文章摘要
周芳,贾暖,吴清兰,陈穗琛,钱万桥,彭一峰,王玉琨.药物治疗管理服务在慢性心力衰竭患者中的应用效果评价[J].中国药事,2021,35(11):1307-1313
药物治疗管理服务在慢性心力衰竭患者中的应用效果评价
Evaluation on Effectiveness of Medication Therapy Management Services in Patients with Chronic Heart Failure
  
DOI:10.16153/j.1002-7777.2021.11.014
中文关键词: 药物治疗管理服务  效果评价  慢性心力衰竭  随机对照研究
英文关键词: medication therapy management services (MTMs)  effect evaluation  chronic heart failure  randomized controlled study
基金项目:
作者单位
周芳 南方科技大学医院,深圳 518055 
贾暖 南方科技大学医院,深圳 518055 
吴清兰 南方科技大学医院,深圳 518055 
陈穗琛 南方科技大学医院,深圳 518055 
钱万桥 南方科技大学医院,深圳 518055 
彭一峰 南方科技大学医院,深圳 518055 
王玉琨 南方科技大学医院,深圳 518055 
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中文摘要:
      目的:评价药物治疗管理服务在慢性心力衰竭患者管理中的应用效果。方法:选取2018年3 月至2020年9月深圳市南山区公立医院确诊为慢性心力衰竭患者,根据性别、年龄、心功能、射血分数、血肌酐、血压分级、是否合并糖尿病进行1∶1配对,筛选配成45组病例,随机分为对照组和干预组。对照组仅接受常规用药教育与指导,干预组接受药师的药物治疗管理服务。6个月后,从经济效果(药品费用月支出)、临床效果(药物不良反应导致住院人次、疾病控制不佳就诊人次)、社会效果(用药依从性、满意度)三个方面进行评估比较。结果:随访期间,发现干预组107个药物治疗相关问题,6个月随访结束时,与对照组相比,干预组患者药品费用月支出显著减少(以下均为对照组 vs.干预组)[元:(798.7±410.3)vs.(637.7±332.7),P=0.044]、用药依从性提高[分:(6.95±0.79) vs.(7.67±0.69),P=0.000)]、两组患者满意度[(分:(83.33±8.59)vs.(91.67±8.79), P=0.000]、疾病控制不佳导致就诊人次数[次:(1.444±1.32)vs.(0.733±0.86),P=0.003]差异均有统计学意义,两组因药物不良反应导致住院人次数无显著性差异[次:(0.044±0.21)vs.(0.000±0.00), P=0.156]。结论:实施基于MTM的药学服务模式,可有效节省医疗费用支出、降低因疾病控制不佳就诊次数、提高患者满意度和用药依从性,在经济、临床和人文效果方面均有一定收获,深入考察后可将其推广至其他慢病管理。
英文摘要:
      Objective: To evaluate the effect of medication therapy management services in the management of patients with chronic heart failure. Methods: Patients diagnosed with chronic heart failure in Nanshan District Public Hospital of Shenzhen City from March, 2018 to September, 2020 were selected and matched at a ratio of 1∶1 according to conditions of gender, age, cardiac function, ejection fraction, serum creatinine, blood pressure grade, and diabetes mellitus. Fourty-five groups of patients were selected and randomly divided into the control group and the intervention group.The control group received routine medication education and guidance only, while the intervention group received medication management services (MTMs) from the pharmacist. After sixmonths, economic effects (monthly expenditure of drug costs), clinical effects (number of inpatients caused by adverse drug reactions and the number of outpatients with poor disease control) and social effects (medication compliance and satisfaction) were evaluated and compared. Results: During the follow-up visits, 107 drug treatment-related problems were found in the intervention group. At the end of the 6-month follow-up visits, compared with the control group, the monthly drug expenditure of the intervention group was significantly reduced (the following data are the control group vs. the intervention group) [yuan: (798.7±410.3) vs. (637.7±332.7), P=0.044], the medication compliance of the intervention group was improved [score: (6.95±0.79) vs. (7.67±0.69), P=0.000], and patient satisfaction scores in the intervention group were higher [score:(83.33±8.59) vs. (91.67±8.79), P=0.000). The numbers of outpatients between the two groups were statistically different due to poor disease control [(1.444±1.32) vs. (0.733±0.86), P=0.003], and there was no significant difference in the number of inpatients due to adverse drug reactions between the two groups [(0.044±0.21) vs. (0.000±0.00), P=0.156]. Conclusion: The implementation of the pharmaceutical care model based on MTM could effectively save medical expenses (monthly cost reduction ratio: the control group vs. the intervention group=2.6% vs. 22.7%), reduce the number of visits due to poor disease control, improve patient satisfaction and medication compliance, and had certain benefits in terms of economic, clinical and humanistic effects. Therefore, it could be extended to other chronic disease management.
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