消化内科患者入院药物重整分析

目的：通过分析消化内科患者入院时药物重整情况，为临床药师参与消化内科患者入院时药物管理及用药指导提供参考。方法：选择2019年6月至2020年6月某院消化内科新入院患者，纳入入院前存在服用药物的病例，通过药学问诊，记录患者的用药目的、用法用量、慢病是否定期随访或监测指标值、过敏史。结果：共纳入111例病例，其中有慢病史的102例，占比91.89%；平均服用药物数量为4.04种；平均药疗差异问题数为1.81；存在药疗差异的有92例，占比82.88%，其中接受药师建议的有90例，占比97.83%。结论：患者自我药疗偏差较大，部分患者规范就医用药意识薄弱；临床药师可通过入院时的药学问诊以及用药宣教提高患者用药的安全性和有效性。

Analysis of medication reconciliation for hospitalized gastrointestinal patients

OBJECTIVE To provide references for clinical pharmacists to participate in medication reconciliation and medication guidance of hospitalized gastrointestinal patients by analyzing the drug restructuring pattern.METHODS From June 2019 to June 2020, a total of 111 newly admitted gastrointestinal patients with pre-admission medications were selected. And pharmaceutical consultations, purpose of medication, usage and dosage, chronic disease follow-ups, monitored parameters and allergy history were recorded.RESULTS Among them, 102 cases had a history of chronic disease, accounting for 91.89%. The average number of medication was 4.04 and the average number of differential problems during pharmacotherapy 1.81. The number of patients with differential medication was 92, accounting for 82.88%; the number of patients accepted pharmacist advice was 90, accounting for 97.83%.CONCLUSION There is a large deviation of patient self-medication. Some patients have a weak awareness of standardized medications. Clinical pharmacists can improve the safety and effectiveness of drug use through pharmaceutical consultations on admission and drug use tutorial.