临床药师对多重用药病人潜在用药风险的分析和干预  

Analysis and intervention of potential drug risks in patients with multiple medications by clinical pharmacists

作　　者：胡文娟[1,2] 黄瑾[1,3] 李璐奕[1] 孙华君 HU WenJuan;HUANG Jin;LI LuYi;SUN HuaJun(Department of Pharmacy,People＇s Hospital of Shanghai Pudong New District,Shanghai 201299,China;Department of Pharmacy,Shanghai Children＇s Hospital,Children＇s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200062,China;Department of Pharrnaey,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海市浦东新区人民医院药剂科,上海201299 [2]上海市儿童医院,上海交通大学附属儿童医院药学部,上海200062 [3]上海中医药大学附属岳阳中西医结合医院药学部,上海200437

出　　处：《药学服务与研究》2018年第5期332-336,共5页Pharmaceutical Care and Research

基　　金：上海市卫生和计划生育委员会科研课题面上项目(201440461);上海市浦东新区卫生和计划生育委员会卫生科技项目(PW2014B-18);上海市浦东新区卫生系统学科带头人培养计划(PWRd2014-11)

摘　　要：目的:探讨临床药师对多重用药病人潜在用药风险的干预作用。方法:收集临床同时口服≥5种药物的多重用药老年病人118例,以比尔斯(Beers)标准和老年人潜在不恰当处方筛选工具(STOPP)作为处方筛选和干预的标准,分析病人用药情况、存在潜在用药风险的疾病分布及药物类别。药师通过出院教育、药师咨询门诊、药学查房等方式,对用药风险进行干预。结果:118例病人中,存在潜在用药风险者有50例(42.37%),存在与疾病相关的潜在用药风险的病人19例(16.10%),有药物潜在相互作用风险的31例(26.27%)。药学干预后,病人的用药品种数、药品数量、中草药及保健品的服用比例均下降,用药依从性提高,差异有统计学意义(P<0.05)。结论:临床药师对有潜在用药风险的多重用药老年病人进行药学干预,有利于促进合理用药。Objective ： To explore the role of clinical intervention by clinical pharmacists in potential risks of multiple medications. Methods ： A total of 118 elderly patients with multiple medications of more than 5 drugs were enrolled for the study. The Beers criteria and the screening tool of old person potentially inappropriate prescriptions （STOPP） were used as the criteria for prescription screening and intervention. Drug application, disease distribution and drug category related with potential drug risks were analyzed in the process of the study . Then, interventions were made on the part of clinical pharmacists on potential drug risks by medication education at the time of discharge from hospital , as well as in outpatient pharmacist consultation and pharmacist ward round . Results： In the 118 patients, there were 50 （42.3%） patients with potential drug risks , 19 （16.10%） patients with disease related potential drug risks and 31 （26.27%） patients with the risk of potential drug interactions , respee tively. After pharmaceutical intervention, the categories and quantities of drugs , as well as the proportions of herbal drugs and health products all decreased considerably and medication adherence was also improved with statistical significance （P〈0.05）. Conclusion ： Pharmaceutical intervention by clinical pharmacists in the patients with potential drug risks of multiple medications helps to improve rational application of drugs.

关 键 词：多重用药 用药风险 临床药师 合理用药 

分 类 号：R969.3[医药卫生—药理学]