引入PCNE分类系统对2型糖尿病患者开展MTM的实践探索

方案的接受及结果等;比较2组患者住院期间（或出院时）和出院3个月时用药依从性（最高分为8分）、糖化血红蛋白（HbA1c）达标（<7%）情况等指标。结果：纳入病例76例，其中药学干预组40例，对照组36例。药学干预组在住院期间共发现51个DRPs，问题类型主要涉及治疗有效性（42个），问题发生原因主要是用法用量不当（23个），干预类型主要是针对患者层面（24个），接受干预38个（接受率达74.51%），有32个问题（占62.75%）完全解决;与入院时相比，3个月随访时药学干预组患者用药依从性评分低（<6分）的患者从26人降至8人（P<0.000 1），评分中等（6～8分）的患者从10人增加至22人（P=0.006 2），评分高（8分）的患者从4人增加至10人，用药依从性提高显著;对照组患者的用药依从性无显著性变化;与出院时比较，出院3个月随访时，药学干预组患者HbA1c达标率从25.00%提高到77.50%，对照组从25.00%提高到55.56%，差异均有统计学意义（P<0.000 1），且药学干预组患者随访时的HbA1c达标率升高幅度明显大于对照组。结论：在MTM服务实践中，临床药师利用PCNE分类系统，可实现DRPs的系统收集、分析、干预、解决和评价;建立的MTM服务模式可为规范药学服务模式提供参考。

关键词 欧洲医药保健网分类系统;药物治疗管理;用药依从性;药物相关问题

ABSTRACT   OBJECTIVE： To introduce Pharmaceutical Care Network Europe （PCNE） classification system to develop medication therapy management （MTM）， and to investigate the application of PCNE classification system in solving drug-related problems （DRPs） in type 2 diabetic patients and the effect of it on clinical outcomes. METHODS： The patients with type 2 diabetes diagnosed in endocrinology department of our hospital from Jul. 10， 2018 to Oct. 31， 2018 were randomly divided into clinical pharmacist-led intervention （“physician-pharmacist-nurse” mode） group and control group receiving only traditional medical services （“physician-nurse” mode）. According to PCNE classification， the number of DRPs found in the pharmaceutical intervention group， the types of problems， causes， the types of interventions， acceptance for interventions and outcomes were analyzed and evaluated. Drug compliance （the highest score is 8） and HbA1c compliance （<7%） were compared between 2 groups during hospitalization （or at the discharge） and 3 months after discharge. RESULTS： Totally 76 cases were included （40 cases in pharmaceutical intervention group and 36 cases in control group）. During hospitalization， 51 DRPs were found in the pharmaceutical intervention group， among which 42 problems were related to the effectiveness of treatment， mainly due to improper usage and dosage （23 problems）; the types of intervention was mainly aimed at the patient level （24 problems）. 38 problems received intervention （acceptance rate was 74.51%） and 32 problems （62.75%） were completely solved. Compared with those at admission， after following up for 3 months patients with low score （6 points） in the drug compliance of the pharmaceutical intervention group decreased from 26 to 8 （P<0.000 1）， patients with medium score （6-8 points） increased from 10 to 22 （P=0.006 2）， patients with high score （8 points） increased from 4 to 10， and drug compliance improved significantly， while there was no significant change in drug compliance in the control group. Compared with those at the discharge， after 3 months’ follow-up， the HbA1c compliance rate of the pharmaceutical intervention group increased from 25.00% to 77.50%， and that of the control group increased from 25.00% to 55.56%. There were statistical differences （P<0.000 1）， and HbA1c compliance rate of the pharmaceutical intervention group was significantly higher than that of the control group. CONCLUSIONS： In the practice of MTM service， clinical pharmacists use PCNE classification system to collect， analyze， intervene， solve and evaluate DRPs systematically. The service mode can provide reference for standardizing pharmaceutical care mode.