咳喘药学门诊的构建及实践

Construction and Practice of Cough and Asthma Pharmacy Clinic

关键词:  咳喘  药学门诊  慢性阻塞性肺疾病  吸入剂

Key words:  cough and asthma  pharmacy clinic  chronic obstructive pulmonary disease  inhalation adherence

摘要:

目的 探讨浙江大学医学院附属杭州市第一人民医院咳喘药学门诊的实践模式。方法 开设咳喘药学门诊，配备相应的软硬件设施，建立咳喘药学服务模式。收集2020年12月1日—2022年8月31日在医院咳喘药学门诊就诊的患者2 357例，分析其一般资料，患者根据吸入剂视频自我学习后再由药师进行指导，评估药师干预前后的患者吸入剂使用技能差异。收集2020年12月1日—2021年7月31日在医院咳喘药学门诊就诊的慢性阻塞性肺疾病患者345例，依据盲抽法分为每30 d随访组(n=173)，每15 d随访组(n=172)，比较随访第1，3，6，12个月的Morisky用药依从性量表(MMAS-8)评分差异。结果 2 357例就诊患者中，男性1 213例(占51.46%)，女性1 144例(占48.54%)；年龄≥60岁1 309例(占55.54%)，年龄40~59岁563例(占23.89%)，年龄20~39岁402例(占17.06%)，年龄14~20岁32例(占1.36%)，年龄＜14岁51例(占2.16%)；患者主要疾病类型为慢性阻塞性肺疾病(占55.38%)、哮喘(占20.73%)；用药频率较高的为布地奈德福莫特罗吸入粉雾剂(占37.08%)、布地格福吸入气雾剂(占25.84%)。药师在患者视频教学的基础上进行干预后患者的吸入剂使用技能掌握情况优于患者通过视频自我学习的掌握情况，干预前评分为5.360±1.208，干预后评分为7.890± 0.356，两者存在显著性差异(P＜0.05)。随访1个月时，15 d随访组的MMAS-8评分为6.310±1.079，30 d随访组的MMAS-8评分为5.250±0.977，两者存在显著性差异(P＜0.05)，随访3，6，12个月的2组患者的MMAS-8评分无显著性差异。结论 咳喘药学门诊的建立推进了药学与呼吸临床学科的融合，提高了患者用药依从性。

Abstract:

OBJECTIVE To explore the practice mode of cough and asthma pharmacy clinic in Affiliates Hangzhou First People's Hospital, Zhejiang University, School of Medicine. METHODS To set up a cough and asthma pharmacy clinic, equipped with corresponding hardware and software facilities, and establish a cough and asthma pharmaceutical care mode. From December 1, 2020 to August 31, 2022, 2 357 patients in the hospital cough and asthma pharmacy clinic were collected, and their general data were analyzed. The patients learned by themselves according to the inhalation video, and then were guided by pharmacists to evaluate the differences in the use skills of patients before and after the intervention of pharmacists. The 345 patients with chronic obstructive pulmonary disease who were treated in the cough and asthma pharmacy clinic from December 1, 2020 to July 31, 2021 were collected. They were divided into 30 d follow-up group(n=173) and 15 d follow-up group(n=172) according to the blind sampling method. The score difference of Morisky medication Compliance Scale(MMAS-8) at 1, 3, 6 and 12 months of follow-up was compared. RESULTS Among 2 357 patients, 1 213(51.46%) were males and 1 144(48.54%) were females, 1 309 cases(55.54%) aged ≥60 years old, 563 cases(23.89%) aged 40-59 years old, 402 cases(17.06%) aged 20-39 years old, 32 cases(1.36%) aged 14-20 years old, and 51 cases(2.16%) aged＜14 years old. The main diseases of the patients were chronic obstructive pulmonary disease(55.38%) and asthma(20.73%). Budesonide and Formoterol Fumarate powder for inhalation(37.08%) and Budesonide, Glycopyrronium Bromide and Formoterol Fumarate Inhalation Aerosol(25.84%) were frequently used. On the basis of patients' video teaching, pharmacists' mastery of inhaler use skills was better than that of patients' self-learning through video. The score before intervention was 5.360±1.208 and that after intervention was 7.890±0.356. There was significant difference between the two groups(P＜0.05). At a month of follow-up, the MMAS-8 score of the 15-day follow-up group was 6.310±1.079. The MMAS-8 score of the 30 d follow-up group was 5.250±0.977, there was a significant difference between the two groups(P＜0.05), but there was no significant difference in the MMAS-8 score of the two groups at 3, 6, 12-month follow-up. CONCLUSION The establishment of cough and asthma pharmacy clinic promotes the integration of pharmacy and respiratory clinical discipline, and improves the medication compliance of patients.