基于最佳抗凝质量联动管理的全程化心房颤动抗凝管理新模式的建立与实践  

Establishment and Practice of New Model of Full-Process Anticoagulation Management for Atrial Fibrillation Based on Best Anticoagulation Quality Linkage Management

作　　者：潘忙忙[1] 张弛[1] 沈珑[2] 孔令璁 双田 王新华[2] 沈慧 沙婧婧 林厚文[1] 顾智淳 PAN Mangmang;ZHANG Chi;SHEN Long;KONG Lingcong;SHUANG Tian;WANG Xinhua;SHEN Hui;SHA Jingjing;LIN Houwen;GU Zhichun(Dept.of Pharmacy,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Dept.of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Shanghai Pudong New Area Huamu Community Health Service Center,Shanghai 201204,China;Shanghai Pudong New Area Jinyang Community Health Service,Shanghai 200136,China)

机构地区：[1]上海交通大学医学院附属仁济医院药剂科,上海200127 [2]上海交通大学医学院附属仁济医院心内科,上海200127 [3]上海市浦东新区花木社区卫生服务中心,上海201204 [4]上海市浦东新区金杨社区卫生服务中心,上海200136

出　　处：《中国医院用药评价与分析》2023年第9期1149-1152,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：上海市“药品临床综合评价与药物治疗路径”研究项目(No.SHYXH-ZP-2021-001);上海申康医院发展中心项目(No.SHDC2022CRS035);上海交通大学医学院附属仁济医院临床科研创新培育基金项目(No.RJPY-LX-008)。

摘　　要：目的:探讨抗凝团队提供基于最佳抗凝质量联动管理(BAQLS)的全程化心房颤动患者抗凝管理的工作模式和应用实践。方法:创新探索循证背景下的BAQLS全程化抗凝管理新模式;通过构建微信小程序的方式,开展新模式下同质化的三级医院-社区-患者联动的抗凝药学服务。收集2019—2022年上海交通大学医学院附属仁济医院及2家社区卫生服务中心接受抗凝治疗的心房颤动患者,对符合入组标准的679例患者开展BAQLS全程化抗凝管理,考察患者用药依从性和抗凝满意度,评价药学服务模式的应用价值。结果:通过对心房颤动患者开展BAQLS全程化抗凝管理,构建了制定最佳策略→优化依从性工具→标化质量控制→实现自我管理→建立联动方式的全程化抗凝管理模式,并制定了相关工作制度及流程。679例心房颤动患者中,使用华法林的患者185例,使用非维生素K拮抗剂口服抗凝血药(NOAC)的患者494例;平均随访时间为(372±173)d;血栓发生率为0.74%(5/679),出血发生率为15.02%(102/679)。使用华法林患者的抗凝治疗窗内时间百分比为(70.5±16.5)%。使用华法林和使用NOAC患者的平均用药依从性评分分别为(24.69±0.79)和(24.89±0.46)分;从基线到3个月,使用华法林和使用NOAC的患者对负担和获益的满意度均有所改善。结论:基于BAQLS的全程化心房颤动患者抗凝管理模式的建立,通过三级医院-社区-患者联动的科学性、标准化的管理模式,可有效提高心房颤动患者抗凝治疗的依从性和满意度,提升心房颤动患者的抗凝效果及生活质量。OBJECTIVE:To explore the working mode and application practice of anticoagulation team providing full-process anticoagulation management based on best anticoagulation quality linkage management(BAQLS) for atrial fibrillation(AF) patients.METHODS:A new model of full-process anticoagulation management based on BAQLS was innovatively explored under the background of evidence-based medicine.A standardized three-level-community-patient linkage anticoagulant pharmacy service was performed under the new model through the construction of WeChat mini-program.A total of 679 AF patients receiving anticoagulation treatment in Renji Hospital,Shanghai Jiao Tong University School of Medicine and two community health service centers from 2019 to 2022 were collected,full-process anticoagulation management based on BAQLS was conducted for patients meeting the inclusion criteria,and the medication adherence and anticoagulation satisfaction of patients were investigated to evaluate the application value of pharmaceutical care model.RESULTS:Through the full-process anticoagulation management based on BAQLS for AF patients,a full-process anticoagulation management model of formulating the best strategy → optimizing adherence tools → standardizing quality control → realizing self-management → establishing linkage mode was performed,and related work systems and processes were formulated.A total of 679 AF patients were included,of which 185 were warfarin patients and 494 were non-vitamin K antagonist oral anticoagulant(NOAC) patients.The average follow-up time was(372±173) d,the thrombosis rate was 0.74%(5/679),and the bleeding rate was 15.02%(102/679).The percentage of time within the anticoagulant window of warfarin patients was(70.5±16.5)%.The average medication adherence scores of warfarin group and NOAC group were(24.69±0.79) points and(24.89±0.46) points,respectively.From baseline to 3 months,the satisfaction of burden and benefit of warfarin group and NOAC group patients was improved.CONCLUSIONS:The establishment of fu

关 键 词：抗凝管理 华法林 非维生素K拮抗剂口服抗凝血药 抗凝依从性 满意度 

分 类 号：R973.2[医药卫生—药品]