临床药师和全科医师对社区多病共存潜在不合理用药的一致性评价分析  

Evaluation and analysis of the consistency of clinical pharmacists and general practitioners on the potentially inappropriate medication with multiple diseases coexisting in the community

作　　者：陶瑛 陈碧华[2] TAO Ying;CHEN Bihua(Pharmacy Department of Longhua Street Community Health Service Center of Xuhui District,Shanghai 200232,China;General Practice Department of Fenglin Street Community Health Service Center of Xuhui District,Shanghai 200030,China)

机构地区：[1]上海市徐汇区龙华街道社区卫生服务中心药剂科,上海200232 [2]上海市徐汇区枫林街道社区卫生服务中心全科,上海200030

出　　处：《上海医药》2023年第16期6-9,21,共5页Shanghai Medical & Pharmaceutical Journal

基　　金：2021年上海市社区卫生协会社区科研面上项目(SWX21M09)。

摘　　要：目的:基于临床药师和全科医师对社区多病共存患者潜在不合理用药(potentially inappropriate medication,PIM)的一致性评价分析,为完善社区慢性病患者的药物管理工作提供建议。方法:采用机械随机抽样方法选取于2020年1月—2021年12月与上海市徐汇区龙华街道社区卫生服务中心家庭医师签约、其医保卡尾号为“0”或“5”的患者为研究对象,采用用药合理性评价问卷对4种疾病主要组合类型的332例患者进行用药合理性评价。结果:应用Beers标准共检出20例(6.02%)PIM,应用老年人不适当处方筛查工具/老年人处方遗漏筛查工具共检出43例(12.95%)PIM,两者取并集共检出49例PIM,总体PIM检出率为14.76%。临床药师组和全科医师组的PIM总体检出例数差异无统计学意义(P>0.05),其中项目1、2、3、5的PIM检出例数差异存在统计学意义(P<0.05);临床药师组和全科医师组对“高血压+高脂血症+糖尿病”疾病组合类型的PIM检出例数差异存在统计学意义(P<0.05)。结论:应进一步开展社区多病共存患者的PIM防范措施:(1)加强全科医师规范化培训,使全科医师重点掌握各类常见疾病的用药原则;(2)发挥临床药师优势,由临床药师对药物处方进行点评、审核;(3)采用门诊处方前置审核系统对全科医师开具的处方进行审核,并及时将PIM处方发送至临床药师处。Objective:To provide suggestions for improving the drug management of patients with chronic diseases in the community based on the consistency evaluation and analysis of clinical pharmacists and general practitioners on the potentially inappropriate medication(PIM)of patients with multiple diseases coexisting in the community.Methods:The patients who signed a contract with the family doctors of the Community Health Service Center of Longhua Community,Xuhui District,Shanghai from January 2020 to December 2021,and whose medical insurance card tail number was“0”or“5”,were selected by mechanical random sampling method as the study subjects,the drug rationality evaluation questionnaire was used to evaluate the drug rationality of 332 patients with the main combination types of four diseases.Results:A total of 20 cases(6.02%)of PIM were detected with the Beers standard,43 cases(12.95%)of PIM were detected with the inappropriate prescription screening tool for the elderly/prescription omission screening tool for the elderly,and 49 cases of PIM were detected with the combination of the two,and the overall PIM detection rate was 14.76%.There was no statistically significant difference in the total number of PIM cases detected between the clinical pharmacist group and the general practitioner group(P>0.05);there was a statistically significant difference in the number of PIM cases detected for items 1,2,3,and 5(P<0.05);there was a statistically significant difference between the clinical pharmacist group and the general practitioner group in the number of PIM cases detected in the disease combination type of“hypertension+hyperlipidemia+diabetes”(P<0.05).Conclusion:PIM prevention measures for patients with multiple diseases in the community should be further developed:(1)Strengthening the standardized training of general practitioners,so that general practitioners can focus on mastering the medication principles of various common diseases;(2)Giving full play to the advantages of clinical pharmacists,and clinical

关 键 词：多病共存 潜在不合理用药 临床药师 全科医师 

分 类 号：R969[医药卫生—药理学]