癌痛管理中规范化临床药学服务模式的建立及应用

目的:建立癌痛管理中规范化的临床药学服务模式,确保药学服务质量和水平。方法:运用专家咨询法建立服务模式,制定临床药师参与癌痛管理的质量标准(工作流程、操作规范)、实践指引、药学干预记录文件和效果评价问卷(患者用药依从性问卷、患者满意度问卷)。应用该工作模式开展癌痛管理实践,考查干预前后患者的疼痛控制、用药依从性变化及对疼痛管理的满意度。结果:32名癌痛患者接受药学干预后的4个疼痛指标,即过去24 h最严重的疼痛程度、最轻微的疼痛程度、平均的疼痛程度、调查当时的疼痛程度数字评分分别由(9.44±0.62)分、(5.59±1.24)分、(8.38±1.07)分、(8.25±1.24)分下降至(4.03±0.93)分、(1.28±0.52)分、(2.59±1.04)分、(2.19±0.82)分(P<0.01),疼痛缓解程度大于50%。患者对疼痛治疗方式、住院期间疼痛照顾、止痛效果及疼痛教育的满意度评分分别为(4.25±0.84)分、(4.09±0.53)分、(4.03±0.86)分和(3.88±0.79)分。患者用药依从性评价为"好"的比例由31.23%上升至84.38%(P<0.01)。结论:形成了癌痛管理中的规范化临床药学服务模式。实施后,患者的疼痛控制及用药依从性情况得到明显改善;患者对疼痛治疗方式、疼痛照顾、止痛效果满意度较好,疼痛教育满意度有待进一步提高。

Establishment and application of clinical pharmacy service mode in cancer pain management

OBJECTIVE To establish a standardized mode in cancer pain management to ensure quality of pharmaceutical care. METHODS Expert consultation method was applied to establish service mode, involving quality standard (work flow and operation specification), practice guidelines, pharmaceutical care records and effect evaluation questionnaires (medication compliance questionnaire and satisfaction questionnaire in patients suffering cancer pain). The mode was used for cancer pain management, and then analgesic effects, patient medication compliance and satisfaction with pain management were evaluated.RESULTS Thirty two patients received pharmaceutical care. Pain scores of worst pain, mild pain and average pain in past 24 hours decreased from (9.44±0.62), (5.59±1.24) and (8.38±1.07) to (4.03±0.93), (1.28±0.52) and (2.59±1.04) points (P<0.01), respectively. Scores at the time of survey decreased from (8.25±1.24) to (2.19±0.82) points (P<0.01). Degrees of pain relief were more than 50%. Patient satisfaction scores of pain treatment, pain care, analgesic effect and pain education were (4.25±0.84), (4.09±0.53), (4.03±0.86) and (3.88±0.79) points, respectively. Proportion of patient medication compliance evaluated as "good" rose from 31.23% to 84.38% (P<0.01).CONCLUSION Clinical pharmacy service mode in cancer pain management is established. After implementation, pain control and medication compliance of patients are improved obviously. Patients satisfaction on pain treatment, pain care and analgesic effect are good. Satisfaction of pain education needes to be further improved.