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家庭医生制度下药师参与脑卒中患者长期药物治疗管理模式实践及评价
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| 篇名： | 家庭医生制度下药师参与脑卒中患者长期药物治疗管理模式实践及评价 |
| TITLE： | Practice and evaluation of pharmacists’participation in long-term MTM models for stroke patients based on family doctor system |
| 摘要： | 目的 探讨药师加入家庭医生团队（FHTs）对脑卒中患者长期药物治疗管理（MTM）的临床效果，并对其服务模式进行实证评价。方法由南京医科大学附属苏州医院（以下简称“我院”）临床药师与社区药师联合组建药师团队，并构建药师参与FHTs的脑卒中患者长期MTM模式。采用前瞻性随机对照试验，纳入2022年7月－2023年12月从我院出院并与苏州市润达社区医院建立FHTs签约关系的脑卒中患者170例，按随机数字表法分为试验组（88例）与对照组（82例）。对照组患者采用常规FHTs照护模式（药师不参与团队协作）；试验组患者采用药师参与FHTs，并依托信息化平台提供为期12个月的MTM服务，具体包括基于MTM框架的个体化用药方案优化、动态化用药依从性管理、用药安全性监测、家庭用药评估及特色服务内容的创新干预。比较两组患者干预前后用药依从性（用药依从率、用药依从性评分）、卒中复发危险因素指标[血压、低密度脂蛋白胆固醇（LDL-C）]达标率及药物不良反应（ADR）发生情况。结果干预12个月后，试验组患者用药依从率、用药依从性评分、血压达标率、LDL-C达标率均显著高于对照组（P＜0.05）；试验组患者的ADR发生率（4.55%）低于对照组（8.11%），但差异无统计学意义（P＞0.05）。结论药师参与FHTs并实施MTM服务，可显著提升脑卒中患者用药依从性、优化卒中复发危险因素水平，为完善家庭医生制度下的慢病药学管理提供了实践依据。 |
| ABSTRACT： | OBJECTIVE To investigate the clinical efficacy of integrating pharmacists into family health teams （FHTs） for long-term medication therapeutical management （MTM） in stroke patients， and empirically evaluate the service model. METHODS A pharmacist team， jointly established by clinical and community pharmacists from the Affiliated Suzhou Hospital of Nanjing Medical University （hereinafter referred to as “our hospital”）， developed a pharmacist-supported MTM model integrated into FHTs. Using a prospective randomized controlled design， 170 stroke patients discharged from our hospital （July 2022-December 2023） and enrolled in FHTs at Suzhou Runda Community Hospital were randomly divided into trial group （88 cases） and control group （82 cases） according to random number table. The control group received routine FHTs care （without pharmacist involvement in the team collaboration）， while the trial group xhz8405@126.com received 12-month MTM services supported by pharmacists via an information platform. These services specifically included innovative interventions such as personalized medication regimen optimization based on the MTM framework， dynamic medication adherence management， medication safety monitoring， a home medication assessment system， and distinctive service offerings. Outcomes of the 2 grousp were compared before and after intervention， involving medication adherence （adherence rate， adherence score）， compliance rates for stroke recurrence risk factors [blood pressure， low-density lipoprotein cholesterol （LDL-C）]， and incidence of adverse drug reactions （ADR）. RESULTS After 12 months， the trial group exhibited significantly higher medication adherence rates， improved adherence scores， higher compliance rates for blood pressure and LDL-C targets compared to the control group （P＜0.05）. The incidence of ADR in the trial group （4.55%） was significantly lower than that in the control group （8.11%）， though the difference was not statistically significant （P＞ 0.05）. CONCLUSIONS Pharmacist involvement in FHTs to deliver MTM services significantly enhances medication adherence and optimizes risk factor for stroke recurrence， offering practical evidence for advancing pharmaceutical care in chronic disease management under the family doctor system. |
| 期刊： | 2025年第36卷第09期 |
| 作者： | 石璐；刘纯；唐莲；李静静；薛苏冬；虞燕霞；李雯雯；于可人；薛建辉；马雯；薛宏志 |
| AUTHORS： | SHI Lu，LIU Chun，TANG Lian， LI Jingjing，XUE Sudong，YU Yanxia，LI Wenwen，YU Keren，XUE Jianhui，MA Wen，XUE Hongzhi |
| 关键字： | 家庭医生制度；医院药师；社区药师；脑卒中；药学服务；药物治疗管理；用药依从性 |
| KEYWORDS： | family doctor system； clinical pharmacist； community pharmacist； stroke； pharmaceutical care； medication |
| 阅读数： | 11 次 |
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