临床药师主导的慢性病管理在提高老年高血压患者对药物了解程度方面的作用
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摘要
目的:评估临床药师主导的慢性病管理在提高老年高血压患者药物了解程度方面的作用。方法:设计随机对照研究,纳入符合标准的老年高血压患者,出院时将患者随机分为对照组及干预组,临床药师对两组患者进行不同周期的随访,干预组前3个月每2周随访1次,后3个月每4周随访1次;对照组每3个月随访1次,随访时间均为6个月。统计两组在随访期内临床药师进行药物重整、用药教育、药物不良反应教育、生活方式教育及患者主动咨询的次数;分别在3、6个月时对两组患者的药物了解程度进行评分(1～3分,1分为完全了解,3分为不了解)。结果:最终分别纳入对照组和干预组患者32、25名,两组患者基线特征及药物了解程度评分[(1.59±0.49)、(1.6±0.5)]比较差异无统计学意义(P>0.05);对照组与干预组在第3个月时药物重整次数分别为(0.34±0.65)、(2.48±2.43)次(P<0.05),用药教育次数分别为(1.56±2.23)、(2.08±2.80)次,药物不良反应教育次数分别为(0.66±1.07)、(4.44±3.01)次(P<0.05),生活方式教育次数分别为(0.38±0.66)、(2.64±2.83)次(P<0.05),患者主动咨询次数分别为(0.41±1.10)、(0.44±0.92)次,药物了解程度评分分别为(2.00±0.67)、(1.32±0.56)分(P<0.05);第6个月时两组的上述6项数据分别为(0.09±0.39)、(1.88±1.76)次(P<0.05),(0.09±0.39)、(1.40±2.10)次(P<0.05),(0.13±0.42)、(1.76±1.56)次(P<0.05),(0.03±0.18)、(0.36±0.81)次(P<0.05),(0.06±0.35)、(0.16±0.47)次,(1.97±0.74)、(1.16±0.37)分(P<0.05),在患者药物了解程度评分上,临床药师干预组优于对照组。结论:临床药师主导的慢性病管理可提高老年高血压患者的药物了解程度。
OBJECTIVE:To evaluate the effects of clinical pharmacist-led chronic disease management on the improvement of drug understanding in elderly hypertensive patients. METHODS:In designed randomized controlled study,elderly hypertensive patients met inclusion criteria were randomly divided into control group and intervention group at discharge;clinical pharmacists followed up two groups during different periods. Intervention group was followed up once every 2 weeks in the first 3 months and once every 4 weeks in the latter 3 months. Control group was followed up once every 3 months,lasting for 6 months. The times of drug reorganization,medication education,ADR education,lifestyle education and patient counseling were counted in 2 groups during follow-up period. The drug understanding of patients was scored in 2 groups at 3 and 6 months(1-3 points,1 point was complete understanding,3 points meant no understanding). RESULTS:Finally,32 and 25 patients were included in control group and intervention group,there was no statistical significance in baseline characteristics and the score of drug understanding [(1.59±0.49),(1.6 ± 0.5)] between 2 groups(P>0.05). In control group and intervention group,at 3 months,the times of drug reorganization were(0.34 ± 0.65)and(2.48 ± 2.43)(P<0.05);those of medication education were(1.56 ± 2.23)and(2.08 ±2.80);those of ADR education were(0.66±1.07)and(4.44±3.01)(P<0.05);those of lifestyle education were(0.38±0.66)and(2.64 ± 2.83)(P<0.05);those of patient counseling were(0.41 ± 1.10) and(0.44 ± 0.92);those of score of drug understanding were(2.00 ± 0.67) and(1.32 ± 0.56),respectively(P<0.05). At 6 months,above 6 indexes of 2 groups were(0.09±0.39)and(1.88±1.76)(P<0.05),(0.09±0.39)and(1.40±2.10)(P<0.05),(0.13±0.42)and(1.76±1.56)(P<0.05),(0.03±0.18)and(0.36±0.81)(P<0.05),(0.06±0.35)and(0.16±0.47),(1.97±0.74)and(1.16±0.37),(P<0.05). For the items of the drug understanding,the intervention group was significantly better than control group. CONCLUSIONS:Clinic pharmacist-led chronic disease management can improve the drug understanding of elderly hypertensive patients.
OBJECTIVE:To evaluate the effects of clinical pharmacist-led chronic disease management on the improvement of drug understanding in elderly hypertensive patients. METHODS:In designed randomized controlled study,elderly hypertensive patients met inclusion criteria were randomly divided into control group and intervention group at discharge;clinical pharmacists followed up two groups during different periods. Intervention group was followed up once every 2 weeks in the first 3 months and once every 4 weeks in the latter 3 months. Control group was followed up once every 3 months,lasting for 6 months. The times of drug reorganization,medication education,ADR education,lifestyle education and patient counseling were counted in 2 groups during follow-up period. The drug understanding of patients was scored in 2 groups at 3 and 6 months(1-3 points,1 point was complete understanding,3 points meant no understanding). RESULTS:Finally,32 and 25 patients were included in control group and intervention group,there was no statistical significance in baseline characteristics and the score of drug understanding [(1.59±0.49),(1.6 ± 0.5)] between 2 groups(P>0.05). In control group and intervention group,at 3 months,the times of drug reorganization were(0.34 ± 0.65)and(2.48 ± 2.43)(P<0.05);those of medication education were(1.56 ± 2.23)and(2.08 ±2.80);those of ADR education were(0.66±1.07)and(4.44±3.01)(P<0.05);those of lifestyle education were(0.38±0.66)and(2.64 ± 2.83)(P<0.05);those of patient counseling were(0.41 ± 1.10) and(0.44 ± 0.92);those of score of drug understanding were(2.00 ± 0.67) and(1.32 ± 0.56),respectively(P<0.05). At 6 months,above 6 indexes of 2 groups were(0.09±0.39)and(1.88±1.76)(P<0.05),(0.09±0.39)and(1.40±2.10)(P<0.05),(0.13±0.42)and(1.76±1.56)(P<0.05),(0.03±0.18)and(0.36±0.81)(P<0.05),(0.06±0.35)and(0.16±0.47),(1.97±0.74)and(1.16±0.37),(P<0.05). For the items of the drug understanding,the intervention group was significantly better than control group. CONCLUSIONS:Clinic pharmacist-led chronic disease management can improve the drug understanding of elderly hypertensive patients.
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.
[2]顾景范.《中国居民营养与慢性病状况报告(2015)》解读[J].营养学报,2016,38(6):525-529.
[3]王彩霞,张蓉,朱梅,等.提高糖尿病患者服药依从性干预措施的国内外对比及对策分析[J].中国初级卫生保健,2017,31(10):11-12.
[4]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,2017,25(10):961-967.
[5]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.
[6] RETA A,DASHTAEI A,LIM S,et al. Opportunities to improve clinical outcomes and challenges to implementing clinical pharmacists into health care teams[J]. Prim Care,2012,39(4):615-626.
[7] SAINI B,LEMAY K,EMMERTON L,et al. Asthma disease management-Australian pharmacists’interventions improve patients’asthma knowledge and this is sustained[J]. Patient Educ Couns,2011,83(3):295-302.
[8]中国高血压防治指南修订委员会.中国高血压防治指南(2010年修订版)[J].中国实用乡村医生杂志,2012,19(10):1-15.
[9]张奇松,马成亮,朱慧,等. N末端B型钠尿肽原与美国纽约心脏病学会心功能分级在心衰诊断中的相关性对比分析[J].当代临床医刊,2012,25(6):42-43.
[10]和晶,虞雪梅.我院糖尿病患者用药依从性和疾病认知程度的调查分析[J].中国药房,2014,25(48):4520-4522.
[11]齐晓涟,王育琴.老年不同人群用药依从性的调查分析[J].中国药学杂志,2002,37(2):141-143.
[12] EVANS CD,EURICH DT,REMILLARD AJ,et al. Firstfill medication discontinuations and nonadherence to antihypertensive therapy:an observational study[J]. Am J Hyperten,2012,25(2):195-203.
[13]张亚同,赵紫楠,李铮,等.对心内科患者中进行药物重整基础上的出院带药教育及应用评价[J].临床药物治疗杂志,2017,15(5):62-65.
[14] PALACIO A,GARAY D,LANGER B,et al. Motivational interviewing improves medication adherence:a systematic review and meta-analysis[J]. J Gen Intern Med,2016,31(8):929-940.
[15]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.
[16]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]顾景范.《中国居民营养与慢性病状况报告(2015)》解读[J].营养学报,2016,38(6):525-529.
[3]王彩霞,张蓉,朱梅,等.提高糖尿病患者服药依从性干预措施的国内外对比及对策分析[J].中国初级卫生保健,2017,31(10):11-12.
[4]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,2017,25(10):961-967.
[5]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.
[6] RETA A,DASHTAEI A,LIM S,et al. Opportunities to improve clinical outcomes and challenges to implementing clinical pharmacists into health care teams[J]. Prim Care,2012,39(4):615-626.
[7] SAINI B,LEMAY K,EMMERTON L,et al. Asthma disease management-Australian pharmacists’interventions improve patients’asthma knowledge and this is sustained[J]. Patient Educ Couns,2011,83(3):295-302.
[8]中国高血压防治指南修订委员会.中国高血压防治指南(2010年修订版)[J].中国实用乡村医生杂志,2012,19(10):1-15.
[9]张奇松,马成亮,朱慧,等. N末端B型钠尿肽原与美国纽约心脏病学会心功能分级在心衰诊断中的相关性对比分析[J].当代临床医刊,2012,25(6):42-43.
[10]和晶,虞雪梅.我院糖尿病患者用药依从性和疾病认知程度的调查分析[J].中国药房,2014,25(48):4520-4522.
[11]齐晓涟,王育琴.老年不同人群用药依从性的调查分析[J].中国药学杂志,2002,37(2):141-143.
[12] EVANS CD,EURICH DT,REMILLARD AJ,et al. Firstfill medication discontinuations and nonadherence to antihypertensive therapy:an observational study[J]. Am J Hyperten,2012,25(2):195-203.
[13]张亚同,赵紫楠,李铮,等.对心内科患者中进行药物重整基础上的出院带药教育及应用评价[J].临床药物治疗杂志,2017,15(5):62-65.
[14] PALACIO A,GARAY D,LANGER B,et al. Motivational interviewing improves medication adherence:a systematic review and meta-analysis[J]. J Gen Intern Med,2016,31(8):929-940.
[15]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.
[16]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.