利用ECHO模型评价药学质控对药物治疗管理服务的影响  

Influence evaluation of pharmaceutical quality control on medication therapy management services by the ECHO model

作　　者：刘坤 蒋欢欢 李玉双 黄炎 张倩影 陈冬 谷秀林 封锦慧 王紫监[5] 陈云飞[6] 齐亚娟 戈艳蕾 付爱双 LIU Kun;JIANG Huanhuan;LI Yushuang;HUANG Yan;ZHANG Qianying;CHEN Dong;GU Xiulin;FENG Jinhui;WANG Zijian;CHEN Yunfei;QI Yajuan;GE Yanlei;FU Aishuang(Dept.of Pharmacy,North China University of Technology and Science Affiliated Hospital,Hebei Tangshan 063000,China;School of Pharmacy,North China University of Technology and Science,Hebei Tangshan 063210,China;Dept.of Clinical Nutrition,North China University of Technology and Science Affiliated Hospital,Hebei Tangshan 063000,China;Dept.of Pharmacy,the Second Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;Dept.of Cardiology,the Second Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;Dept.of Hand Surgery and Anesthesia,the Second Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;School of Basic Medical Sciences,North China University of Science and Technology,Hebei Tangshan 063210,China;Dept.of Respiratory and Critical Care Medicine,North China University of Technology and Science Affiliated Hospital,Hebei Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院药学部,河北唐山063000 [2]华北理工大学药学院,河北唐山063210 [3]华北理工大学附属医院临床营养科,河北唐山063000 [4]河北北方学院附属第二医院药剂科,河北张家口075000 [5]河北北方学院附属第二医院心内科,河北张家口075000 [6]河北北方学院附属第二医院手麻科,河北张家口075000 [7]华北理工大学基础医学院,河北唐山063210 [8]华北理工大学附属医院呼吸与危重症医学科,河北唐山063000

出　　处：《中国药房》2025年第9期1123-1128,共6页China Pharmacy

基　　金：河北省卫生健康委2020年政府资助临床医学人才培养项目(No.冀卫办科教〔2021〕1号)。

摘　　要：目的利用经济、临床、人文产出(ECHO)模型评价药学质控对冠心病患者实施标准化药物治疗管理(MTM)服务效率和产出的影响。方法收集2023年1-3月(质控实施前组,96例)和6-8月(质控实施后组,164例)接受MTM服务的冠心病患者病例资料,采用倾向性评分匹配法,每组各纳入80例患者,比较匹配后两组患者药学服务的经济、临床和人文产出指标差异。结果匹配后两组患者的基线资料比较差异均无统计学意义(P>0.05)。与质控实施前组比较,质控实施后组患者的日均治疗总成本(16.26元vs.24.40元,P<0.001)、成本-效用比[23.12元/质量调整生命年(QALY)vs.32.32元/QALY,P<0.001]、一般的药品不良反应发生率(2.50%vs.10.00%,P=0.049)均显著降低,欧洲五维生存质量量表效用值(0.74±0.06 vs.0.71±0.07,P=0.003)、药物治疗相关问题减少数量(1.0个vs.0.5个,P<0.001)、用药依从性评分[(6.32±0.48)分vs.(6.10±0.37)分,P=0.001]和满意度评分[(92.56±1.52)分vs.(91.95±1.56)分,P=0.013)]均显著升高;两组患者均未发生严重的药品不良反应,新的药品不良反应发生率比较差异无统计学意义(1.25%vs.3.75%,P=0.310)。结论药学质控可提高药学服务工作质量;ECHO模型可对MTM服务效果进行量化评价,使药学服务更好计价,更能适应社会需求,值得推广。OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management(MTM)services for patients with coronary heart disease by using Economic,Clinical and Humanistic Outcomes(ECHO)model.METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023(pre-quality control implementation group,n=96)and June-August 2023(post-quality control implementation group,n=164).Using propensity score matching analysis,80 patients were selected from each group.The study subsequently compared the economic,clinical,and humanistic outcome indicators of pharmaceutical services between the two matched groups.RESULTS There were no statistically significant differences in baseline data between the two groups after matching(P>0.05).Compared with pre-quality control implementation group,the daily treatment cost(16.26 yuan vs.24.40 yuan,P<0.001),cost-effectiveness ratio[23.12 yuan/quality-adjusted life year(QALY)vs.32.32 yuan/QALY,P<0.001],and the incidence of general adverse drug reactions(2.50%vs.10.00%,P=0.049)of post-quality control implementation group were decreased significantly;the utility value of the EuroQol Five-Dimensional Questionnaire(0.74±0.06 vs.0.71±0.07,P=0.003),the reduction in the number of medication related problems(1.0 vs.0.5,P<0.001),the medication adherence score[(6.32±0.48)points vs.(6.10±0.37)points,P=0.001],and the satisfaction score[(92.56±1.52)points vs.(91.95±1.56)points,P=0.013]all showed significant improvements.Neither group experienced serious adverse drug reactions.There was no statistically significant difference in the incidence of new adverse reactions between the two groups(1.25%vs.3.75%,P=0.310).CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care,and the ECHO model can quantitatively evaluate the effect of MTM services,making pharmaceutical care better priced and more adaptable to social needs,thus being worthy of prom

关 键 词：药物治疗管理 药学质控 ECHO模型 药学服务 

分 类 号：R95[医药卫生—药学]