药学干预对临床帕洛诺司琼止吐预防性使用的影响  

Influence of pharmacist intervention in prophylactic antiemetic palonosetron

作　　者：周芷筠 王琳[1] 钟海利[1] 温金华[1] 熊建萍[1] 陈璿瑛[1] 

机构地区：[1]南昌大学第一附属医院药学部,江西南昌330006 [2]江西省人民医院药学部,江西南昌330006

出　　处：《中国医院药学杂志》2018年第4期431-435,共5页Chinese Journal of Hospital Pharmacy

基　　金：江西省卫生计生委科技计划课题(编号:20165175)

摘　　要：目的:探讨临床药师的药学干预对帕洛诺司琼止吐预防性使用的影响。方法:设计一项前后测试的准实验,由一名专职临床药师主导药学干预过程。考察指标包括帕洛诺司琼止吐预防性使用的处方合格率、止吐方案与指南(专家共识)的一致性、不良反应发生率、呕吐完全缓解率及帕洛诺司琼预防呕吐的平均费用。在药学干预结束后半年内,继续考察,以评估药学干预作用有无延续性。结果:与对照组相比,干预组帕洛诺司琼止吐预防性使用的处方合格率、止吐方案与指南(专家共识)的一致性均由11%提高至56%(P<0.01),不良反应发生率由26%减少至14%(P=0.034),呕吐完全缓解率由100%降至96%(P=0.043),帕洛诺司琼预防呕吐的平均费用由815元/例降至591.5元/例(P=0.014)。对术后恶心呕吐组与化疗相关性恶心呕吐组分别进行亚组分析,经过药学干预,帕洛诺司琼预防术后恶心呕吐的安全性、经济性得到提高,有效性同干预前。帕洛诺司琼预防化疗相关性恶心呕吐的安全性、经济性同干预前,有效性虽降低,但仍高达94.74%(P=0.043)。干预后组与干预组比较,相关指标无显著性差异(P>0.05)。结论:药学干预对促进帕洛诺司琼临床合理使用,增强临床循证行为,具有积极作用,且干预作用具延续性。OBJECTIVE To investigate the impact of multifaceted pharmacist interventions on prophylactic antiemetic palonosetron.METHODS A pretest-posttest quasi-experimental study was conducted.During the intervention phase,a dedicated pharmacist was assigned and multifaceted interventions were implemented.Then the differences were inspected in palonosetron utilization,percentage of qualified prescriptions,clinical and economic outcomes.Furthermore,patients were collected after the intervention to evaluate the sustained effects of pharmacist interventions.RESULTS Compared with baseline group,a significant increase was found in percentage of qualified prescriptions,the proportion of consistency between antiemetic regimen and published guidelines,from 11% to 56%（P〈0.01）.Meanwhile,a significant reduction was seen in the proportion of adverse drug reaction.Furthermore,there were also significant decrease of the rates of average cost（P〈0.05）.Moreover,the effects were sustained after discontinuation of the active interventions,as shown in prophylactic palonosetron utilization data.CONCLUSION Pharmacist interventions in prophylactic palonosetron utilization result in a high adherence to evidence-based treatment guidelines and a profound culture change in drug prescribing with favorable outcomes.The effects of pharmacist intervention are sustained and the role of pharmacists is emphasized for rational medication and optimal outcomes in clinical treatment.

关 键 词：临床药师 药学干预 帕洛诺司琼 合理用药 

分 类 号：R95[医药卫生—药学]