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骨科关节置换术围术期药学服务模式构建及评价
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| 篇名： | 骨科关节置换术围术期药学服务模式构建及评价 |
| TITLE： | Construction and evaluation of a perioperative pharmaceutical care model for orthopedic joint replacement |
| 摘要： | 目的 基于临床药学专科协作和药物治疗管理（MTM）构建并评价骨科关节置换术围术期药学服务模式，为提升临床合理用药水平、降低医疗费用提供参考。方法以骨科关节置换术患者为研究对象，组建由临床药学组组长、驻科临床药师和多专科临床药师组成的专科协作组，明确MTM在骨科关节置换术围术期的实践路径、服务内容与工作流程，构建骨科关节置换术围术期药学服务模式。收集2022年7月至2023年6月（干预前，581例）与2023年7月至2024年6月（干预后，843例）陆军军医大学大坪医院骨科疾病诊断相关分组（DRG）-IC29病组患者的资料，统计干预后工作开展指标，比较干预前后效率指标及药事管理指标；同时，分别从干预前后患者中随机抽取200例患者病历资料，评价医嘱合理率。结果2023年7月至2024年6月，协作组通过骨科关节置换术围术期药学服务模式对843例骨科关节置换术患者实施MTM，共识别出药物相关问题（DRPs）1163个，筛选出用药高风险患者79例；最常见的DRPs类型为（可能）发生药物不良事件/反应（48.93%）、不必要的药物治疗（21.58%）、药物治疗效果不佳（16.25%）；1163个DRPs中，895个为完全解决（76.96%）。与干预前相比，干预后患者的住院次均费用、次均药品费用、平均住院日、药占比、抗菌药物使用率、抗菌药物使用强度、6类主要药物的人均费用均降低，医嘱合理率由78.25%提升至98.11%。结论基于临床药学专科协作和MTM的骨科关节置换术围术期药学服务模式有助于药师发现并解决骨科关节置换术围术期患者的DRPs，提升临床合理用药水平，节约治疗费用。 |
| ABSTRACT： | OBJECTIVE To construct and evaluate a perioperative pharmaceutical care model for orthopedic joint replacement based on clinical pharmacy specialty collaboration and medication therapy management （MTM）， so as to provide a reference for improving the level of clinical rational drug use and reducing medical costs.METHODS Patients undergoing orthopedic joint replacement were taken as the research subjects. A specialized collaboration group was established， consisting of the head of the clinical pharmacy group， ward-based clinical pharmacists， and multi-specialty clinical pharmacists. The practice path， service contents，and workflow of MTM for the perioperative period of orthopedic joint replacement were clarified，and a perioperative pharmaceutical care model for orthopedic joint replacement was developed. Data of patients in the orthopedic diagnosis-related groups （DRG）-IC29 group of the department of orthopedics in Daping Hospital，Army Medical University were collected from July 2022 to June 2023 （pre-intervention， 581 cases） and from July 2023 to June 2024 （post-intervention， 843 cases）. The work-implementation indicators in the post-intervention period were counted， and the efficiency indicators and pharmaceutical management indicators were compared between the pre- and post-intervention periods. Meanwhile，200 patients were randomly selected from the pre-intervention and post-intervention groups， respectively， to evaluate the rate of rational medical orders.RESULTS From July 2023 to June 2024， the collaboration group implemented MTM for 843 patients undergoing orthopedic joint replacement via the established perioperative pharmaceutical care model. A total of 1 163 drug‑related problems （DRPs） were identified， and 79 patients with high medication‑related risks were screened out. The most common types of DRPs included （possible） adverse drug events/reactions （48.93%）， unnecessary drug therapy （21.58%）， and ineffective drug therapy （16.25%）. Among the 1 163 DRPs， 895 （76.96%） were completely resolved. Compared with the pre‑intervention period， the post‑intervention period showed reductions in average hospitalization cost per case， average drug cost per case， average length of hospital stay， proportion of drug cost， utilization rate and use intensity of antibacterial agents， and per‑capita drug cost of six main drug categories. The rate of rational medical orders increased from 78.25% to 98.11%.CONCLUSIONS The perioperative pharmaceutical care model for orthopedic joint replacement based on clinical pharmacy specialty collaboration and MTM can help pharmacists identify and resolve DRPs during the perioperative period of orthopedic joint replacement，improve the level of clinical rational drug use，and reduce treatment costs. |
| 期刊： | 2026年第37卷第18期 |
| 作者： | 向婷；刘耀；杨雪；刘芳；杨霞 |
| AUTHORS： | XIANG Ting，LIU Yao，YANG Xue，LIU Fang，YANG Xia |
| 关键字： | 关节置换术;围术期;药学服务;DRG支付;药物治疗管理;临床药学专科协作 |
| KEYWORDS： | Joint replacement;Perioperative;Pharmaceutical care;DRG payment;Medication therapy management;clinical pharmacy specialty collaboration |
| 阅读数： | 1 次 |
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