摘要
目的:评价临床药师主导的药物重整服务对老年2型糖尿病患者慢病管理的效果。方法:采用前瞻性随机对照方法,397例老年2型糖尿病患者随机分为干预组(200例)和对照组(197例),入组患者均接受2型糖尿病常规检查和治疗,在此基础上干预组患者由临床药师为其提供规范的药物重整服务。两组患者均随访至出院后6个月。比较两组患者出院3个月、6个月的血糖达标率[糖化血红蛋白(HbA1c)<7%患者比例]、用药依从性评分及用药依从性差的患者比例、出院180 d内再入院率以及住院期间相关经济指标。结果:两组患者随访过程中分别脱落19例和21例,总脱落率10.08%。干预组患者中57例(28.5%)存在至少1个用药偏差;潜在药物不良事件(pADEs)评分≥0.01患者比例为86.0%。出院后3个月、6个月时,两组患者的HbA1c水平均较入院时显著降低(P<0.05),且干预组HbA1c水平明显低于对照组(P<0.05);干预组血糖达标率和低血糖发生率均显著优于对照组(P<0.05或P<0.01)。干预组再入院率显著低于对照组(P<0.05)。出院后3个月、6个月时干预组用药依从性评分明显高于入院时和同期对照组(P<0.05或P<0.01);两组用药依从性差患者比例均逐渐减少,且干预组显著优于对照组(P<0.05或P<0.01)。两组患者住院时间、总住院费用、药品费用以及药占比等指标差异无统计学意义(P>0.05)。结论:临床药师主导的药物重整服务可显著改善老年2型糖尿病患者的血糖达标率和服药依从性,减少低血糖发生率和再入院率。
Objective:To evaluate the effect of clinical pharmacists-led medication reconciliation in chronic disease management for elderly patients with type 2 diabetes.Methods:Totally 397 elderly patients with type 2 diabetes in our hospital were divided into intervention group(200 cases)and control group(197 cases)at random.The patients received type 2 diabetes routine examination and drug treatment at admission;on this basis,the patients in the intervention group received medication reconciliation implemented by clinical pharmacist.Patients were followed for 6 months after discharge.The glycemic control(proportions of patients HbA1 c<7%),medication adherence score and the proportion of patients with poor medication compliance,readmission rate within 180 d after discharge and economic indicators during hospitalization were compared between the two groups.Results:During the follow-up of the two groups,19 and 21 cases were shed,with a total shadding rate of 10.08%.In the intervention group,57 patients(28.5%)had at least 1 medication discrepancy;The percentage of patients with pADEs≥0.01 was 86.0%.Three and six months after discharge,the HbA1 c in of 2 groups were significantly lower than at admission(P<0.05),and the HbA1 c in intervention group was significantly lower than control group.The glycemic control rate and the incidence of hypoglycemia in the intervention group were significantly superior to the control group(P<0.05 or P<0.01);The readmission rate of the intervention group was significantly lower than that of control group(P<0.05);At 3 months and 6 months after discharge,the medication compliance score of the intervention group was significantly higher than that of the control group at admission and the same period(P<0.05 or P<0.01).The proportion of patients with poor medication compliance in 2 groups decreased gradually,and the intervention group were superior to the control group(P<0.05 or P<0.01).There were no statistically significant differences between the two groups in terms of length of stay,total hospitalization expenses,drug expenses and drug proportion(P>0.05).Conclusion:The clinical pharmacist-led medication reconciliation program in chronic disease management for elderly patients with type 2 diabetes can significantly improve the glycemic control,medication adherence,reduce the incidence of hypoglycemia and the readmission rate.
作者
聂晓静
白荷荷
张利红
王金萍
彭莉蓉
赵萌
Nie Xiaojing;Bai Hehe;Zhang Lihong;Wang Jinping;Peng Lirong;Zhao Meng(Department of Pharmacy,Xi’an Central Hospital,Xi’an 710003,China;Department of Endocrinology,Xi’an Central Hospital,Xi’an 710003,China)
出处
《药物流行病学杂志》
CAS
2020年第9期623-628,共6页
Chinese Journal of Pharmacoepidemiology
基金
陕西省自然科学基础研究计划一般项目(青年)(编号:.2019JQ-984)。
关键词
药物重整
慢病管理
临床药师
血糖控制
用药依从性
Medication reconciliation
Chronic disease management
Clinical pharmacist
Glycemic control
Medication compliance
