医联体模式下药师主导的慢病管理对高血压患者的实施效果分析  

Effect of pharmacist-led chronic disease management on hypertensive patients under a medical consor⁃tium model

作　　者：武明芬 马力[2] 贾自力[3] 马超[3] 国警月 林琛 张帅 赵志刚[1] WU Mingfen;MA Li;JIA Zili;MA Chao;GUO Jingyue;LIN Chen;ZHANG Shuai;ZHAO Zhi-gang(Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical Univer-sity,Beijing 100070,China;Department of General Practice,Beijing Tiantan Hospital,Capital Medical Univer-sity,Beijing 100070,China;Department of Pharmacy,Beijing Fengtai Hospital,Beijing 100071,China;Department of Pharmacy,Majiapu Community Health Service Center,Beijing 100068,China;Department of Pharmacy,Puhuangyu Com-munity Health Service Center,Beijing 100075,China;Department of Pharmacy,Fengtai Community Health Service Cen-ter,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院药学部,北京100070 [2]首都医科大学附属北京天坛医院全科医疗科,北京100070 [3]北京丰台医院药剂科,北京100071 [4]北京市丰台区马家堡社区卫生服务中心药剂科,北京100068 [5]北京市丰台区蒲黄榆社区卫生服务中心药剂科,北京100075 [6]北京市丰台区丰台社区卫生服务中心药剂科,北京100070

出　　处：《中国医院药学杂志》2024年第16期1926-1931,共6页Chinese Journal of Hospital Pharmacy

基　　金：北京药学会2022年临床药学研究项目(编号:LCYX-2022-02)。

摘　　要：目的:评价医联体模式下药师主导的慢病管理对高血压患者的实施效果。方法:采用队列研究,选取2022年9月至2023年2月在北京天坛医院“1+2+3”药学服务医联体内就诊的高血压患者,随机数字表法分为干预组和对照组。干预组由药师实施标准的药物治疗管理服务(medication therapy management service,MTMs),第1、3、6个月随访;对照组只提供传统的药学服务。从临床、经济和人文3个方面评估实施效果。结果:共纳入高血压患者307例,其中干预组148例、对照组159例。经过6个月的标准化MTMs干预后,患者的收缩压由(145.75±19.24)mmHg下降到(133.52±9.58)mmHg,舒张压由(94.01±11.29)mmHg下降到(86.31±7.73)mmHg,血压控制率由36.49%提高到68.24%,药物不良反应发生率由28.38%下降至6.76%,用药依从率由33.11%提高到66.22%,差异有统计学意义(P<0.01);共识别308个治疗相关问题,主要是用药依从性不佳(66.89%)、需要增加药物治疗(23.65%)和药物不良反应(22.30%);干预临床结果前3位是血压及合并症控制率提高(72.30%)、漏服或忘记服药次数减少(49.32%)、不良反应减少或消失(28.38%);干预后患者日药品费用降低1.38元,满意度为100%,与对照组相比差异具有统计学意义(P<0.01)。结论:医联体模式下药师主导的慢病管理可以为高血压患者带来临床和经济获益,患者满意度提升,值得进一步推广。OBJECTIVE To evaluate the effect of pharmacist-led chronic disease management on hypertensive patients under a medical consortium model.METHODS From September 2022 to February 2023,this cohort study selected 307 hyper⁃tensive patients receiving medical care within the“1+2+3”pharmaceutical service medical consortium at Beijing TianTan Hospi⁃tal.They were randomized into two groups of intervention(n=148)and control(n=159).Intervention group received standard⁃ized medication therapy management services(MTMs)by pharmacists with follow-ups at Month 1/3/6 while control group tradi⁃tional pharmaceutical services only.The effect was evaluated from clinical,economic and humanistic outcomes.RESULTS After 6-month standardized MTMs intervention,systolic blood pressure decreased from(145.75±19.24)mmHg to(133.52±9.58)mmHg and diastolic blood pressure dropped from(94.01±11.29)mmHg to(86.31±7.73)mmHg.Blood pressure con⁃trol rate spiked from 36.49%to 68.24%,the incidence of adverse reactions dipped from 28.38%to 6.76%and medication adher⁃ence rate jumped from 33.11%to 66.22%.There were statistically significant differences(P<0.01).A total of 308 drugrelated problems were correlated with poor adherence(66.89%),need for additional medication therapy(23.65%)and adverse reactions(22.30%).After intervention,top three clinical outcomes included better control rates of blood pressure and comorbid⁃ity(72.30%),lowered instances of missed or forgotten doses(49.32%)and fewer or disappearing adverse reactions(28.38%).After intervention,daily medication expense per patient decreased by 1.38 yuan with a satisfaction rate of 100%.There were sig⁃nificant differences with control group(P<0.01).CONCLUSION Under a medical consortium model,pharmacist-led chronic disease management may bring clinical and economic benefits and greater satisfaction to hypertensive patients.It is worthy of a wider promotion.

关 键 词：医联体 高血压患者 慢病管理 药师主导 药物治疗管理服务 医药协作 

分 类 号：R969.3[医药卫生—药理学]