基于KAP理论的医师-药师合作模式对口服糖皮质激素的风湿免疫病患者管理及成本-效果分析

Management and Cost-effectiveness Analysis of a Physician-pharmacist Collaborative Model Based on KAP Theory for Rheumatologic Patients Taking Oral Glucocorticoids

关键词:  知信行理论  糖皮质激素  风湿免疫病  成本-效果分析

Key words:  KAP theory  glucocorticoids  rheumatic immune diseases  cost-effect analysis

摘要:

目的 基于知信行（knowledge, attitude, practice，KAP）理论的医师-药师合作模式对口服糖皮质激素（以下简称“激素”）的风湿免疫病患者进行管理，并对其进行药物经济学评价，促进合理用药。方法 对242例经激素治疗的门诊风湿免疫病患者进行为期6个月的随机对照前瞻性研究，随机分为基于KAP理论的医师-药师合作模式组（以下简称“干预组”）和常规诊疗组（以下简称“对照组”）。药师对干预组患者采用门诊跟诊、电话随访等方式，积极开展全程管理，包括病情管理、用药方案管理、药物不良反应（adverse drug reaction，ADR）管理、依从性管理。6个月后分析两组患者KAP各维度评分、红细胞沉降率（erythrocyte sedimentation rate，ESR）阴转率、ADR发生率、疾病控制率，并通过成本-效果分析进行药物经济学评价。结果 204名患者完成了研究，其中干预组96人，对照组108人。6个月后，干预组的KAP各维度评分、ESR阴转率（75.00% vs 52.78%）明显高于对照组（P < 0.01），ADR发生率（51.04% vs 58.33%）低于对照组，疾病控制率（64.58% vs 55.56%）高于对照组，但无统计学差异（P > 0.05）。成本-效果分析显示基于KAP理论的医师-药师合作模式具有经济性。结论 基于KAP理论的医师-药师合作模式对口服激素的风湿免疫患者管理体现了药师的价值，值得推广和借鉴。

Abstract:

OBJECTIVE To evaluate the physician-pharmacist cooperation model based on knowledge, attitude, practice (KAP) theory for the management on rheumatic immune patients with oral glucocorticoids (hereinafter referred to as GC) and promote rational drug use. METHODS A 6-month randomized, controlled, prospective study was undertaken in 242 patients with rheumatic diseases treated with glucocorticoids and randomly divided into the KAP mode group (hereinafter referred to as the ‘intervention group’) and conventional pharmaceutical care group (hereinafter referred to as the ‘control group’). Pharmacists actively carried out whole-process management of patients in the intervention group by means of outpatient follow-up and telephone follow-up, including disease management, medication regimen management, adverse drug reaction (ADR) management, and compliance management. After 6 months, the KAP scores, erythrocyte sedimentation rate (ESR) negative conversion rate, ADR incidence, and disease control rate were analyzed in the two groups, and pharmacoeconomic evaluation was carried out through cost-effect analysis. RESULTS 204 patients finished the study with 96 in the intervention group and 108 in the control group. After 6 months,the KAP’s scores and the negative rate of ESR (75.00% vs 52.78%) in the intervention group were significantly higher than those of the control group (P < 0.01).The incidence of ADR (51.04% vs 58.33%) was lower and the disease control rate (64.58% vs 55.56%) was higher in the intervention group compared to control group, but there were no statistical differences (P > 0.05). Both the cost-effect analyses showed that the physician-pharmacist cooperation model based on KAP theory was economical. CONCLUSION The physician-pharmacist cooperation model based on KAP theory for the management of rheumatism and immunity patients with oral GC reflects the value of pharmacists, which is worthy of promotion and reference.