临床药学延伸服务在脑卒中二级预防中的实践及评价

摘要

Objective To evaluate the application effect of clinical pharmacy services in the secondary prevention ot stroke.Methods Hospitalized stroke patients were selected in Taihe Hospital from June 2013 to August 2014.The patients meeting the inclusion criteria were paired and sequentially numbered,and randomly divided into observation group (n =100) and control group (n =102).The patients were treated routinely during thc hospitalization.The clinical pharmacists conducted the drug education.The control group implemented the telephone follow-up for guiding compliance behavior one month after discharge.The observation group continued to perform clinical pharmacist-leading service projects.The medication compliance (Morisky scale),systolic blood pressure (SBP),diastolic blood pressure (DBP),glycated hemoglobin (HbA1 C),serum total cholesterol (TC),low density lipoprotein-C (LDL-C) and relapse rate were compared three months,six months and twelve months after the two groups discharged.Results The medication compliance,SBP,DBP,HbA1C,TC,LDL-C and recurrence rate after hospital discharge were no statistically significant (P ＞ 0.05) three months after the two groups discharged,but statistically significant between the two groups (P ＜ 0.05 or P ＜ 0.01) six months and twelvc months after the two groups discharged.Levels of SBP,DBP,HbA1 C,TC and LDL-C in the two groups were both significantly lower than before (P ＜ 0.05 or P ＜ 0.01).The relapse rate of the observation group three months,six months and twelve months after they discharged was 2.00％,5.00％ and 15.00％,respectively,and that of the control group was 2.94％,13.72％ and 28.43％,respectively.Conclusion The pharmacy services in the secondary prevention of stroke can improve the patient medication compliance and better control the blood pressure,blood glucose and blood lipid lcvcls,and reduce the relapse rate.It should be recommended in the clinical practice work.%目的 评价临床药学延伸服务在脑卒中二级预防中的应用效果.方法 选择湖北省十堰市太和医院2013年6月-2014年8月住院治疗的脑卒中患者,将符合纳入标准的患者配对并依次编号,用随机的方法分为观察组(n=100)和对照组(n=102).两组患者住院治疗期间按疾病临床路径进行护理,由临床药师行药物宣教.对照组出院后1个月实施电话随访,指导遵医行为.观察组执行临床药师主导的延续服务方案.比较两组患者出院后3,6和12个月的服药依从性(Morisky量表)、收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1C)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和复发率的差异.结果 两组患者出院后3个月,服药依从性、SBP、DBP、HbA1C、TC和LDL-C差异无统计学意义(P＞0.05),但SBP、DBP、HbA1C、TC和LDL-C水平均低于入组时(P＜0.05或P＜0.01);两组患者出院后6和12个月服药依从性、SBP、DBP、HbA1C、TC和LDL-C差异有统计学意义(P＜0.05或P＜0.01).出院后3,6和12个月复发率为2.00％,5.00％和15.00％;对照组复发率为2.94％,13.72％和28.43％.结论 临床药学延伸服务在脑卒中患者二级预防中可提高患者用药的依从性,更好控制血压、血糖和血脂水平,降低复发率,值得在临床实践工作中推荐.