老年高血压患者远程慢病药学服务的实践及效果评价  

Practiceand evaluation of telemedicine-based pharmaceutical care for elderly patients with hypertension

作　　者：施楠楠 甄健存[2,3] 梁健华[3] 韩爽[3] 杨丽娟[3] 武丹威[3] 张威[3] 宋再伟 赵荣生[1,2] SHI Nan-nan;ZHEN Jian-cun;LIANG Jian-hua;HAN Shuang;YANG Li-juan;WU Dan-wei;ZHANG Wei;SONG Zai-wei;ZHAO Rong-sheng(Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Pharmaceutical Administration&Clinical Pharmacy,School of Pharmaceutical Science,Peking University,Beijing 100191 China;Department of Pharmacy,Beijing Jishuitan Hospital,Beijing 100035,Chin)

机构地区：[1]北京大学第三医院药剂科,北京100191 [2]北京大学药学院药事管理与临床药学系,北京100191 [3]北京积水潭医院药学部,北京100035

出　　处：《中国医院药学杂志》2021年第10期1069-1074,1084,共7页Chinese Journal of Hospital Pharmacy

基　　金：首都卫生发展科研专项项目(编号:2016-2-2072)。

摘　　要：目的:探索临床药师主导、基于远程的慢病药学服务实践模式,并对老年高血压患者接受药学服务的效果进行评价。方法:采用前瞻性、随机对照试验设计,纳入符合研究标准的老年高血压出院患者,随机分成两组:干预组和对照组。出院后两组患者分别接受临床药师不同周期及监护级别的随访:干预组前3个月每2周随访1次,后3个月每4周随访1次,由临床药师进行远程用药指导和药学服务;对照组每3个月随访1次,进行一般慢病管理建议。两组随访时间均为6个月。随访方式包括远程药学服务平台、电话及微信,具体选择方式根据患者需求决定。结果:研究共纳入109例符合纳排标准的老年高血压出院患者,有93例患者完成6个月随访,其中干预组48例,对照组45例。出院6个月时,干预组血压达标率显著高于对照组(97.30%vs.63.89%,P<0.05);药物了解程度评分干预组优于对照组[(1.44±0.65)分vs.(2.17±0.66)分,P<0.05];用药依从性评分干预组优于对照组[(1.41±0.69)分vs.(2.17±0.82)分,P<0.05];不良反应的错误处置率显著低于对照组(0.00%vs.61.53%,P<0.05);体质指数(BMI)改善干预组优于对照组(87.80%vs.32.43%,P<0.05)。结论:临床药师主导的远程慢病药学服务可有效改善老年高血压患者血压达标率、对药物的了解程度、用药依从性、不良反应的错误处置率及BMI。OBJECTIVE To explore the clinical pharmacist-led and telemedicine-based pharmaceutical care model for patients with chronic diseases and evaluate the outcomes of pharmaceutical care for these patients.METHODS A prospective, randomized controlled trial(RCT) was conducted for 109 discharged elderly patients with hypertension fulfilling the study criteria.They were randomly divided into intervention and control groups.After discharging, both groups were followed up by clinical pharmacists in different periods and received different levels of pharmaceutical care.The intervention group were followed up once every 2 weeks in the first 3 months and once every 4 weeks in the last 3 months.And telemedicine-based pharmaceutical care was provided by clinical pharmacists.The control group were followed up once every 3 months to offer tutorials on the management of chronic diseases.The follow-up period was 6 months.The telemedicine pharmaceutical care service platform, telephone and We Chat were utilized for follow-ups.The patients picked the specific kind of communicating tool.RESULTS Among them, 93 completed a 6-month follow-up, including 48 patients in intervention group and 45 in control group.At Month 6 post-discharge, the standard rate of blood pressure was significantly higher in intervention group than that in control group(97.30% vs 63.89%, P<0.05).The score of drug understanding was higher in intervention group than that in control group[(1.44±0.65) vs(2.17±0.66), P<0.05].The score of medication adherence was higher in intervention group than that in control group[(1.41±0.69) vs(2.17±0.82), P<0.05].The wrong disposal rate of adverse reaction was lower than that of control group(0.00% vs 61.53%, P<0.05).The improvement of body mass index(BMI) of intervention group was better than that of control group(87.80% vs 32.43%, P<0.05).CONCLUSION The telemedicine-based pharmaceutical care led by clinical pharmacists can effectively improve the standard rate of blood pressure in elderly patients with hypertension, help the

关 键 词：慢病管理 远程药学服务 高血压 临床药师 

分 类 号：R95[医药卫生—药学]