临床药师参与心血管疾病合并心理障碍患者管理的效果观察
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摘要
目的:观察临床药师参与心血管疾病合并心理障碍患者管理的效果,为临床治疗提供帮助。方法:选取2016年7月—2017年7月某院心内科收治的212例心血管疾病合并心理障碍患者,按随机数字表法分为对照组(105例)和试验组(107例),对照组接受常规治疗和医师或护士的常规用药指导及生活方式指导等;试验组在对照组基础上接受心血管专业临床药师的专业指导。比较两组患者合理用药认知水平及复诊率,医疗过程、医疗满意度评分,以及试验组治疗前、服药1月后、2个月后、3个月后复诊时躯体化症状量表(SSS)、抑郁自评量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)评分变化。结果 :试验组合理用药认知水平及复诊率高于对照组,退出研究例数少于对照组,差异有统计学意义(P <0.05);试验组医疗过程、医疗满意度评分高于对照组,差异有统计学意义(P <0.05);两组第一次、第二次、第三次复诊SSS、PHQ-9、GAD-7三个量表的总分值均低于治疗前,且治疗组分值变化大于对照组,差异有统计学意义(P <0.05)。结论 :SSS、PHQ9、GAD7三个量表用于识别心血管疾病合并心理障碍患者可行性强;临床药师参与心血管疾病合并心理障碍患者的管理,能明显提高患者对疾病及药物的认知,提高治疗效果及用药依从性,提高患者对临床医疗服务的满意度。
Objective: To observe the effect of clinical pharmacists participating in the management of the patients with cardiovascular diseases and psychological disorders and to provide assistance for clinical treatment. Methods: 212 patients with cardiovascular diseases and psychological disorders admitted to the Department of Cardiology of a hospital from July 2016 to July 2017 were selected and divided into a control group(105 cases) and an experimental group(107 cases) according to the random number table method. The patients in the control group received conventional treatment and conventional medication guidance and lifestyle guidance from doctors or nurses. The patients in the experimental group received professional guidance from cardiovascular clinical pharmacists on the basis of the control group. The cognitive level of the rational use of drugs and further consultation rate, medical procedure and medical satisfaction scores and somatization symptom scale(SSS), patient health questionnaire(PHQ)-9 and generalized anxiety disorder scale(GAD-7) score changes before treatment, after 1 month, 2 months and 3 months of treatment were compared between the two groups. Results: The cognitive level of the rational use of drugs and further consultation rate in the experimental group were higher than those in the control group, and the number of withdrawal cases was less than that in the control group, with statistically significant differences(P<0.05). The medical procedure and medical satisfaction scores in the experimental group were higher than those in the control group, with statistically significant difference(P<0.05). The total scores of SSS, PHQ-9 and GAD-7 in the first, second and third further consultation were lower than those before treatment in the two groups(P<0.05), and the changes in the scores in the experimental were greater than those in the control group, with statistically significant differences(P<0.05). Conclusion: The three scales of SSS, PHQ9 and GAD7 are feasible in identifying the patients with cardiovascular disease and psychological disorders. The participation of the clinical pharmacists in the management of the patients with cardiovascular diseases and psychological disorders can significantly improve patients' awareness to diseases and drugs, improve treatment effect and medication compliance and improve patients' satisfaction to clinical care services.
Objective: To observe the effect of clinical pharmacists participating in the management of the patients with cardiovascular diseases and psychological disorders and to provide assistance for clinical treatment. Methods: 212 patients with cardiovascular diseases and psychological disorders admitted to the Department of Cardiology of a hospital from July 2016 to July 2017 were selected and divided into a control group(105 cases) and an experimental group(107 cases) according to the random number table method. The patients in the control group received conventional treatment and conventional medication guidance and lifestyle guidance from doctors or nurses. The patients in the experimental group received professional guidance from cardiovascular clinical pharmacists on the basis of the control group. The cognitive level of the rational use of drugs and further consultation rate, medical procedure and medical satisfaction scores and somatization symptom scale(SSS), patient health questionnaire(PHQ)-9 and generalized anxiety disorder scale(GAD-7) score changes before treatment, after 1 month, 2 months and 3 months of treatment were compared between the two groups. Results: The cognitive level of the rational use of drugs and further consultation rate in the experimental group were higher than those in the control group, and the number of withdrawal cases was less than that in the control group, with statistically significant differences(P<0.05). The medical procedure and medical satisfaction scores in the experimental group were higher than those in the control group, with statistically significant difference(P<0.05). The total scores of SSS, PHQ-9 and GAD-7 in the first, second and third further consultation were lower than those before treatment in the two groups(P<0.05), and the changes in the scores in the experimental were greater than those in the control group, with statistically significant differences(P<0.05). Conclusion: The three scales of SSS, PHQ9 and GAD7 are feasible in identifying the patients with cardiovascular disease and psychological disorders. The participation of the clinical pharmacists in the management of the patients with cardiovascular diseases and psychological disorders can significantly improve patients' awareness to diseases and drugs, improve treatment effect and medication compliance and improve patients' satisfaction to clinical care services.
引文
[1]魏万林,张磊.动脉粥样硬化性心血管疾病与精神心理障碍[J].中国循证心血管医学杂志,2015,7(5):579-582.
[2]中国康复学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.在心血管科就诊患者的心理处方中国专家共识[J].中华心血管病杂志,2014,42(1):6-13.
[3]张二箭,田福利,张宾,等.心血管疾病患者焦虑抑郁症状调查研究[J].中国循证心血管医学杂志,2013,5(4):405-407.
[4]徐蔚,刘兢晟,毛家亮.外资医院全科及内科门诊外籍华人多躯体症状调查分析[J].临床军医杂志,2016,44(3):304-308.
[5]龚昌华,陆向红.临床药师参与2型糖尿病患者管理效果观察[J].药物流行病学杂志,2016,25(5):309-313.
[6]庄琦,毛家亮,李春波,等.躯体化症状自评量表的初步编制及信度和效度研究[J].中华行为医学与脑科学杂志,2010,19(9):847-849.
[7]李晓丽,毛家亮,何奔,等.心脏神经症患者躯体化症状自评量表的临床应用[J].中国误诊学杂志,2008,8(20):4798-4799.
[8]姜智敏,陆晓晔,刘黎,等.综合医院急诊科患者躯体化症状对其住院时间和住院费用的影响[J].现代生物医学进展,2016,16(33):6456-6459.
[9]汤静,潘慧,徐松,等.临床药师的认知度和需求情况调研[J].中国临床药学杂志,2009,18(2):101-104.
[10]Koshman SL,Charrois TL,Simpson SH,et al.Pharmacist care of patients with heart failure:a systematic review of randomized trials[J].Arch Intern Med,2008,168(7):687-694.
[11]Glynn LG,Murphy AW,Smith SM,et al.Interventions used to improve control of blood pressure in patients with hypertension[M].Cochrane Database Syst Rev,2010:CD005182.
[12]中华医学会神经病学分会神经心理学与行为神经病学组.综合医院焦虑、抑郁与躯体化症状诊断治疗的专家共识[J].中华神经科杂志,2016,49(12):908-917.
[2]中国康复学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.在心血管科就诊患者的心理处方中国专家共识[J].中华心血管病杂志,2014,42(1):6-13.
[3]张二箭,田福利,张宾,等.心血管疾病患者焦虑抑郁症状调查研究[J].中国循证心血管医学杂志,2013,5(4):405-407.
[4]徐蔚,刘兢晟,毛家亮.外资医院全科及内科门诊外籍华人多躯体症状调查分析[J].临床军医杂志,2016,44(3):304-308.
[5]龚昌华,陆向红.临床药师参与2型糖尿病患者管理效果观察[J].药物流行病学杂志,2016,25(5):309-313.
[6]庄琦,毛家亮,李春波,等.躯体化症状自评量表的初步编制及信度和效度研究[J].中华行为医学与脑科学杂志,2010,19(9):847-849.
[7]李晓丽,毛家亮,何奔,等.心脏神经症患者躯体化症状自评量表的临床应用[J].中国误诊学杂志,2008,8(20):4798-4799.
[8]姜智敏,陆晓晔,刘黎,等.综合医院急诊科患者躯体化症状对其住院时间和住院费用的影响[J].现代生物医学进展,2016,16(33):6456-6459.
[9]汤静,潘慧,徐松,等.临床药师的认知度和需求情况调研[J].中国临床药学杂志,2009,18(2):101-104.
[10]Koshman SL,Charrois TL,Simpson SH,et al.Pharmacist care of patients with heart failure:a systematic review of randomized trials[J].Arch Intern Med,2008,168(7):687-694.
[11]Glynn LG,Murphy AW,Smith SM,et al.Interventions used to improve control of blood pressure in patients with hypertension[M].Cochrane Database Syst Rev,2010:CD005182.
[12]中华医学会神经病学分会神经心理学与行为神经病学组.综合医院焦虑、抑郁与躯体化症状诊断治疗的专家共识[J].中华神经科杂志,2016,49(12):908-917.