基于医联体的社区慢病患者药物治疗管理服务实践  

Practice of medication therapy management service for community patients with chronic diseases based on the medical consortium

作　　者：于绍帅 钟雅男 雍彩萍 王娜 谈德斐 眭丹娟 王艳 YU Shaoshuai;ZHONG Yanan;YONG Caiping;WANG Na;TAN Defei;SUI Danjuan;WANG Yan(Department of Pharmacy,Zhenjiang First People’s Hospital/Affiliated People’s Hospital of Jiangsu University,Jiangsu Zhenjiang 212001,China;Department of Pharmacy,Si Pai-lou Community Health Service Center,Jiangsu Zhenjiang 212002,China)

机构地区：[1]镇江市第一人民医院/江苏大学附属人民医院药剂科,江苏镇江212001 [2]四牌楼社区卫生服务中心药剂科,江苏镇江212002

出　　处：《中国医院药学杂志》2025年第7期815-819,共5页Chinese Journal of Hospital Pharmacy

基　　金：江苏省药学会-天晴医院药学基金科研项目(编号:Q202155)。

摘　　要：目的:探讨构建医联体内社区慢病患者药物治疗服务模式。方法:以医联体内四牌楼社区医院2022年11月共300例符合纳排标准的家庭医生签约慢病患者为研究对象,分别比较药师管理组与对照组,在入组12个月内治疗目标达成率、依从性达标率、住院率、治疗药物问题数、患者12个月内月平均医疗费用,以评估医联体内上下联动的一体化药学服务模式的实施效果。结果:药师管理组治疗目标达成率在入组后3个月为64.0%、6个月为71.33%、12个月为70.0%,较对照组有明显提高,差异有统计学意义(P<0.05);药师管理组患者依从性达标率在入组后1个月为80.67%、3个月为78.67%、6个月为76.0%、12个月为72.67%,较对照组有明显提高,差异有统计学意义(P<0.05);12个月内入院率、12个月内患者平均医疗费用和药物相关性问题,亦较对照组有明显下降,差异有统计学意义(P<0.05)。结论:药师通过加入家庭医生团队,对老年慢病患者实施药物治疗管理(MTM),可以提高患者用药的有效性、安全性和依从性,并减少医疗相关支出。OBJECTIVE To explore the construction of a medication therapy management(MTM)service for community patients with chronic diseases based on the medical consortium.METHODS In November 2022,300 eligible community patients with chronic diseases who were contracted by family doctors in a community medical institution in the medical consortium were selected as the study object.They were divided into the pharmacist management group and control group.The treatment goal attainment rate,compliance rate,hospitalization rate,number of drug problems,and average monthly medical expenses within 12 months of enrollment were evaluated to estimate the implementation effect of the integrated pharmaceutical care model within the medical consortium.RESULTS The treatment goal attainment rate in the pharmacist management group was 64.0%,71.33%and 70.0%at 3,6 and 12 months,respectively,which was significantly higher than that of the control group(P<0.05).The 1-month,3-month,6-month and 12-month compliance rate in the pharmacist management group was 80.67%,78.67%,76.0%,and 72.67%,respectively,which was significantly higher than that of the control group(P<0.05).The hospitalization rate,average medical expenses and drug-related problems in the pharmacist management group were significantly lower than those of the control group(P<0.05).CONCLUSION MTM with the engagement of pharmacists in the family doctor team for elderly community patients with chronic diseases can improve the effectiveness,safety and compliance of medication,and reduce medical related expenses.

关 键 词：医联体 家庭药师 药物治疗管理 

分 类 号：R969.3[医药卫生—药理学]