临床药师基于药物重整挖掘2型糖尿病患者发生用药偏差的危险因素  

Clinical pharmacists explore the risk factors of medication deviation in T2DM patients based on medica-tion reconciliation

作　　者：杨莉 吴慧[1] 张琳琳 张思维 李婕 卞海林 杨鹏森 卞海兰 Yang Li;Wu Hui;ZhangLinlin;ZhangSiwei;Li Jie;Bian Hailin;Yang Pengsen;Bian Hailan(Department of Pharmacy,Yancheng First People′s Hospital,Affiliated to Medical School of Nanjing University,Yancheng,Jiangsu 224000,China;Department of Pharmacy,People′s Hospital of Sheyang County,Yancheng,Jiangsu 224300,China;Department of Pharmacy,Binhai County Hospital of Traditional Chinese Medicine,Yancheng,Jiangsu 224500,China;Department of Endocrinology,Yancheng First People′s Hospital,Affiliated to Medical School ofNanjing University,Yancheng,Jiangsu 224000,China)

机构地区：[1]南京大学医学院附属盐城第一人民医院药学部,江苏盐城224000 [2]射阳县人民医院药剂科,江苏盐城224300 [3]滨海县中医院药剂科,江苏盐城224500 [4]南京大学医学院附属盐城第一人民医院内分泌科,江苏盐城224000

出　　处：《中国药物与临床》2024年第17期1095-1100,共6页Chinese Remedies & Clinics

基　　金：江苏省药学会—天晴医院药学基金科研项目(Q202049);江苏省盐城市医学科技发展计划项目(YK2021023)。

摘　　要：目的探讨2型糖尿病患者发生用药偏差危险因素及临床药师在该类患者中开展药物重整服务的必要性及其作用。方法采取横断面研究方法,选取2022年6月至2023年6月南京大学医学院附属盐城第一人民医院内分泌科收治的符合纳入标准的2型糖尿病患者为研究对象,在入院48 h内开展药物重整服务,分析患者用药问题并进行临床药师干预。结果共纳入275例2型糖尿病患者,其中90例患者存在用药偏差,发生率32.7%,涉及105次用药偏差,主要表现为用法用量不适宜、药物漏服等。Logistic回归分析显示,合并疾病数≥5种相对于合并疾病数<5种的2型糖尿病发生用药偏差的风险增加[OR(95%CI):2.114(1.042,4.608)];入院前用药数目≥5种的患者相对于入院前用药数目<5种的患者发生用药偏差的风险增加[OR(95%CI):2.994(1.792,6.250)];同时患者用药依从性评分<6分相对于用药依从性≥6分发生用药偏差的风险增加[OR(95%CI):2.360(1.190,4.373)]。临床药师给出用药建议的接纳率为72.7%。结论以临床药师为主导的药物重整服务有利于发现并修正2型糖尿病患者的用药偏差,提高药物治疗的有效性和安全性。Objective To investigate the risk factors of medication deviation in patients with type 2 dia-betes mellitus(T2DM)and the necessity and role of clinical pharmacists in carrying out medication reconciliation services in patients with type 2 diabetes.Methods A cross-sectional study was conducted,patients with T2DM who met the inclusion criteria and were admitted to the Yancheng First People′s Hospital,Affiliated to Medical School of Nanjing University from June 2022 to June 2023 were selected as the study subjects.Medication recon-ciliation services were carried out within 48 hours of admission to analyze the medication problems of patients and perform clinical pharmacist intervention.Results A total of 275 patients with T2DM were included,among which 90 patients(32.7%)had medication discrepancies,involving 105 incidents of medication discrepancies.The main manifestations were inappropriate dosage and administration,missed doses,etc.Logistic regression analysis showed that the risk of medication discrepancies in patients with T2DM with≥5 concomitant diseases had an in-creased risk of medication deviation relative to T2DM with<5 concomitant diseases[OR(95%CI):2.114(1.042,4.608)].Patients with≥5 preadmission medications had an increased risk of medication deviation relative to pa-tients with<5 preadmission medications[OR(95%CI):2.994(1.792,6.250)].Additionally,patients with a medica-tion compliance scores<6 had an increased risk of medication deviation relative to medication compliance≥6[OR(95%CI):2.360(1.190,4.373)].The acceptance rate of medication recommendations given by clinical pharma-cists was 72.7%.Conclusion The medication reconciliation services led by clinical pharmacists are conducive to identifying and correcting medication deviation in patients with T2DM,thereby improving the effectiveness and safety of drug therapy.

关 键 词：药剂师 糖尿病 2型 药学服务 药物重整 危险因素 

分 类 号：R969.3[医药卫生—药理学]