临床药师主导的社区药学服务对老年患者他汀类药物治疗服务系统构建与评价的影响

doi:10.19803/j.1672-8629.2020.09.11

摘要/Abstract

摘要： 目的研究临床药师参与社区药学服务对老年患者他汀类药物用药安全性、有效性、经济性、适用性、依从性及生活质量的影响,同时建立临床药师主导的社区药学服务工作模式对社区老年患者潜在用药合理性的影响。方法选取南京三条巷社区和江苏省军区南京第二十离职干部休养所(原南京军区第五干休所)符合指南规定的他汀类药物治疗适应证的老年患者161例,将其分为对照组(n=81)和药师主导组(n=80),分别从患者、临床状态和药物相关角度对患者的患病情况、Beers标准(2015年)判断老年患者他汀类药物的有效性和安全性、Naranjo ADR评分评价他汀类药品不良反应(ADR)、医院就诊平均药费评价老年患者用药的经济性、依从性赋分值定量评价老年患者的用药依从性、EQ-5D生活量表评价患者的生理、社会和精神健康,综合判定老年患者他汀类药物使用的安全性、有效性、经济性、适宜性、依从性及生活质量。分析临床药师主导的社区药学服务对老年患者他汀类药物治疗的服务系统的构建与评价的影响。结果安全性指标中,药师主导组临床药师干预前与干预后相比ADR发生率、重复用药发生率、相互作用发生率、潜在不适宜用药(PIM)发生率及其他(药品储存不当等)分别由原来的28%、4.2%、4.9%、15.3%、45%下降至13%、2.0%、1.3%、2.1%、26.3%(P<0.001),对照组干预前后无明显变化;在有效性指标中,依从性差占比、用药信念差占比、用药知识差的占比、EQ-VAS均值分别由原来的23.8%、55%、51.8%、(84.2±12.3)下降至13.8%(P>0.05)、34.8%(P<0.05)、21.1%(P<0.05)、(77.2±11.4)(P<0.05)。近3个月就诊率由原来21.5%上升至40.8%(P<0.001),而EQ-5D均值未见明显变化(P>0.05)。经济性指标中,医保用药数量均值、用药数量均值、月药费均值均由原来的5.6%、27.2、8.9%下降至3.4%、17.3、4.3%(P<0.05)。适当性指标中,超适应证、无适应证用药未见明显变化(P>0.05),剂量不足、治疗不当由27.2%、8.9%下降至17.3%、4.3%(P<0.05)。EQ-5D维度指标中焦虑、沮丧由25.3%下降至20.8%(P<0.05)。结论临床药师主导的社区药学服务,可以提高老年患者用药的安全性、有效性、经济性、适当性相关指标的明显改善,提升了临床药师的地位与公众认同感,为管理决策部门法规制定提供了数据支持,为社区药学服务软件的研发起到了一定的作用。

关键词: 临床药师, 社区药学服务, 高脂血症, 他汀类药物, 慢病管理, 老年患者

Abstract: Objective To study the influence of clinical pharmacists' participation in community pharmaceutical care on the safety, effectiveness, expense, applicability, compliance and quality of life among elderly patients treated with statins and the influence of the community pharmaceutical service mode led by clinical pharmacists on the rationality of potential drug use among elderly patients in a community. Methods One hundred and sixty-one elderly patients with indications of statins were divided into the control group (n=81) and pharmacist-led group (n=80). The safety, effectiveness, expense and applicability of treatment with statins as well as compliance and quality of life of elderly patients were assessed from different perspectives and by related standards. Results In the safety indexes, the incidence of ADRs, repeated use, interactions, PIM and improper storage of drugs decreased from 28%, 4.2%, 4.9%, 15.3% and 45% to 13%, 2.0%, 1.3%, 2.1% and 26.3% respectively (P< 0.001). However, there was no significant change in the control group after the intervention. In the effectiveness indexes, the proportion of low compliance, lack of belief, poor knowledge and EQ-VAS decreased from 23.8%, 55%, 51.8%, 84.2±12.3 to 13.8 (P >0.05), 34.8 (P <0.05), 21.1 (P<0.05), 77.2±11.4 (P <0.05) respectively. In the past three months, the rate of hospital visits increased from 21.5% to 40.8% (P<0.001), but the mean value of EQ-5D did not change significantly (P >0.05). As for the economic indicators, the average number of medical insurance drugs, the average amount of drugs used and the average monthly drug cost decreased from 5.6%, 27.2 and 8.9% to 3.4%, 17.3% and 4.3% (P<0.05) respectively. In terms of the appropriateness indexes, there was no significant change in the usage of drugs with or without indications(P >0.05).The rate of insufficient dosage and improper treatment decreased from 27.2% and 8.9% to 17.3 and 4.3% (P <0.05) respectively. In EQ-5D indexes, the percentage of anxiety and depression decreased from 25.3% to 20.8% (P <0.05). Conclusion The community pharmaceutical care led by clinical pharmacists can significantly improve the safety, effectiveness, cost-effectiveness and validity of medication for elderly patients. Besides, this approach can enhance the social status and acceptance of clinical pharmacists while providing data for decision-makers to formulate laws and regulations.

Key words: clinical pharmacist, community pharmaceutical care, hyperlipemia, statins, chronic disease management, elderly patients

中图分类号:

R969.3

蓝晓红, 周永刚, 臧菊香, 吴冬妮, 李祥, 许锐, 陈曙东, 于浩, 张烨. 临床药师主导的社区药学服务对老年患者他汀类药物治疗服务系统构建与评价的影响[J]. 中国药物警戒, 2020, 17(9): 594-599.

LAN Xiaohong, ZHOU Yonggang, Zang Juxiang, WU Dongni, LI Xiang, XU Rui, CHEN Shudong, YU Hao ZHANG Ye. Influence of Community Pharmaceutical Care Service Led by Clinical Pharmacists on Construction and Evaluation of Service Systems for Medication of Elderly Patients with Statins[J]. Chinese Journal of Pharmacovigilance, 2020, 17(9): 594-599.

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