基于德尔菲法构建类风湿关节炎患者治疗药物管理体系及应用  

Construction of the medication therapy management system of rheumatoid arthritis patients based on Delphi method and preliminary application

作　　者：姚瑶[1] 蔡文婷 严晶 王春[2] 张晋萍[1] YAO Yao;CAI Wenting;YAN Jing;WANG Chun;ZHANG Jinping(Department of Pharmacy,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Rheumatology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院药学部,南京210008 [2]南京大学医学院附属鼓楼医院风湿免疫科,南京210008

出　　处：《临床药物治疗杂志》2025年第3期82-86,共5页Clinical Medication Journal

基　　金：南京大学中国医院改革发展研究院课题(NDYG2022056)。

摘　　要：目的构建药师主导的类风湿关节炎(RA)治疗药物管理(MTM)体系。方法通过查阅国内外文献,基于MTM理念,结合风湿免疫驻科药师工作实践,初步形成类风湿关节炎MTM体系框架;采用德尔菲法进行两轮专家函询,依据评价标准,完善该MTM体系;驻科药师按照该体系管理86例类风湿关节炎患者,比较管理前后患者药物治疗知晓度。结果两轮专家函询的积极系数均为100%;权威程度分别为0.86和0.91;二级和三级肯德尔协调系数为0.305和0.314(P<0.01)。经过两轮函询和专家小组会议,最终形成MTM体系,包括3个一级指标(管理的必要性、内容和形式),8个二级指标(管理的现状和需求,药物治疗的适宜性、有效性、安全性、依从性,住院和门诊患者管理形式)和27个三级指标。驻科药师应用该MTM体系服务类风湿关节炎住院患者后,患者药物治疗知晓度评分显著提高[(3.94±1.52)分比(6.55±1.10)分,P<0.05]。结论本研究构建的类风湿关节炎患者MTM体系可为类风湿关节炎患者慢病管理提供思路,可协助驻科药师提高RA患者药物治疗知晓度。Objective To construct a medication therapy management system of rheumatoid arthritis(RA)led by pharmacists and enhance the chronic disease management efficiency.Methods Based on the concept of therapeutic drug management(MTM)and the practice of clinical pharmacists in the Department of Rheumatology,the framework of MTM system of rheumatoid arthritis was preliminarily constructed.Delphi method was used to conduct two rounds of expert correspondence consultation and further improve the MTM system according to the evaluation criteria.A total of 86 patients with rheumatoid arthritis were managed by resident pharmacists according to the system,and the drug treatment awareness was compared before and after the management.Results The positive coefficient of the two rounds of expert correspondence was 100%.The authority levels were 0.86 and 0.91,respectively.The secondary and tertiary Kendall's W coordination coefficients of the second round of correspondence were 0.305 and 0.314,respectively(P<0.01).After two rounds of correspondence and an expert panel discussion,the medication therapy management of rheumatoid arthritis was finally constructed.The framework includes 3 Level 1 indicators(necessity of management,content and format),8 Level 2 indicators(current status and needs of management,appropriateness,effectiveness,safety,and adherence of medication therapy,management formats of inpatient and outpatient patients),and 27 Level 3 indicators.The drug treatment awareness score of RA inpatients was significant improved through resident pharmacists'service according to the established MTM system(from(3.94±1.52)points to(6.55±1.10)points,P<0.05).Conclusion The medication therapy management of rheumatoid arthritis constructed in this study provides ideas and framework for chronic disease management of patients with rheumatoid arthritis.Moreover,the drug treatment awareness score of RA can be significantly improved by resident pharmacists'intervention.

关 键 词：类风湿关节炎 药物治疗管理 德尔菲法 评价指标 

分 类 号：R95[医药卫生—药学] R979.5