临床药师参与慢性心力衰竭临床路径管理的效果评价  

Effect Evaluation of Clinical Pharmacists Participating in Clinical Pathway Management for Chronic Heart Failure

作　　者：潘金[1] 刘梅霞[2] 车峰远[3] 李峥嵘[4] 张宗林[4] 石增成[1] 欧知宏[1] 

机构地区：[1]临沂市人民医院心内科,山东临沂276000 [2]临沂市中医医院药剂科,山东临沂276000 [3]临沂市人民医院神经内科,山东临沂276000 [4]临沂市人民医院药学部,山东临沂276000

出　　处：《中国药房》2017年第23期3277-3281,共5页China Pharmacy

基　　金：山东省科技惠民计划项目(No.2013kjhm130406);山东省医药卫生科技发展计划项目(No.2015WS0367)

摘　　要：目的:评价临床药师参与慢性心力衰竭临床路径管理的作用和效果。方法:选取2014年1月-2015年10月临沂市人民医院心内科收治的107例成人慢性心力衰竭住院患者,按照随机数字表法分为对照组(56例,脱落3例,共53例完成研究)和试验组(58例,脱落4例,共54例完成研究),对照组采用常规慢性心力衰竭临床路径管理方法,试验组采用临床药师参与的临床路径管理方法。比较两组患者的临床疗效、心衰药物使用情况、经济学指标、出院后用药依从性及因心衰再入院率等。结果:试验组患者临床总有效率显著高于对照组,差异有统计学意义(P<0.05)。试验组患者血管紧张素转化酶抑制药(ACEI)/血管紧张素受体阻滞药(ARB)、β受体阻滞药的使用率与AECI/ARB的靶剂量率均显著高于对照组,差异有统计学意义(P<0.05);而β受体阻滞药的靶剂量率虽高于对照组,但差异无统计学意义(P>0.05)。试验组患者住院时间、药品费用、总住院费用、药占比均低于或低于对照组,但差异均无统计学意义(P>0.05)。出院1个月后,试验组患者服药依从率显著高于对照组,差异有统计学意义(P<0.05);再入院率虽低于对照组,但差异无统计学意义(P>0.05)。出院3个月后,试验组患者服药依从率显著高于对照组,再入院率低于对照组,差异均有统计学意义(P<0.05)。结论:临床药师参与慢性心力衰竭临床路径管理,可以明显提高指南推荐药物的使用率、临床疗效及患者用药依从性,降低再入院率。OBJECTIVE：To evaluate the effects of clinical pharmacists participating in clinical pathway management for chronic heart failure（CHF）. METHODS：A total of 107 CHF adult inpatients in Linyi People＇s Hospital during Jan. 2014-Oct. 2015 were divided into control group（56 cases,3 withdrawal,53 in total）and trial group（58 cases,4 withdrawal,54 in total）according to random number table. Control group received routine clinical pathway management method of CHF;trial group received clinical pathway management with the participation of clinical pharmacists. Clinical efficacy,the utilization of heart failure drugs,economic indexes,medication compliance after discharge,re-hospitalization rate due to heart failure were compared between 2 groups.RESULTS：Total response rate of trial group was significantly higher than control group,with statistical significance（P〈0.05）.The utilization rate of ACEI/ARB,β-receptor blocker,target dose rate of ACEI/ARB in trial group were significantly higher than control group,with statistical significance（P〈0.05）;target dose rate of β-receptor blocker was higher than control group,without statistical significance（P〈0.05）. Hospitalization time,drug cost,total hospitalization cost and drug ratio of trial group were shorter or lower than control group,without statistical significance（P〈0.05）. One month after discharge,the proportion of medication compliance in trial group was significantly higher than control group,with statistical significance（P〈0.05）;re-hospitalization rate was lower than control group,without statistical significance（P〈0.05）. Three months after discharge,the proportion of medication compliance in trial group was higher than control group,while re-hospitalization rate was lower than control group,with statistical significance（P〈0.05）. CONCIUSIONS：The participation of clinical pharmacists in clinical pathway management of CHF can significantly improve the utilization rate of recommended drugs by guideline,clinical eff

关 键 词：慢性心力衰竭 临床路径 临床药师 药学服务 

分 类 号：R952[医药卫生—药学] R541.6