借鉴MAPEX 计划:构建辅助生殖患者“CMO-PC”药学服务新模式

Establishment of a New "CMO-PC" Pharmaceutical Service Model for Assisted Reproductive Patients Drawing on the MAPEX Plan in Spain

关键词:  药学服务、辅助生殖、临床药师、药师门诊

Key words:  pharmaceutical services, assisted reproduction, clinical pharmacist, pharmacist outpatient.

摘要:

摘要：目的 探索西班牙“CMO-PC”模式在我院辅助生殖药师门诊患者管理中的应用；方法 利用“CMO-PC”模式，即“能力（CAPACITY）-动力（MOTIVATION）-时机（OPPORTUNITY）的药学服务”，以我院辅助生殖药师门诊患者为服务对象，构建“患者分层评估-实施药学服务行动-利用远程药学服务，启发患者依从性共济管理”的临床实践工作模式。并对咨询病例进行回顾性分析。结果 2023年6月-2024年6月，利用“CMO-PC”模式累计管理患者350人次，同期增加43.0%，建立患者档案163例，占比46.6%。采用分层模型对患者的高危因素进行评估，其中Prioridad 1级为42例次（12.00%），Prioridad 2级为95例次（27.14%），Prioridad 3级213例次（60.86%）。共实施药学服务行动497次，包括提供备孕期用药咨询和指导16次（8.12%）；对辅助生殖患者进周期前院外使用药物进行重整，评估所使用药物对生育力的影响185次（37.22%）；对进周期后的特殊患者促排卵方案进行个体化制定27次（5.43%）；提供降调节药物、促排卵药物、诱发排卵药物、黄体支持药物的用药指导124次（24.95%）；移植前及移植后提供药物致畸风险评估以及环境因素暴露风险评估127次（25.55%）；妊娠后提供特殊疾病的治疗方案选择11次（2.21%）；在整个过程中，识别及处理辅助生殖药物不良反应7次（1.41%）。通过微信、电话等渠道对患者实施远程药学服务19次。结论 作为一种新型药学服务模式，“CMO-PC”模式可作为门诊药学服务的重要补充，帮助提升门诊药学服务效能，也为国家药事服务改革提供新思路。

Abstract:

ABSTRACT: Objective?Drawing on the MAPEX program, to explore the "CMO-PC" model in the reproductive outpatient of our hospital. Methods:?Utilizing the "CMO-PC" model, which is based on "Capacity (CAPACITY) - Motivation (MOTIVATION) - Opportunity (OPPORTUNITY) for pharmaceutical care," we constructed clinical practice work models for managing outpatient reproductive patients. These models include "building a patient stratification model, implementing pharmaceutical service actions, utilizing remote pharmaceutical services, and inspiring patient adherence through collaborative management". Furtherly, we conducted a retrospective analysis of consultation cases. Results:?From June 2023 to June 2024, a total of 350 patient management instances were recorded using the "CMO-PC" model, representing a 43.0% increase compared to the previous period. Clinical pharmacists established patient records for 163 cases, accounting for 46.6%. The stratification model was used to assess high-risk factors among patients, with 42 cases (12.00%) classified as Priority 1, 95 cases (27.14%) as Priority 2, and 213 cases (60.86%) as Priority 3. A total of 497 pharmaceutical service actions were implemented, including 16 instances (8.12%) of providing preconception medication consultations and guidance; 185 instances (37.22%) of reorganizing medications used outside the hospital prior to the treatment cycle and assessing their impact on fertility; 27 instances (5.43%) of individualized protocol development for patients undergoing ovarian stimulation after the treatment cycle; 124 instances (24.95%) of medication guidance for down-regulating agents, ovarian stimulation medications, ovulation-inducing agents, and luteal support medications; 127 instances (25.55%) of conducting risk assessments for teratogenicity of medications and exposure to environmental factors before and after embryo transfer; 11 instances (2.21%) of selecting treatment plans for special diseases after pregnancy; and 7 instances (1.41%) of identifying and managing adverse drug reactions related to assisted reproductive medication. Remote pharmaceutical services were provided to patients 19 times through WeChat, phone calls. Conclusion:?As a novel pharmaceutical service model, the "CMO-PC" model can serve as an important supplement to outpatient pharmaceutical services, helping to enhance the effectiveness of these services and providing new insights for national pharmaceutical service reform.