综合护理干预对精神病患者服药依从性的影响

目的采取综合护理,改善精神病患者的服药依从性。方法选取笔者所在医院从2011年1月～2012年6月所收治的精神病患者120例作为临床研究对象,将患者随机分为护理组和对照组两组,对照组患者采取常规护理措施,护理组在对照组基础上采用综合护理干预。在两组患者出院时,出院6个月和出院12个月评定患者的服药依从性。结果护理组在出院前,出院6个月和出院12个月后的服药依从性都显著高于对照组患者,差异有统计学意义(P<0.05)。结论采取综合性护理后,精神病患者服药依从性有显著提高,是符合今后护理趋势的理想方案。     

In-hospital medication reviews reduce unidentified drug-related problems

Purpose

To examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting.

Methods

In a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were ≥ 65 years old, used ≥ 3 medications on a regular basis and had stayed on the ward for ≥ 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category.

Results

The study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st–3rd quartile 0–2), control group 9 (6–13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0–2), control group 8 (5–10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group.

Conclusions

A multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients.     

The General Practitioner-Pharmacist Collaboration (GPPC) study: a randomised controlled trial of clinical medication reviews in community pharmacy

Objectives There are conflicting results in studies of pharmacists undertaking medication reviews for older people. With increasing promotion and funding for ‘medication reviews’ there is a need for them to be standardised, and to determine their effectiveness and the feasibility of providing them from a community pharmacy. The objective was to determine whether involvement of community pharmacists undertaking clinical medication reviews, working with general practitioners, improved medicine‐related therapeutic outcomes for patients. Methods A randomised controlled trial was carried out in people 65 years and older on five or more prescribed medicines. Community pharmacists undertook a clinical medication review (Comprehensive Pharmaceutical Care) and met with the patient's general practitioner to discuss recommendations about possible medicine changes. The patients were followed‐up 3‐monthly. The control group received usual care. The main outcome measures were Quality of Life (SF‐36) and Medication Appropriateness Index. Key findings A total of 498 patients were enrolled in the study. The quality‐of‐life domains of emotional role and social functioning were significantly reduced in the intervention group compared to the control group. The Medication Appropriateness Index was significantly improved in the intervention group. Only 39% of the 44 pharmacists who agreed to participate in the study provided adequate data, which was a limitation of the study and indicated potential barriers to the generalisability of the study. Conclusion Clinical medication reviews in collaboration with general practitioners can have a positive effect on the Medication Appropriateness Index. However, pharmacist withdrawal from the study suggests that community pharmacy may not be an appropriate environment from which to expand clinical medication reviews in primary care.     

Medication reviews provided by general medical practitioners (GPs) and nurses: an evaluation of their quality

Objective To train general medical practitioners (GPs) and nurses in providing medication review services in the primary care setting and to evaluate the reviews provided. Setting One medical practice in Scotland with five whole‐time equivalent (WTE) GP partners, two practice nurses and six community‐based nurses. Method Training for GPs was provided as a group session plus individual supported clinic sessions. Nurse training consisted of a group session only. Patients aged over 75 were invited to attend the medical practice to receive a medication review. Output measures were: number of patients with pharmaceutical care issues (PCIs) documented, changes made to repeat medicines and computer records, monitoring undertaken, number of PCIs, PCIs identifiable from notes and records but not documented (‘missed’ PCIs). A sample of GP reviews provided before training and all GP and nurse reviews during training were evaluated. Key findings In 45 case note reviews provided prior to training, GPs documented PCIs in 20% of patients; average 0.3 per patient, but missed 1.75 per patient. In 56 reviews provided during training, they documented PCIs in 98% of patients; average 3.0 per patient, missing 0.8 per patient. The proportion of patients with changes to drug therapy or monitoring carried out during training increased significantly compared to pre‐training reviews. Nurses documented PCIs in 97% of 33 patients reviewed, average 1.5 PCIs per patient, but missed 0.8. The mean number of repeat drugs prescribed reduced from 4.73 to 4.42 per patient after nurse review, but increased after GP review from 4.07 to 4.18. Conclusion After training, both GPs and nurses identified PCIs appropriate to their expertise. The sustainability of this effect in the longer term is not known. Since all patients should have repeat medication reviewed regularly, involving these professionals in providing routine reviews would allow pharmacist medication review clinics to be optimised.     

对近年门急诊药房干预不合理处方的分析

对门急诊药房干预的不合理处方进行回顾性分析,了解本院门急诊不合理处方现状,为改进处方质量提供数据参考。对2016~2017年门急诊药房调剂前成功干预的512张不合理处方进行处方规范性、用药适宜性等方面的分析和总结。药师实时干预并记录不合理处方共512张,占同期门急诊处方总数的0.14%,其中不规范处方207张（占不合理处方的40.43%）;不适宜处方294张（占57.42%）;超常规处方11张（占2.15%）。药师通过实时干预并及时与处方医师沟通,规范了药品的使用,提高了处方质量,降低药品毒副作用及不良反应发生率,保证患者用药安全有效。     

Impact of Students Pharmacists on the Medication Reconciliation Process in High-Risk Hospitalized General Medicine Patients

Objective. To compare the accuracy of medication lists obtained by student pharmacists, nurses, and physicians, and quantify the number of discrepancies identified as part of the medication reconciliation process.Methods. Between May and July 2012, patients admitted to an internal medicine team at a 350-bed tertiary academic medical center were assessed for inclusion in the study. Physicians and/or nurses conducted medication reviews for these patients at the time of admission, while student pharmacists conducted medication reconciliation. Results. Eighty-six patients were assessed, and 52 met all inclusion criteria. A total of 268 discrepancies were identified as part of the medication reconciliation performed by the student pharmacists, approximating 5 discrepancies per patient (range 0-13). Student pharmacists identified 532 preadmission medications, significantly more than did nurses (355) or physicians (368), p=0.006.Conclusion. Student pharmacists, with appropriate oversight, can be used in several tasks that previously may have been designated to pharmacists only, such as medication reconciliation.     

某院门诊慢性前列腺炎用药合理性干预前后的对比分析1

目的：分析西京医院干预前后泌尿外科门诊慢性前列腺炎的药物治疗使用情况。方法：对照组采用2012年6月-2012年11月间就诊患者的用药处方,干预组则采用2012年12月-2013年5月间用药处方,对就诊患者干预治疗前后的用药情况进行对比分析。结果：治疗慢性前列腺炎3114张处方中,其中使用最多为植物类制剂,对照组不合理处方率为9．41％,干预组为1．16％,其差异有统计学意义（P〈0．05）。结论：门诊慢性前列腺炎用药情况基本合理,干预用药后其合理性有明显改善。     

北京市某三级口腔医院医务人员合理用药现状调查分析

目的 了解北京市某三级口腔医院医务人员对合理用药相关知识与行为的现状,为制定管理对策提供参考.方法 结合医院实际,设计合理用药调查问卷,专业不同、调研侧重点不同,对该院病区医师、护士及药师等医务人员进行无记名调查.结果 共发放问卷98份,有效回收率为92％(90/98).药师得分最高,医师略高于护士.多数医务人员能经常...     

临床药师参与治疗管理对门诊2型糖尿病合并高血压患者 血压控制的影响*

目的:探究临床药师参与治疗管理及对门诊Ⅱ型糖尿病合并高血压患者血压控制的作用。方法:纳入2017年6月至2018年6月500例心内科门诊Ⅱ型糖尿病合并高血压患者,随机分为对照组和药师干预组,各25例。对照组完成常规诊疗流程,每月电话咨询其药物使用情况;药师干预组现场记录患者一般情况,与医生讨论处方优化并决定是否执行,对患者进行用药指导。就诊后1个月内每2周随访1次,其后每4周随访1次,随访期间药师可根据情况与医生讨论是否调整降压方案并作出最终决定,患者根据药师建议或自己意愿回医院随诊,随访时间1年。主要终点事件为12个月后血压≤130/80 mmHg;次要终点事件为药物调整情况、药师建议采纳率、药物持有率(评估患者依从性)。结果:最终378例完成随访。对照组68名(36.4%)及干预组152名(79.6%)患者血压≤130/80 mmHg,P<0.01;干预组收缩压与舒张压降幅显著>对照组(P<0.01)。对照组药物调整35次,干预组调整129次,药师建议采纳率为85.18%。1年后,对照组药物持有率为0.22±0.04,干预组为0.77±0.11,P<0.01。结论:临床药师参与治疗管理有助于优化降压方案,提升用药依从性,提高了门诊Ⅱ型糖尿病合并高血压患者的血压控制达标率。     

临床药师参与门诊甲亢患者治疗的药学服务实践

目的探讨临床药师随同医师坐诊,参与门诊甲亢患者治疗的药学服务效果。方法将156例门诊甲亢患者随机分为干预组和对照组。对干预组进行用药教育,建立用药档案,参与用药方案调整;对照组由门诊医生进行常规治疗。统计药物咨询例次及内容,观察2组患者的依从性、不良反应发生情况及药物疗效。结果药学咨询468例次,其中患者咨询390例次,医师咨询78例次。咨询内容中药物的用法用量占42.31%;对治疗方案的调整,药师意见被采纳率为86.27%。与对照组相比,干预组依从性明显增高,不良反应发生率减少,治疗效果更好(P<0.05)。结论临床药师随同医师坐诊,参与门诊甲亢患者的治疗,提供药学服务,能协助医生更好地做到安全、有效、合理的药物治疗,提高药学服务质量。     

系统化护理干预在精神分裂症治疗中的作用

目的 观察系统化护理干预在精神分裂症治疗中的作用.方法 采用随机数字表法将140例精神分裂症患者随机分为观察组和对照组,最终128例纳入统计分析,其中观察组66例,对照组62例.对照组采用常规护理,观察组采用系统化护理,观察3个月,观察结束后评价护理效果.结果 观察组的简明精神病量表（BPRS）积分、护士用住院患者观察量表（NOSIE）总消极积分及住院精神病患者康复疗效评定量表（IPROS）积分降低,NOISE总积极积分增高,与对照组比较,差异有统计学意义（P＜0.05）.结论 系统化护理干预能积极促进精神分裂症患者的康复.