基于药物治疗管理以药物治疗相关问题(MTM-MRPs)为导向的抗栓药学会诊实践及效果评价

Effect Evaluation and Practice of Anti-thrombotic Pharmacy Consultation Oriented Towards Medicine Related Problems Based on Medication Therapy Management (MTM-MRPs)

关键词:  药物治疗管理  药物治疗相关问题  抗栓  药学会诊  

Key words:  medication therapy management  medication-related problems  anticoagulation  pharmacy consultation

摘要:

目的：为确保高质高效地完成日益增多的复杂血栓栓塞性疾病的抗栓会诊,拟构建以药物治疗问题为导向的抗栓药学会诊路径与决策方法,探讨临床药师利用药物治疗管理模式在抗栓药学会诊中促进个体化抗栓药物治疗的作用及其效果评价。方法：基于药物治疗管理模式,结合血栓栓塞性疾病特点,建立以药物治疗问题为导向的抗栓药学会诊路径与决策方法,开发结构化抗栓会诊评估与随访表,对2020年5月-2023年12月采用本方法的322例抗栓会诊进行质量评估及效果评价。结果：位列前三的抗栓药物治疗问题分别为需要增加的抗栓药物治疗(31.68%)、不必要的抗栓药物治疗(22.67%)、抗栓药物治疗剂量过低(9.94%),同时合并≥2种药物治疗问题的有26.71%。临床对抗凝药师干预建议的整体采纳率为91.31%,经抗凝药师会诊干预,出院时85.09%的血栓性疾病好转或治愈,血栓性不良事件和出血性不良事件仅分别为0.62%、4.97%,仅1例(0.31%)患者既发生血栓性事件,又发生出血性事件。通过logistic回归多因素分析,查尔森合并症指数(Charlson Comorbidity Index,CCI)评分、会诊采纳情况、出血高风险及血栓高风险是影响患者转归的重要因素。结论：基于药物治疗管理以药物治疗相关问题(MTM-MRPs)为导向的抗栓药学会诊路径与决策方法,可系统、精准地识别与解决抗栓药学会诊中的药物治疗问题,高效提供个体化抗栓药物治疗会诊建议,有助提升抗栓药学会诊质量与安全性、有效性,为临床药师及高质量抗栓药学服务体系建设提供了实践范式。

Abstract:

ABSTRACT: OBJECTIVE To ensure high-quality and efficient completion of the increasing number of anticoagulation consultations for complex thrombotic diseases, a medication therapy problem (MRP)-oriented anticoagulation pharmacy consultation pathway and decision-making system was constructed. This aimed to explore the role of clinical pharmacists using the medication therapy management (MTM) model in promoting personalized anticoagulation medication therapy in anticoagulation pharmacy consultations and to evaluate its effectiveness. METHODS Based on the MTM and combined with the characteristics of thrombotic diseases, an MRP-oriented anticoagulation pharmacy consultation pathway and decision-making system was established. An anticoagulation consultation evaluation and follow-up form was developed to structurally collect data on anticoagulation therapy evaluation and effectiveness assessment. A quality assessment and effectiveness evaluation were conducted on 322 anticoagulation consultations using this method from May 2020 to December 2023. RESULTS The top three MRPs were the need for increased anticoagulation medication therapy (31.64%), unnecessary anticoagulation medication therapy (22.67%), low dose of anticoagulation medication therapy (9.94%). At the same time, 26.71% of the patients had ≥2 types MRPs. The overall clinical adoption rate of consultation opinions from anticoagulation pharmacists was as high as 91.31%. After consultation and intervention by anticoagulation pharmacists, 85.09% of thrombotic diseases improved or were cured upon discharge, with thrombotic adverse events and bleeding adverse events accounting for only 0.62% and 4.97%, respectively. Only one case (0.31%) of the patient experienced both thrombotic events and hemorrhagic events. Through multivariate logistic regression analysis, Charlson Comorbidity Index (CCI) score, consultation adoption status, high risk of bleeding, and high risk of thrombosis emerged as critical determinants impacting patient outcomes. CONCLUSION The antithrombotic pharmacy consultation pathway and decision-making method oriented towards medicine related problems based on medication therapy management (MTM-MRPs) developed in this study can systematically and accurately identify and solve MRPs in antithrombotic pharmacy consultations, efficiently provide individualized antithrombotic drug treatment consultation suggestions, and improve the quality, safety and effectiveness of antithrombotic pharmacy consultations. It provides a practical model for clinical pharmacists and the construction of a high-quality antithrombotic pharmaceutical service system.