临床药学服务对幽门螺杆菌阳性消化性溃疡患者用药依从性及治疗效果的影响分析
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摘要
目的:评价临床药学服务对幽门螺杆菌(H.pylori)阳性消化性溃疡患者用药依从性及治疗效果的影响。方法:前瞻性纳入2015年7月-2016年6月我院消化内科门诊H.pylori阳性消化性溃疡患者96名,随机分为对照组和干预组,对照组予常规门诊服务,干预组予用药教育及随访。分别于根除H.pylori治疗前后对患者用药依从性、胃肠道症状进行评分,抗酸治疗结束至少4周后~(14)C尿素呼气试验复查H.pylori根除率。结果:临床药学服务干预组患者用药依从性评分显著高于对照组(3.73 vs.2.58,P<0.01),提高程度具有显著性差异(1.71 vs.0.44,P<0.01),干预组患者的完全服药率为81.25%,对照组为60.42%,差异有统计学意义(P<0.05);干预组胃肠道症状改善44人,对照组36人(91.67%vs.75.00%,P<0.05);HP根除率干预组显著高于对照组(91.67%vs.72.92%,P<0.05)。结论:临床药学服务能显著提高门诊消化性溃疡患者根除H.pylori治疗的用药依从性和H.pylori根除率,并改善患者胃肠道症状。
AIM: To assess the influence of clinical pharmaceutical care on medication compliance and treatment effect in Helicobacter pylori( H.pylori) eradication in outpatients with peptic ulcer.METHODS: Ninety-six outpatients with H. pylori positive peptic ulcer from July 2015 to June 2016 were prospectively collected and were randomly divided into control group and intervention group. Patients in the control group were given the traditional outpatient service. The intervention group patients received pharmaceutical education and follow-up by clinical pharmacist. Medication compliance and gastrointestinal symptom were assessed in both groups before and after H. pylori eradication therapy. H. pylori eradication rates of all patients were tested by ~(14)C urea breath test after the end of stopping all medicines for at least 4 weeks. RESULTS: The score and the improvement of compliance with medication of intervention group patients were significantly higher than those of the control group( 3. 73 vs.2. 58,1. 71 vs. 0. 44,P < 0. 01). 81. 25% of patients in intervention group and 60. 42% of patients in control group took all prescribed doses. The difference was statistically different( P < 0. 05).Forty-four patients of the intervention group and thirty-six patients in the control group reported less gastrointestinal symptoms( 91. 67% vs. 75. 00%,P <0. 05). The H. pylori eradication rate of the intervention group was significantly higher than that of the control group( 91. 67% vs. 72. 92%, P <0. 05). CONCLUSION: Clinical pharmaceutical care has a significant effect on H. pylori eradication rate,medication compliance and the improvement of gastrointestinal symptom.
AIM: To assess the influence of clinical pharmaceutical care on medication compliance and treatment effect in Helicobacter pylori( H.pylori) eradication in outpatients with peptic ulcer.METHODS: Ninety-six outpatients with H. pylori positive peptic ulcer from July 2015 to June 2016 were prospectively collected and were randomly divided into control group and intervention group. Patients in the control group were given the traditional outpatient service. The intervention group patients received pharmaceutical education and follow-up by clinical pharmacist. Medication compliance and gastrointestinal symptom were assessed in both groups before and after H. pylori eradication therapy. H. pylori eradication rates of all patients were tested by ~(14)C urea breath test after the end of stopping all medicines for at least 4 weeks. RESULTS: The score and the improvement of compliance with medication of intervention group patients were significantly higher than those of the control group( 3. 73 vs.2. 58,1. 71 vs. 0. 44,P < 0. 01). 81. 25% of patients in intervention group and 60. 42% of patients in control group took all prescribed doses. The difference was statistically different( P < 0. 05).Forty-four patients of the intervention group and thirty-six patients in the control group reported less gastrointestinal symptoms( 91. 67% vs. 75. 00%,P <0. 05). The H. pylori eradication rate of the intervention group was significantly higher than that of the control group( 91. 67% vs. 72. 92%, P <0. 05). CONCLUSION: Clinical pharmaceutical care has a significant effect on H. pylori eradication rate,medication compliance and the improvement of gastrointestinal symptom.
引文
[1]中华消化杂志编委会.消化性溃疡诊断与治疗规范(2016年,西安)[J].中华消化杂志,2016,36(8):508-513.
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[5]戴巧君,舒小莉.影响幽门螺杆菌阳性消化性溃疡患者病原菌根除效果的相关因素分析[J].中国现代医生,2013,51(12):9-11.
[6]姒健敏,王杭勇,蔡建庭,等.中国人溃疡病流行状况及其治疗依从性[J].中华内科杂志,2000,39(3):153-155.
[7]Laskin DM.Following the doctor`s orders[J].J Oral Maxillofac Surg,1994,52(5):437.
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[9]Morisky DE,Green LW,Levine DM.Concurrent and predictive validity of a self-reported measure of medication adherence[J].Med Care,1986,24(1):67-74.
[10]虞燕霞,朱莉红,唐莲,等.药学服务干预对高脂血症患者用药依从性、治疗效果及颈动脉粥样斑块的影响分析[J].中国药学杂志,2014,49(19):1760-1762.
[11]Al-Eidan FA,Mc Elnay JC,Scott MG,et al.Management of Helicobacter pylori eradication-the influence of structured counselling and follow-up[J].Br J Clin Pharmacol,2002,53(2):163-171.
[12]Funakoshi R,Yokoyama H,Kawai N,et al.Effect of pharmaceutical care on diagnosis based on assessment of 13C-urea breath test for Helicobacter pylori infection[J].YAKUGAKU ZASSHI,2012,132(5):601-607.
[13]李晓娟,李哲轩,汤富兵,等.幽门螺杆菌根除效果影响因素分析[J].中华肿瘤防治杂志,2015,22(15):1165-1169.
[14]Shahid SK.Novel anti-Helicobacter pylori therapies[J].Pharm Pat Anal,2014,3(4):411-427.
[15]Greenberg ER,Anderson GL,Morgan DR,et al.14-day triple,5-day concomitant,and 10-day sequential therapies for Helicobacter pylori infection in seven Latin American sites:a randomised trial[J].Lancet,2011,378(9790):507-514.
[16]Wang CH,Liao ST,Yang J,et al.Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori eradication:A prospective single-center study from China[J].World J Gastroenterol,2015,21(39):11179-11184.
[17]彭昕,宋丽秀,陈卫刚,等.电话随访对幽门螺杆菌感染患者服药依从性及根除率的影响[J].中南大学学报(医学版),2017,42(3):308-312.
[18]王艳,周惠琴,唐文.苏州市胃肠病患者幽门螺杆菌耐药分析[J].中国公共卫生,2010,26(1):122-123.
[2]Malfertheiner P,Megraud F,O'Morain CA,et al.Management of Helicobacter pylori infection-the Maastricht IV/Florence Consensus Report[J].Gut,2012,61(5):646-664.
[3]Lanas A,Chan FK.Peptic ulcer disease[J].Lancet,2017(Feb 23).doi:10.1016/S0140-6736(16)32404-7.
[4]胡伏莲.重视幽门螺杆菌感染根除治疗中的几个问题[J].中华医学杂志,2013,93(44):3489-3490.
[5]戴巧君,舒小莉.影响幽门螺杆菌阳性消化性溃疡患者病原菌根除效果的相关因素分析[J].中国现代医生,2013,51(12):9-11.
[6]姒健敏,王杭勇,蔡建庭,等.中国人溃疡病流行状况及其治疗依从性[J].中华内科杂志,2000,39(3):153-155.
[7]Laskin DM.Following the doctor`s orders[J].J Oral Maxillofac Surg,1994,52(5):437.
[8]Svedlund J,Sjodin I,Dotevall G.GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease[J].Dig Dis Sci,1988,33(2):129-134.
[9]Morisky DE,Green LW,Levine DM.Concurrent and predictive validity of a self-reported measure of medication adherence[J].Med Care,1986,24(1):67-74.
[10]虞燕霞,朱莉红,唐莲,等.药学服务干预对高脂血症患者用药依从性、治疗效果及颈动脉粥样斑块的影响分析[J].中国药学杂志,2014,49(19):1760-1762.
[11]Al-Eidan FA,Mc Elnay JC,Scott MG,et al.Management of Helicobacter pylori eradication-the influence of structured counselling and follow-up[J].Br J Clin Pharmacol,2002,53(2):163-171.
[12]Funakoshi R,Yokoyama H,Kawai N,et al.Effect of pharmaceutical care on diagnosis based on assessment of 13C-urea breath test for Helicobacter pylori infection[J].YAKUGAKU ZASSHI,2012,132(5):601-607.
[13]李晓娟,李哲轩,汤富兵,等.幽门螺杆菌根除效果影响因素分析[J].中华肿瘤防治杂志,2015,22(15):1165-1169.
[14]Shahid SK.Novel anti-Helicobacter pylori therapies[J].Pharm Pat Anal,2014,3(4):411-427.
[15]Greenberg ER,Anderson GL,Morgan DR,et al.14-day triple,5-day concomitant,and 10-day sequential therapies for Helicobacter pylori infection in seven Latin American sites:a randomised trial[J].Lancet,2011,378(9790):507-514.
[16]Wang CH,Liao ST,Yang J,et al.Effects of daily telephone-based re-education before taking medicine on Helicobacter pylori eradication:A prospective single-center study from China[J].World J Gastroenterol,2015,21(39):11179-11184.
[17]彭昕,宋丽秀,陈卫刚,等.电话随访对幽门螺杆菌感染患者服药依从性及根除率的影响[J].中南大学学报(医学版),2017,42(3):308-312.
[18]王艳,周惠琴,唐文.苏州市胃肠病患者幽门螺杆菌耐药分析[J].中国公共卫生,2010,26(1):122-123.