慢病患者用藥時間軸教育單的建立與效果評價

程慧 黃德紅 王兵娥 鄭俊敏

【摘要】 目的：建立慢病患者用藥時間軸教育單，考察其對患者用藥依從性和有效性的影響。方法：以2018年1-10月筆者所在醫院心病科、內分泌科患者作為研究對象，將其分為對照組（n=65）和觀察組（n=65），對照組接受傳統醫療服務項目，觀察組在此基礎上增加用藥時間軸教育單，比較兩組患者入院期間和出院3個月隨訪時的用藥依從性、用藥偏差，以及6個月后的再入院次數及藥物不良反應發生例數。結果：觀察組出院3個月用藥依從性顯著高于對照組（P<0.01），觀察組出院3個月用藥偏差發生率和6個月后再入院次數、藥物不良反應發生例數均明顯低于對照組（P<0.01）。結論：臨床藥師以用藥時間軸教育單對慢病患者開展藥學服務，顯著提高患者用藥依從性，降低用藥偏差，減少非預約再入院率和相關藥物不良反應發生例數，用藥時間軸教育單在慢病患者管理中起著重要作用。

【關鍵詞】 用藥時間軸教育單 用藥依從性 藥學服務 用藥偏差 再入院率

doi：10.14033/j.cnki.cfmr.2019.30.078 文獻標識碼 B 文章編號 1674-6805（2019）30-0-03

[Abstract] Objective： To establish a medication timeline education list and investigate the influence of medication timeline education list in patients with drug safety and efficacy. Method： Taking the patients of cardiology and endocrinology in our hospital from January to October 2018 as the research object. Patients were divided into control group （n=65） and experimental group （n=65）. The control group received the traditional medical service program. On the basis of this， the experimental group increased the medication timeline education list. We compared medication adherence， medication bias， the number of readmissions after 6 months and the number of adverse drug reactions in the two groups at the time of admission and at the 3-month follow-up. Result： The medication adherence of the experimental group during admission and discharge for 3 months was significantly higher than that of the control group （P<0.01）. The incidence of medication deviation in the observation group， the number of readmissions after 6 months and the number of adverse drug reactions were significantly lower than the control group （P<0.01）. Conclusion： Clinical pharmacists use the medication timeline education list to provide pharmacy services to patients with chronic diseases， significantly improve patient compliance， reduce medication bias， and reduce non-reserved readmission rate. The medication timeline education list plays an important role in the management of chronically ill patients.

[Key words] Medication timeline education list Medication compliance Pharmaceutical service Medication bias Readmission rate

First-authors address： Traditional Chinese Medicine Hospital of Xiangyang， Xiangyang 441000， China

伴隨人口老齡化的進展，慢性疾病發病人數和患病率均逐年上升，慢性病疾病已經成為危害人類健康的主要問題，慢性疾病包括多個病種如高血壓、冠心病、腦梗死、糖尿病、慢性阻塞性肺部疾病等多種疾病[1]。慢性疾病患者需要長期口服藥品，隨著治療時間的增長以及多種藥物的聯合使用，使得患者特別是老年患者容易混淆導致用藥依從性降低，從而達不到臨床治療效果。

研究表明，臨床藥師參與慢病管理，提供藥學服務可以改善患者預后與轉歸，對患者慢性病的發展有著極大的益處[2]。本院臨床藥師通過參與慢病管理，設計用藥時間軸教育單，將患者所用藥品以時間軸進行展示，時間軸以一天時間為橫坐標，坐標軸主要分布5個坐標點即：晨起（6：00）、早餐前后（8：00）、中餐前后（12：00）、晚餐前后……