风湿免疫科长期口服糖皮质激素患者的知信行现状及药学监护

目的:分析风湿免疫科长期口服糖皮质激素患者的知信行(knowledge-attitude-practice,KAP)现状及其影响因素;考察药学监护对KAP的影响,促进糖皮质激素在临床的合理应用。方法:选取某三甲医院风湿免疫科门诊长期口服糖皮质激素患者246例,随机分为干预组和对照组(1:1),入组时采用一般资料调查表、自行设计的疾病与用药知识问卷、汉化的患者服药信念特异性量表(Brief medication questionnaire,BMQ)、Morisky药物依从性量表(Morisky medication adherence scale,MMAS-8)分析KAP现状及其影响因素,临床药师对干预组患者薄弱方面进行针对性干预,对照组进行常规教育。6个月后比较两组患者的KAP维度改善情况、不良反应发生率和疾病控制情况。结果:风湿免疫科长期口服糖皮质激素的患者知识得分(3.08±3.80)分,信念得分(0.96±2.95)分,行为得分(5.40±1.81)分,且自我管理知识、信念、行为三者之间均相关(P<0.01)。年龄和文化程度是影响患者自我管理知识的主要因素(P<0.01),病程是影响患者自我管理信念、行为得分的主要因素(P<0.01)。6个月后,干预组的KAP维度得分均较对照组有显著提高(P<0.05);干预组的不良反应发生率低于对照组(52.03%vs 57.72%)、疾病控制情况优于对照组(61.78%vs 54.47%),但无统计学差异(P>0.05)。结论:风湿免疫科长期口服糖皮质激素的患者自我管理KAP水平有待加强,临床药师针对其影响因素进行药学监护可显著提高其KAP水平,改善疾病控制水平。

Current status of knowledge-attitude-practice of patients with long-term oral administration of glucocorticoids in the rheumatic immunology department and the pharmaceutical monitoring

OBJECTIVE To analyze the current status of knowledge-attitude-practice (KAP) and its influencing factors in patients with long-term oral glucocorticoids in the Department of Rheumatology and Immunology; to investigate the effect of pharmaceutical care on KAP and promote the rational use of glucocorticoids in clinical practice.METHODS A total of 246 patients with long-term oral glucocorticoid in the outpatient department of rheumatology and immunology in a tertiary care hospital were randomly divided into intervention group (1:1) and control group (1:1). The status quo of KAP and its influencing factors were analyzed by general data questionnaire, self-designed disease and medication knowledge questionnaire, Chinese Patient Medication Belief Specific Questionnaire (BMQ) and Morisky Medication Adherence Scale (MMAS-8). Clinical pharmacists conducted targeted intervention on the weakness of patients in the intervention group, and routine education was provided in the control group.Six months later, the improvement of KAP dimension, incidence of adverse reactions and disease control were compared between the two groups.RESULTS The KAP scores of long-term oral glucocorticoids in the rheumatology department were (3.08±3.80), (0.96±2.95), and (5.40±1.81), respectively. And the three dimensions of self-management KAP were related (P<0.01). Age and education were the main factors affecting patients ‘self-management knowledge (P<0.01), while course of disease was the main factor affecting patients’ self-management beliefs and behavioral scores (P<0.01).After six months, the scores of the intervention group were significantly higher than those of the control group (P<0.05). The incidence of adverse reactions in the intervention group was lower than that of the control group(52.03% vs 57.72%), and the disease control was better than the control group(61.78% vs 54.47%), but there was no statistical difference (P>0.05).CONCLUSION The level of self-management KAP in patients with long-term oral glucocorticoid in the Department of Rheumatology and Immunology needs to be strengthened. Pharmaceutical care by clinical pharmacists according to its influencing factors can significantly increase the level of KAP and improve the level of disease control.