抗凝门诊分级管理的药学模式的实践与探索  

Practice and Exploration of Hierarchical Management Model of Anticoagulant Clinic

作　　者：李舒悦 王宝彦 葛卫红[1] 徐航[1] LI Shuyue;WANG Baoyan;GEI Weihong;XU Hang(Department of Pharmacy,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing,Jiangsu 210008,China;School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing,Jiangsu 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院药学部,南京210008 [2]中国药科大学基础医学与临床药学学院,南京210009

出　　处：《药学与临床研究》2021年第1期65-68,共4页Pharmaceutical and Clinical Research

基　　金：江苏省药学会-Shire生物药学基金(S201606);南京市医学科技发展资金资助(QRX17060);南京大学医院管理研究所2017立项课题(NDYG2017012)。

摘　　要：目的:通过对抗凝门诊的分级管理制度进行分析评价,为业内抗凝治疗管理提供借鉴。方法:根据本院抗凝门诊分级管理标准对患者进行分级。对抗凝风险较高的一级患者实施专业化的抗凝管理;二级患者采用常规的抗凝管理手段;稳定的三级患者通过自我管理和定期的复诊保持抗凝水平。选取2019年8月至2020年1月在本院抗凝门诊就诊的患者,分析患者抗凝管理质量及等级变化情况。结果:在上述时间段抗凝门诊就诊患者共计1587人次,一级、二级、三级患者分别为401、547、639人次。随访次数≥3次的患者共251人,等级变化趋势分为波动型、平稳型、趋优型、趋劣型四类,分别为34、76、122、19人。抗凝门诊患者国际标准化比值(INR)达标率为72.8%,轻微出血发生率为6.55%,未发生大出血和血栓栓塞事件。结论:本院抗凝门诊实施分级管理模式后,提升了抗凝管理质量,提高了药师工作效率。Objective:To analyze and evaluate the hierarchical management system of anticoagulant clinic,so as to provide reference for the management of anticoagulant treatment in China.Methods:Patients were graded according to the grade management standard of anticoagulation clinic in our hospital.The first-grade patients with high risk of anticoagulation should be managed professionally;conventional anticoagulant management was used in secondary patients;stable tertiary patients maintain anticoagulant levels through self-management and regular follow-up visits.From August 2019 to January 2020,patients in the anticoagulant clinic of Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School were selected.The quality and changes in grade of anti-coagulation management of the patients were analyzed.Results:From August 2019 to January 2020,a total of 1587 patients were treated in anticoagulant clinic,including 401,547 and 639 patients in the first,second and third levels.A total of 251 patients were followed up for at least three times,and the grade change trend was divided into four categories:undulated type,stationary type,superior type and inferior type,which were 34,76,122 and 19 patients,respectively.The international normalized ratio of patients reached 72.8%,the incidence of minor bleeding was 6.55%,and no major bleeding or thromboembolism events occurred.Conclusion:The implementation of the hierarchical management model in our hospital has improved the quality of the management of the anticoagulant clinic and the work efficiency of pharmacists.

关 键 词：抗凝门诊 分级管理 药学监护 华法林 新型口服抗凝药 

分 类 号：R973.2[医药卫生—药品] R95[医药卫生—药学]