作答中,男性、年龄<60岁和服用多种ASMs的患者得分>30分比例显著多于普通宣教组(OR=3.59,95%CI:1.01~12.73;OR=2.67,95%CI:1.03~6.89;OR=4.58,95%CI:1.08~19.38)。结论年龄<60岁和服用多种ASMs的患者通过智能微信群宣教后,获益较多,例如增加疾病和用药知识、依从性,从而提高无癫痫发作的可能,但仍需要更多患者的随机对照研究来证实。同时,癫痫患者对于合并用药、咳嗽感冒药、消化道及代谢药的信息需求高,可在这些方面多做科普宣教。

AIM To study the education effect of the smart WeChat group led by pharmacists for patients with epilepsy who need long-term medication and their needs for pharmaceutical care.METHODS A randomized controlled research was conducted to include adult patients who had been diagnosed with epilepsy and started the therapy of antiseizure medications(ASMs).After face-to-face education,the patients were randomly divided into conventional education group and smart WeChat education group.WeChat group provided education by short texts daily and short videos weekly.There was a pharmacist and 2 physicians in the group who were responsible for answering the other questions raised by patients.There was also a keyword-matching auto-response function.For example,by entering the corresponding number,users could automatically receive links to private chat programs,clinic appointments and more knowledge about epilepsy.After the 3-month follow-up,the frequency of seizures,high compliance rate,and medication knowledge were compared between the overall population and subgroup patients.Pharmacists were responsible for collecting and classifying questions from all patients in the group.RESULTS There were 64 patients enrolled in each group.The seizure-free rate,high compliance(8 points)rate and medication knowledge(>30 points)rate in conventional group and smart WeChat education group was 49%and 63%(P=0.128),38%and 47%(P=0.427),20%and 34%(P=0.085),respectively,with no statistically significant differences.In the subgroup analysis,the seizure-free rate of patients under the age of 60 years or with high school education in the smart WeChat education group was significantly higher than those in the conventional education group(OR=2.67,95%CI 1.12-6.34;OR=4.42,95%CI 1.21-16.12).Regarding compliance,patients who took multiple ASMs in the smart WeChat education group had significantly higher compliance than those in the conventional education group(OR=3.40,95%CI 1.07-10.77).When answering the knowledge questionnaire,patients under the age of 60,male patients or those who took multiple ASMs scored higher than 30 points than the conventional education group(OR=3.59,95%CI 1.01-12.73,OR=2.67,95%CI 1.03-6.89 and OR=4.58,95%CI 1.08-19.38).CONCLUSION Patients with epilepsy under the age of 60 years and taking multiple ASMs can benefit more from the smart WeChat group education,such as increasing their knowledge of the disease and medication,as well as their compliance,thereby improving the possibility of being seizure-free.However,more randomized controlled studies with more patients are needed to confirm the point.Since patients with epilepsy have a high demand for information about drug combinations,cough and cold drugs,digestive tract and metabolic drugs,more popular science education should be conducted in these aspects.