中国药师药学服务转型效果的meta分析

Transformation Effect of Pharmaceutical Care of Pharmacists in China: A Meta-analysis

关键词:  药师  转型  药学服务  效果  meta分析

Key words:  pharmacists  transformation  pharmaceutical care  effect  meta-analysis

摘要:

目的 系统评价中国药师药学服务转型的工作效果，为今后开展药学服务提供参考。方法 计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库、中国知网、万方和维普数据库，收集中国药师为转型而开展药学服务、并有明确服务效果评价指标的文献，包括随机对照试验(randomized controlled trial，RCT)和非随机干预性研究(non-randomized studies of interventions，NRSI)。筛选文献、提取资料并采用相关量表对纳入文献质量进行评价，采用RevMan5.4软件进行meta分析。结果 纳入RCT 8篇、NRSI 43篇，共计51篇文献。Meta分析结果显示，试验组抗菌药物的处方合理性[OR=5.17，95%CI(4.10，6.52)，P<0.000 01]和单药使用率[OR=2.87，95%CI(2.16，3.81)，P<0.000 01]、患者的依从性[OR=3.40，95%CI(1.73，6.66)，P=0.000 4]和满意度[OR=2.54，95%CI(1.58，4.10)，P=0.000 1]均显著高于对照组，试验组不合理处方的比例[OR=0.29，95%CI(0.22，0.37)，P<0.000 01]、不良反应的发生率[OR=0.17，95%CI(0.12，0.24)，P<0.000 01]、治疗费用和治疗时间(P<0.05)均显著低于对照组。结论 药师开展的处方审核、用药咨询、患者用药教育、处方点评、不良反应上报等药学服务取得了显著成效，这种转型符合国家对药师队伍的要求，也可为临床合理用药提供保障。

Abstract:

OBJECTIVE To systematically evaluate the transformation effect of pharmaceutical care of pharmacists in China, and to provide reference for pharmacists to carry out pharmaceutical care in the future. METHODS Retrieved from PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP database, randomized controlled trials(RCTs) and non-randomized studies of interventions(NRSIs) about pharmaceutical care carried out by pharmacists with clear outcome evaluation indicators were collected. Related scales used to evaluate the quality of the included literatures after literature screening and data extraction, and meta-analysis was conducted by using RevMan 5.4 software. RESULTS A total of 51 studies were included, including 8 RCTs and 43 NRSIs. Meta-analysis showed that the prescription rationality of antibiotics[OR=5.17, 95%CI(4.10, 6.52), P<0.000 01], single use rate of antibiotics[OR=2.87, 95%CI(2.16, 3.81), P<0.000 01], patient compliance[OR=3.40, 95%CI(1.73, 6.66), P=0.000 4] and patient satisfaction[OR=2.54, 95%CI(1.58, 4.10), P=0.000 1] in the trial group were significantly better than those in control group. The proportion of unreasonable prescriptions[OR=0.29, 95%CI(0.22, 0.37), P<0.000 01], incidence of adverse drug reactions[OR=0.17, 95%CI(0.12, 0.24), P<0.000 01], cost and duration of treatment(P<0.05) in the trial group were significantly lower than those in control group. CONCLUSION Prescription audit, medication consultation, medication education, prescription review, adverse drug reaction reporting and other pharmaceutical services carried out by pharmacists have achieved remarkable results. This transformation meets the requirements of the state for pharmacists, and can also provide guarantee for clinical rational drug use.