临床药师主导慢病管理对老年高血压患者用药依从性的影响
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摘要
目的:探讨临床药师主导的慢病管理对老年高血压患者用药依从性的改善效果。方法:共纳入调查对象71例,按照随机数字表法分为对照组及干预组,临床药师对2组进行不同周期的药学服务。在出院第3、6个月分别对2组患者是否有漏服药物、自行停药或减少药量情况、药物了解程度及用药依从性进行评价。结果:在出院第3、6个月,干预组漏服药物率(12.00%、24.00%)、自行停药或减少药量情况发生率(16.00%、4.00%)明显少于对照组漏服药物率(56.25%、59.38%)、自行停药或减少药量情况发生率(46.88%、43.75%),P<0.05干预组药物了解程度[(1.32±0.56)分、(1.16±0.37)分]明显优于对照组[(2.00±0.67)分、(1.97±0.74)分],P<0.05;干预组用药依从性[(1.36±1.11)分、(1.04±0.89)分]明显优于对照组[(2.44±1.19)分、(2.38±1.29)分],P<0.05。结论:临床药师主导的慢病管理可改善老年高血压患者的用药依从性,从而进一步提高临床指标达标率。
Objective: To explore the effect of chronic disease management led by clinical pharmacists on improving,drug compliance in elderly patients with hypertension. Methods: A total of 71 patients were enrolled in the study. They were divided into control group and intervention group according to the random number table method. Clinical pharmacists provided pharmaceutical care to both the two groups in different cycles. At the 3 rd and 6 th month after discharge, the patients in the two groups were assessed whether they had missed medication, stopped medication or reduced dosage, and the degree of drug understanding and drug compliance. Results: At the 3 rd and 6 th month after discharge, the rate of drug omission(12.00%, 24.00%) and the rate of drug withdrawal or reduction(16.00%, 4.00%) in the intervention group were significantly lower than those in the control group(drug omission 56.25%,59.38%; drug withdrawal or reduction 46.88%, 43. 75%),P < 0.05. The degree of understanding [(1. 32 ± 0. 56),(1.16 ±0.37)] was significantly better than that of the control group[(2.00 ±0. 67),(1.97 ±0. 74)],P <0. 05; the compliance of the intervention group[(1.36±1. 11),(1.04±0.89)] was significantly better than that of the control group[(2.44±1.19),(2. 38±1.29)],P<0.05. Conclusion: Clinical pharmacist-led chronic disease management can improve the medication adherence in elderly patients with hypertension, further improving the rate of reaching the standard of clinical indicators.
Objective: To explore the effect of chronic disease management led by clinical pharmacists on improving,drug compliance in elderly patients with hypertension. Methods: A total of 71 patients were enrolled in the study. They were divided into control group and intervention group according to the random number table method. Clinical pharmacists provided pharmaceutical care to both the two groups in different cycles. At the 3 rd and 6 th month after discharge, the patients in the two groups were assessed whether they had missed medication, stopped medication or reduced dosage, and the degree of drug understanding and drug compliance. Results: At the 3 rd and 6 th month after discharge, the rate of drug omission(12.00%, 24.00%) and the rate of drug withdrawal or reduction(16.00%, 4.00%) in the intervention group were significantly lower than those in the control group(drug omission 56.25%,59.38%; drug withdrawal or reduction 46.88%, 43. 75%),P < 0.05. The degree of understanding [(1. 32 ± 0. 56),(1.16 ±0.37)] was significantly better than that of the control group[(2.00 ±0. 67),(1.97 ±0. 74)],P <0. 05; the compliance of the intervention group[(1.36±1. 11),(1.04±0.89)] was significantly better than that of the control group[(2.44±1.19),(2. 38±1.29)],P<0.05. Conclusion: Clinical pharmacist-led chronic disease management can improve the medication adherence in elderly patients with hypertension, further improving the rate of reaching the standard of clinical indicators.
引文
[1]中国老年学和老年医学学会心脑血管病专业委员会.老年高血压的诊断与治疗中国专家共识(2017版)[J].中华内科杂志,2017,56(11):885-893.
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[3] Ramírez E, Bellon T, Tong H Y, et al.Significant HLA class I type associations with aromaticantiepileptic drug(AED)-induced SJS/TEN are different from those found for the same AED-induced DRESS in the Spanish population[J].Pharmacol Res,2017,115(1):168-178.
[4]梁长秀.慢病管理中健康管理的应用[J].中国社区医师:医学专业,2011,13(4):211-212.
[5] Park H Y,Seo S A,Yoo H,et al.Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases[J].Patient Prefer Adherence,2018,12(1):175-181.
[6] Readdean K C,Heuer A J,Scott P J.Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology:a systematic review and meta-analysis[J].Res Social Adm Pharm,2018,14(4):321-331.
[7]王陇德,齐小秋,陈传宏,等.中国居民营养与健康状况调査报告:2002综合报告[R].北京:人民卫生出版社,2005.
[8] Evans C D,Eurich D T,Remillard A J,et al.First-fill medication discontinuations and nonadherence to antihypertensive therapy:an observational study[J].Am J Hypertens,2012,25(2):195-203.
[9]胡康,吴士艳,孙凯歌,等.高血压患者自我管理行为与服药依从性的关联[J].中华高血压杂志,2017,23(10):961-967.
[10]孙洁,阮婷婷,林飞,等.药师主导的药学服务对社区高血压病人疗效的影响[J].药学服务与研究,2012,12(3):180-184.
[11] Bubalo J,Jr C R,Jiing S S,et al.Medication adherence:pharmacist perspective[J] J Am Pharm Assoc,2010,50(3):394-406.
[12] Bryant J,Mcdonald V M,Boyes A,et al.Improving medication adherence in chronic obstructive pulmonary disease:a systematic review[J].Respir Res,2013,14(1):1-8.
[13] Sathira-Angkura T,Kongsin S,Intaraprasong B,et al.Factors associated with the effectiveness of diabetes care at primary care settings[J].J Med Assoc Thai,2011,94,(12):1513-20.
[14] De Vera M A,Bhole V,Burns L C,et al.Impact of statin adherence,on cardiovascular disease,and mortality outcomes:a systematic review[J].Br J Clin Pharmacol,2014,78(4):684-698.
[15]施楠楠,甄健存,谢颖,等.临床药师慢病管理工作模式的探讨[J].临床药物治疗杂志,2015,13(1):83-86.
[16]李全志,甄健存,潘鹏玉,等.临床药师主导慢病管理对改善2型糖尿病患者临床指标的前瞻性随机对照研究[J].临床药物治疗杂志,2015,13(6):29-33.
[17]李磊,吴晓静,闫文杰,等.社区慢性病管理的失访状况及影响因素探讨[J].中国全科医学,2017,20(25):3079-3083.
[2]国家卫生计生委.中国居民营养与慢性病状况报告(2015年)[EB/OL].(2015-06-30)[2018-02-15]. http://www. nhfpc. gov. cn/jkj/s5879/201506/4505528e65f3460fb88685081ff158a2.shtml.
[3] Ramírez E, Bellon T, Tong H Y, et al.Significant HLA class I type associations with aromaticantiepileptic drug(AED)-induced SJS/TEN are different from those found for the same AED-induced DRESS in the Spanish population[J].Pharmacol Res,2017,115(1):168-178.
[4]梁长秀.慢病管理中健康管理的应用[J].中国社区医师:医学专业,2011,13(4):211-212.
[5] Park H Y,Seo S A,Yoo H,et al.Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases[J].Patient Prefer Adherence,2018,12(1):175-181.
[6] Readdean K C,Heuer A J,Scott P J.Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology:a systematic review and meta-analysis[J].Res Social Adm Pharm,2018,14(4):321-331.
[7]王陇德,齐小秋,陈传宏,等.中国居民营养与健康状况调査报告:2002综合报告[R].北京:人民卫生出版社,2005.
[8] Evans C D,Eurich D T,Remillard A J,et al.First-fill medication discontinuations and nonadherence to antihypertensive therapy:an observational study[J].Am J Hypertens,2012,25(2):195-203.
[9]胡康,吴士艳,孙凯歌,等.高血压患者自我管理行为与服药依从性的关联[J].中华高血压杂志,2017,23(10):961-967.
[10]孙洁,阮婷婷,林飞,等.药师主导的药学服务对社区高血压病人疗效的影响[J].药学服务与研究,2012,12(3):180-184.
[11] Bubalo J,Jr C R,Jiing S S,et al.Medication adherence:pharmacist perspective[J] J Am Pharm Assoc,2010,50(3):394-406.
[12] Bryant J,Mcdonald V M,Boyes A,et al.Improving medication adherence in chronic obstructive pulmonary disease:a systematic review[J].Respir Res,2013,14(1):1-8.
[13] Sathira-Angkura T,Kongsin S,Intaraprasong B,et al.Factors associated with the effectiveness of diabetes care at primary care settings[J].J Med Assoc Thai,2011,94,(12):1513-20.
[14] De Vera M A,Bhole V,Burns L C,et al.Impact of statin adherence,on cardiovascular disease,and mortality outcomes:a systematic review[J].Br J Clin Pharmacol,2014,78(4):684-698.
[15]施楠楠,甄健存,谢颖,等.临床药师慢病管理工作模式的探讨[J].临床药物治疗杂志,2015,13(1):83-86.
[16]李全志,甄健存,潘鹏玉,等.临床药师主导慢病管理对改善2型糖尿病患者临床指标的前瞻性随机对照研究[J].临床药物治疗杂志,2015,13(6):29-33.
[17]李磊,吴晓静,闫文杰,等.社区慢性病管理的失访状况及影响因素探讨[J].中国全科医学,2017,20(25):3079-3083.