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基于健康行为改变整合理论的抗凝药学服务模式构建与应用
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| 篇名： | 基于健康行为改变整合理论的抗凝药学服务模式构建与应用 |
| TITLE： | Construction and application of anticoagulant pharmacy service model based on the integrated theory of health behavior change |
| 摘要： | 目的 建立药师主导的基于健康行为改变整合理论（ITHBC）的抗凝药学服务模式，并分析其应用效果。方法参考相关文献，并征求药学部、呼吸科、血管外科等科室共8名多学科专家意见，最终形成药师主导的基于ITHBC的抗凝药学服务模式。选择2023年12月－2024年6月石河子大学第一附属医院的VTE住院患者为研究对象，采用随机数字表法将其分为干预组（58例）和对照组（60例）。干预组采取药师主导的基于ITHBC的抗凝药学服务模式，对照组采取常规抗凝药学服务模式。比较两组患者启动抗凝治疗3个月时的抗凝达标率、药物不良反应发生率、用药依从性评分、抗凝药物处方依从率，并进行经济学评价。结果在启动抗凝治疗3个月时，干预组患者抗凝达标率、用药依从性评分、抗凝药物处方依从率均显著高于对照组（P＜0.05）。两组患者的药物不良反应总发生率差异无统计学意义（P＞0.05）。每增加1%的抗凝达标率，医院需多投入的药师服务费用为4.35元。与2023年我国人均国内生产总值（GDP，89358元）相比，增加50%抗凝达标率的增量成本-效果比值远低于1倍人均GDP。结论药师主导的基于ITHBC的抗凝药学服务模式可有效改善VTE患者抗凝治疗结局，提升患者用药依从性，提高患者对抗凝药物不良反应的认识和识别能力，具有一定的经济和社会效益。 |
| ABSTRACT： | OBJECTIVE To establish anticoagulation pharmaceutical service model based on the integrated theory of health behavior change （ITHBC）， and analyze its effects. METHODS Referring to relevant literature and soliciting opinions from 8 experts from departments such as pharmacy， respiratory medicine， and vascular surgery， a anticoagulation pharmaceutical service model based on ITHBC was ultimately formed. VTE inpatients were selected from The First Affiliated Hospital of Shihezi University from December 2023 to June 2024 as the research subjects. They were randomly assigned into intervention group （58 cases） and control group （60 cases） using a random number table method. The intervention group implemented pharmacist-led anticoagulant pharmaceutical service model based on ITHBC， while the control group adopted a conventional anticoagulant pharmaceutical service model. The anticoagulation-related outcomes of two groups were compared after 3 months： anticoagulation compliance rate， the incidence of adverse drug reactions， the score of medication adherence and compliance rate of anticoagulant prescription； economic evaluation was conducted. RESULTS After implementing ITHBC-based anticoagulant pharmaceutical services for 3 months， the intervention group had higher anticoagulation compliance rate， score of medication adherence， and compliance rate of anticoagulant prescription than the control group （P＜0.05）. There was no statistically significant difference in the total incidence of adverse drug reactions between the two groups （P＞0.05）. For every 1% point increase in anticoagulant compliance rate， the hospital needed to invest 4.35 yuan additionally in anticoagulant pharmaceutical service fees. Compared with China’s per capita gross domestic product （GDP， 89 358 yuan） in 2023， the incremental cost-effectiveness ratio value that increased the anticoagulation compliance rate by 50% is far less than one time of per capita GDP. CONCLUSIONS The pharmacist- led anticoagulant pharmaceutical service model based on ITHBC can effectively improve the outcomes of anticoagulant therapy for VTE patients， enhance medication compliance， improve patients’ awareness and recognition of adverse drug reactions to anticoagulants， and has certain economic and social benefits. |
| 期刊： | 2024年第35卷第23期 |
| 作者： | 梁侠兵；凡保华；文志萍；王晓义 |
| AUTHORS： | LIANG Xiabing，FAN Baohua，WEN Zhiping，WANG Xiaoyi |
| 关键字： | 健康行为改变整合理论；静脉血栓栓塞症；抗凝治疗；药学服务；用药依从性 |
| KEYWORDS： | integrated theory of health behavior change； venous thromboembolism； anticoagulant therapy； pharmaceutical |
| 阅读数： | 8 次 |
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