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驻科药师主导的药物治疗管理模式在老年心血管内科的应用与效果评价
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| 篇名： | 驻科药师主导的药物治疗管理模式在老年心血管内科的应用与效果评价 |
| TITLE： | Application and effectiveness evaluation of resident clinical pharmacist-led medication therapy management model in geriatric cardiology departments |
| 摘要： | 目的 探讨驻科药师主导的药物治疗管理（MTM）模式在老年医学中心心血管内科的应用效果，为优化驻科药学服务提供参考。方法采用回顾性队列研究，纳入2023年3－8月（传统组，n＝903）与2024年3－8月（MTM组，n＝963）我院老年医学中心心血管内科住院患者的数据。传统组患者仅接受常规药学服务（处方前置审核、事后医嘱点评），MTM组患者在常规服务基础上，接受驻科药师主导的药物重整、治疗药物监测（TDM）、静脉输液规范化管理的MTM服务。通过比较两组患者的主要结局指标（如静脉输液率、TDM达标率等）和次要结局指标[如药物相互作用（DDIs）发生率、3级及以上急性肾损伤发生率、人均住院时长及人均总药费等]评估MTM模式实施效果。结果与传统组相比，在主要结局指标方面，MTM组患者的总静脉输液使用率、抑酸类药物注射剂使用率均显著降低（P＜0.05），地高辛、万古霉素TDM达标率均显著升高（P＜0.05）；在次要结局指标方面，MTM组患者3级及以上急性肾损伤发生率、DDIs发生率、非医嘱离院率、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、胆固醇及人均总药费均显著降低（P＜0.05），肌酐、估算的肾小球滤过率均显著升高（P＜0.05），人均住院时长显著缩短（P＜0.05）。结论驻科药师主导的MTM模式能有效优化药物治疗流程，提升用药安全性与经济性，对促进合理用药、改善患者结局具有积极作用。 |
| ABSTRACT： | OBJECTIVE To investigate the effectiveness of resident clinical pharmacist-led medication therapy management （MTM） model in geriatric cardiology departments， and provide reference for optimizing resident pharmaceutical services. METHODS A retrospective cohort study was conducted， incorporating data from inpatients admitted to the Department of Cardiovascular Medicine in the Geriatric Medical Center of our hospital during March to August 2023 （conventional group， n＝ 903） and the same period in 2024 （MTM group， n＝963）. The conventional group received only standard pharmaceutical services （including prospective prescription review and retrospective order evaluation）， while the MTM group received additional resident clinical pharmacist-led interventions-such as medication reconciliation， personalized therapeutic drug monitoring （TDM）， standardized intravenous infusion management， and a four-stage closed-loop monitoring process-based on conventional care. The effectiveness of the MTM model was evaluated by comparing the primary outcome measures （e.g.， intravenous infusion rate， TDM target attainment rate） and secondary outcome measures [e.g.， incidence of drug-drug interactions （DDIs）， incidence of grade 3 or higher acute kidney injury， average length of hospital stay， cholesterol， and medication cost per capita] between the two groups. RESULTS Compared with the conventional group， in terms of primary outcome indexes： both the overall intravenous infusion rate and the use rate of acid-suppressive injection were significantly lowered in the MTM group （P＜0.05）； serum concentration target attainment rates for digoxin and vancomycin were increased significantly （P＜0.05）. For secondary outcome indexes， the MTM group exhibited significant decreases in the work incidence of grade 3 or higher acute kidney injury， the incidence of DDIs， the rate of patients leaving the hospital against medical advice， alanine amino-transferase， aspartate transferase and the per capita total medication cost （P＜0.05）. Additionally， there was a notable increase in the creatinine， estimated glomerular filtration rate and a significant shortening of the per capita length of hospital stay （P＜0.05）. CONCLUSIONS The resident clinical pharmacist-led MTM model can significantly optimize medication therapy processes， enhance medication safety and cost-effectiveness， thus playing a positive role in promoting rational drug use and improving patient outcomes. |
| 期刊： | 2025年第36卷第21期 |
| 作者： | 郭静文；田文；张博瑒；常利双；蔡爽 |
| AUTHORS： | GUO Jingwen，TIAN Wen，ZHANG Bochang，CHANG Lishuang，CAI Shuang |
| 关键字： | 临床药学；药物治疗管理；驻科药学服务模式；静脉输液率；治疗药物监测达标率 |
| KEYWORDS： | clinical pharmacy； medication therapy management； resident pharmaceutical service model； intravenous infusion |
| 阅读数： | 4 次 |
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