基于药物治疗管理的门诊癌痛患者全程化疼痛管理模式的效果评价

目的 评价药物治疗管理服务模式对门诊癌痛患者全程化疼痛管理的疼痛治疗效果、药物不良反应、服药依从性及生存质量的影响。方法 选取上海市浦东医院2021年1—12月门诊接受强阿片类药物镇痛治疗的80例癌痛患者，采用随机数字表法，随机分为对照组和干预组。对照组（n=40）：传统医学模式下无临床药师参与；干预组（n=40）：临床药师在药学门诊为门诊癌痛患者提供全程化的药物治疗管理服务。主要观察指标为疼痛评分及疼痛影响评分，和不良反应发生率；次要观察指标为服药依从性评分和生存质量评分（ECOG）。结果 干预后两组的最剧烈疼痛评分、平均疼痛评分均显著低于同组干预前（P<0.001），且干预组显著低于对照组（P<0.05）。干预后两组的疼痛影响评分均显著低于同组干预前（P<0.001），疼痛对生活兴趣的影响在两组间差异无统计学意义，而疼痛对日常生活、情绪、行走能力、正常工作、他人关系和睡眠的影响干预组显著低于对照组（P<0.05）。干预后两组间不良反应发生率差异有统计学意义（P<0.05）。干预后对照组的服药依从性评分、ECOG评分差异均无统计学意义，干预组与干预前相比，服药依从性评分、ECOG评分差异均有统计学意义（P<0.001）。结论 基于药物治疗管理的门诊癌痛患者全程化疼痛管理的服务模式可显著改善患者疼痛治疗效果，降低不良反应发生率，提高服药依从性，改善生存质量。

Effect of whole-process management for outpatients with cancer pain based on medication therapy management

Objective To evaluate the effect on the pain treatment effect, the incidence of adverse reactions, medication compliance, and quality of life under the pharmaceutical service model based on medication therapy management of the whole-process management for outpatients with cancer pain.Methods Totally 80 outpatients with cancer pain who received strong opioid analgesics were selected from outpatient department of Shanghai Pudong Hospital from Jan 2021 to Dec 2021, and divided into intervention group and control group according to random number table method. Control group (n=40):no clinical pharmacists participated in the traditional medical mode; Intervention group (n=40):clinical pharmacists provided the whole-process pharmaceutical services based on medication therapy management for outpatients with cancer pain. Main outcome indicators were pain score and pain effect score, and the incidence of adverse reactions; Secondary outcome indicators were medication compliance score and quality of life score(ECOG).Results After intervention, the most serious NRS score and the average NRS score of the two groups were significantly lower than before intervention(P < 0.001), the intervention group was significantly lower than the control group(P < 0.05). After intervention, the pain effect score of the two groups were significantly lower than before intervention(P < 0.001), there was no difference between the two groups in the effect of pain on interest in life, while there were significant differences between the two groups in the effect of pain on daily life, mood, walking ability, normal work, relationship with others and sleeping (P < 0.05). There was significant difference in the incidence of adverse reactions between the two groups(P < 0.05). After intervention, there was no difference in the medication compliance and ECOG score of the control group, but significant difference in the medication compliance and ECOG score was found in the intervention group compared with before intervention (P < 0.001).Conclusion The pharmaceutical service model based on medication therapy management of the whole-process management for outpatients with cancer pain can significantly improve the treatment effect of outpatients with cancer pain, reduce the incidence of adverse drug reactions, improve medication compliance and quality of life.