基于药物治疗管理的药师抗凝模式探索与建立
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摘要
本文基于药物治疗管理(medication therapy management, MTM)的服务理念和方法,参考国内外抗凝门诊工作内容,结合北京清华长庚医院患者特点,从个人药物记录、药物相关计划、提出参考建议及记录随访4个方面,探索门诊和住院患者MTM服务模式。门诊以提高患者用药安全性及依从性为重点,住院患者以用药重整和患者用药教育为重点。初步建立了药师主导的抗凝MTM模式,该模式分为门诊患者管理和住院患者管理,包含标准服务流程、标准MTM记录表单、患者档案,同时建立用药安全性、依从性、患者满意度、药物经济性等信息的数据库。目前,基于MTM的药师抗凝服务工作各项条件已初步形成,标准化的工作流程和记录将有利于该项工作的持续开展。
This paper based on the concept and method of medication therapy management(MTM), referring to the work contents of anticoagulant clinics at home and abroad, and combining with the characteristics of patients in our hospital, we explored the MTM services for outpatients and inpatients in four aspects: personal medication record, medication-related action plan, documented suggestion/intervention and follow-up. Outpatient management should focus on improving the safety and compliance of patients with medication, while inpatients management should focus on medication reconciliation and medication education for patients. A pharmacist-led management model of anticoagulant drugs in our hospital was initially established The model was divided into outpatient management and inpatient management It included standard workflow, standard MTM record form and patient file. At the same time,a database of drug safety,compliance,patient satisfaction and drug economy was established. This MTM anticoagulant service has been preliminarily formed, and standardized workflow and records will be conducive to the continuous development of the work.
This paper based on the concept and method of medication therapy management(MTM), referring to the work contents of anticoagulant clinics at home and abroad, and combining with the characteristics of patients in our hospital, we explored the MTM services for outpatients and inpatients in four aspects: personal medication record, medication-related action plan, documented suggestion/intervention and follow-up. Outpatient management should focus on improving the safety and compliance of patients with medication, while inpatients management should focus on medication reconciliation and medication education for patients. A pharmacist-led management model of anticoagulant drugs in our hospital was initially established The model was divided into outpatient management and inpatient management It included standard workflow, standard MTM record form and patient file. At the same time,a database of drug safety,compliance,patient satisfaction and drug economy was established. This MTM anticoagulant service has been preliminarily formed, and standardized workflow and records will be conducive to the continuous development of the work.
引文
[1] Pellegrino A N, Martin M T, Tilton J J, et al. Medication therapy management services:definitions and outcomes[J]. Drugs, 2009,69(4):393-406.
[2]刘伊,管晓东,信枭雄,等.药物治疗管理研究综述[J].中国药事,2015, 29(11):1172-1180.
[3]王可,侯凯旋,闫素英.国内外药物治疗管理开展现状[J].中国药房,2018, 29(5):580-586.
[4] Witt D M. The Kaiser Permanente Colorado Clinical PharmacyAnticoagulation Service as a model of modern anticoagulant care[J]. Thromb Res, 2008, 123(Suppl.):S36-S41.
[5] Heilmann R M, Campbell S M, Kroner B A, et al. Evolution,current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization[J]. Ann Pharmacother, 2013, 47(1):124-131.
[6] Verret L, Couturier J,Rozon A, et al. Impact of a pharmacist-led warfarin self-management program on quality of life and anticoagulation control:a randomized trial[J]. Pharmacotherapy, 2012,32(10):871-879.
[7]Bungard T J, Gardner L, Archer S L, et al. Evaluation of a pharmacist-managed anticoagulation clinic:improving patient care[J]. Open Med, 2009, 3(1):e16-e21.
[8] Harrison J, Shaw J P, Harrison J E. Anticoagulation management by community pharmacists in New Zealand:an evaluation of a collaborative model in primary care[J]. Int J Pharm Pract, 2015,23(3):173-181.
[9] Kong M C, Ng H J, Lee P L, et al. Implementation and impact of a hybrid pharmacist-assisted anticoagulation clinic model on the quality of anticoagulation therapy[J]. Clin Appl Thromb Hemost, 2012, 18(3):334-337.
[10] Chua W B, Cheen H H, Kong M C, et al. Modelling the cost-effectiveness of pharmacist-managed anticoagulation service for older adults with atrial fibrillation in Singapore[J]. Int J Clin Pharm, 2016, 38(5):1230-1240.
[11]侯珂露,崔向丽,刘丽宏.药师参与抗凝治疗管理研究进展[J].医学综述,2018, 24(3):565-570.
[12] Chan F W, Wong R S, Lau W H, et al. Management of Chinese patients on warfarin therapy in two models of anticoagulation service:a prospective randomized trial[J]. Br J Clin Pharmacol,2006, 62(5):601-609.
[13]林鑫,徐瑞娟,葛卫红.美国药师参与住院抗凝管理的服务模式[J].药学与临床研究,2015, 23(6):611-614.
[14] Viswanathan M, Kahwati L C, Golin C E, et al. Medication therapy management interventions in outpatient settings:a systematic review and meta-analysis[J]. JAMA Intern Med,2015, 175(1):76-87.
[15] Hui R L, Yamada B D, Spence M M, et al. Impact of a medicare MTM program:evaluating clinical and economic outcomes[J]. Am J Manag Care, 2014, 20(2):e43-e51.
[16] Rosenthal M, Holmes E, Banahan B. Making MTM implementable and sustainable in conmnunity pharmacy:Is it time for a different game plan[J]. Res Social Adm Pharm, 2016,12(3):523-528.
[17] Reidt S, Holtan H, Stender J, et al. Integrating home-based medication therapy management(MTM)services in a health system[J]. J Am Pharm Assoc, 2016, 56(2):178-183.
[18]丁征,王莹,潘文斐,等.抗凝门诊模式的建立和展望[J].临床药物治疗杂志,2016, 14(2):40-43.
[2]刘伊,管晓东,信枭雄,等.药物治疗管理研究综述[J].中国药事,2015, 29(11):1172-1180.
[3]王可,侯凯旋,闫素英.国内外药物治疗管理开展现状[J].中国药房,2018, 29(5):580-586.
[4] Witt D M. The Kaiser Permanente Colorado Clinical PharmacyAnticoagulation Service as a model of modern anticoagulant care[J]. Thromb Res, 2008, 123(Suppl.):S36-S41.
[5] Heilmann R M, Campbell S M, Kroner B A, et al. Evolution,current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization[J]. Ann Pharmacother, 2013, 47(1):124-131.
[6] Verret L, Couturier J,Rozon A, et al. Impact of a pharmacist-led warfarin self-management program on quality of life and anticoagulation control:a randomized trial[J]. Pharmacotherapy, 2012,32(10):871-879.
[7]Bungard T J, Gardner L, Archer S L, et al. Evaluation of a pharmacist-managed anticoagulation clinic:improving patient care[J]. Open Med, 2009, 3(1):e16-e21.
[8] Harrison J, Shaw J P, Harrison J E. Anticoagulation management by community pharmacists in New Zealand:an evaluation of a collaborative model in primary care[J]. Int J Pharm Pract, 2015,23(3):173-181.
[9] Kong M C, Ng H J, Lee P L, et al. Implementation and impact of a hybrid pharmacist-assisted anticoagulation clinic model on the quality of anticoagulation therapy[J]. Clin Appl Thromb Hemost, 2012, 18(3):334-337.
[10] Chua W B, Cheen H H, Kong M C, et al. Modelling the cost-effectiveness of pharmacist-managed anticoagulation service for older adults with atrial fibrillation in Singapore[J]. Int J Clin Pharm, 2016, 38(5):1230-1240.
[11]侯珂露,崔向丽,刘丽宏.药师参与抗凝治疗管理研究进展[J].医学综述,2018, 24(3):565-570.
[12] Chan F W, Wong R S, Lau W H, et al. Management of Chinese patients on warfarin therapy in two models of anticoagulation service:a prospective randomized trial[J]. Br J Clin Pharmacol,2006, 62(5):601-609.
[13]林鑫,徐瑞娟,葛卫红.美国药师参与住院抗凝管理的服务模式[J].药学与临床研究,2015, 23(6):611-614.
[14] Viswanathan M, Kahwati L C, Golin C E, et al. Medication therapy management interventions in outpatient settings:a systematic review and meta-analysis[J]. JAMA Intern Med,2015, 175(1):76-87.
[15] Hui R L, Yamada B D, Spence M M, et al. Impact of a medicare MTM program:evaluating clinical and economic outcomes[J]. Am J Manag Care, 2014, 20(2):e43-e51.
[16] Rosenthal M, Holmes E, Banahan B. Making MTM implementable and sustainable in conmnunity pharmacy:Is it time for a different game plan[J]. Res Social Adm Pharm, 2016,12(3):523-528.
[17] Reidt S, Holtan H, Stender J, et al. Integrating home-based medication therapy management(MTM)services in a health system[J]. J Am Pharm Assoc, 2016, 56(2):178-183.
[18]丁征,王莹,潘文斐,等.抗凝门诊模式的建立和展望[J].临床药物治疗杂志,2016, 14(2):40-43.