基于Triangle理论的华法林抗凝患者分级管理模式的建立与实践  

Establishment and Practice of Hierarchical Warfarin Anticoagulation Management Mode Based on Triangle Theory

作　　者：戴梦飞 李舒悦 王宝彦 葛卫红[1] 于锋 徐航[1] DAI Meng-fei;LI Shu-yue;WANG Bao-yan;GE Wei-hong;YU Feng;XU Hang(Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院,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：《中国药学杂志》2022年第21期1800-1804,共5页Chinese Pharmaceutical Journal

基　　金：江苏省药学会-Shire生物药学基金资助(S201606);南京市医学科技发展资金资助(QRX17060)。

摘　　要：目的建立基于Triangle理论的华法林抗凝患者分级管理模式(hierarchical warfarin anticoagulation management mode,HWAMM),并评价其实践成效。方法采用文献计量学方法建立HWAMM。纳入2020年5月至2020年9月于南京大学医学院附属鼓楼医院住院的华法林抗凝患者。临床药师对试验组患者进行分级管理,对照组患者进行无差别监护管理,比较两组的抗凝管理质量和药师工作情况等。结果共计纳入使用华法林抗凝的住院患者237例。相较于对照组,试验组中患者凝血检测次数与术后住院天数的比值显著降低[(89.2±9.0)%vs(94.5±8.9)%,P<0.001],且在住院期间国际标准化比值(international normalized ratio,INR)达标率[(33.8±19.9)%vs(28.3±19.0)%,P=0.032]、出院时INR达标人数(65.0%vs 47.9%,P=0.008)等方面显著更优,而单位患者每日管理时间显著减少[(27.8±9.6)min vs(34.6±11.6)min,P<0.001]。在不良事件发生率、服药依从性和抗凝知识评分等方面无显著性差异。结论临床药师建立的HWAMM,能够帮助临床药师识别抗凝治疗高风险患者,使临床药师减负增效,最终提升抗凝管理质量。OBJECTIVE To establish a hierarchical warfarin anticoagulation management mode(HWAMM)based on Triangle theory and to evaluate its practical effect.METHODS The method of bibliometrics was used to establish HWAMM.Patients receiving warfarin in Drum Tower Hospital Affiliated to Nanjing University Medical School from May 2020 to September 2020 were included.Clinical pharmacists conducted hierarchical management for patients in the experimental group,and patients in the control group were managed by pharmacists with original mode.The quality of anticoagulation management and the work efficiency of pharmacists were compared between the two groups.RESULTS A total of 237 patients receiving warfarin were enrolled.Compared with the control group,the ratio of coagulation test times to postoperative hospitalization days[(89.2±9.0)%vs(94.5±8.9)%,P<0.001]for the experimental group was significantly reduced,and the rate of the International Normalized Ratio(INR)in therapeutic range[(33.8±19.9)%vs(28.3±19.0)%,P=0.032]and the number of patients with INR reached the target range before discharge(65.0%vs 47.9%,P=0.008)were significantly higher,and the management time of per patient[(27.8±9.6)min vs(34.6±11.6)min,P<0.001]was significantly reduced.There were no significant differences in the incidence of adverse events,medication compliance,and anticoagulation knowledge between the two groups.CONCLUSION The HWAMM established by clinical pharmacists can help clinical pharmacists identify high-risk patients in anticoagulant therapy,reduce burdens and increase work efficiency of clinical pharmacists,and improve the quality of anticoagulation management ultimately.

关 键 词：华法林 Triangle分层分级管理模型 分级管理 临床药师 工作效率 

分 类 号：R969.3[医药卫生—药理学]