柴东燕;劳海燕;赵成龙;段红艳;冯静;马培志;
CHAI Dongyan;LAO Haiyan;ZHAO Chenglong;DUAN Hongyan;FENG Jing;MA Peizhi;Department of Pharmacy,Henan Provinical People's Hospital;International Medical Center of Henan Province;Department of Pharmacy,Guangdong Provincial People's Hospital;Department of General Practice,Henan Provincial People's Hospital;

• 1:河南省人民医院药学部
• 2:河南省国际医疗中心
• 3:广东省人民医院药学部
• 4:河南省人民医院全科医学科

摘要(Abstract)：

目的 通过对慢病患者中开展的药物重整工作进行分析，探讨药物重整目标人群和分级服务。方法 2021年3月-2021年9月药师收集入住河南省国际医疗中心一病区诊断为高血压、糖尿病、冠心病患者的药物清单，开展药物重整工作并进行资料汇总分析。结果 共收集了252例患者的院外最可能收集的用药清单，共发现108个非故意用药差异（干预率42.85%），对发现药物问题的患者进行Logistic因素分析发现老年、冠心病患者适宜开展药物重整，Ⅰ型干预中药物遗漏（40.00%）和用法用量差异（36.00%）比例较大，Ⅱ型干预主要集中在用法用量调整（31.00%）和依从性问题（21.00%）方面；Ⅰ型干预接受度为90.00%，Ⅱ型干预接受度为79.31%。结论 在老年及冠心病患者中适宜开展药物重整工作，建议通过信息化辅助和分级药学服务推动药物重整的广泛开展。
OBJECTIVE To analyze the medication reconciliation carried out in patients with chronic diseases,to explore target population and graded services.METHODS From March 2021 to September 2021,the best possible medication histories(BPMH) for patients diagnosed with hypertension,diabetes,and coronary heart disease in a ward of Henan International Medical Center were collected by pharmacists,and the medication reconciliation and conducted data analysis were carried out.RESULTS A total of 252 patients' BPMHs were collected,and 108 unintentional discrepancies were found(42.85%).Logistic factor analysis of patients with medication problems found that elderly and patients with coronary heart disease were suitable for medication reconciliation.The proportion of drug omissions(40.00%) and differences in usage and dosage(36.00%) in type-Ⅰ interventions was relatively large.TypeⅡinterventions mainly focused on usage and dosage adjustments(31.00%) and compliance issues(21.00%).The acceptance rate of type Ⅰ intervention was 90.00%,and the acceptance rate of type Ⅱ intervention was 79.31%.CONCLUSION It is appropriate to carry out medication reconciliation in the elderly and patients with coronary heart disease.Information-based assistance and graded pharmacy services are recommended to promote the extensive implementation of medication reconciliation.

关键词(KeyWords)： 药物差错;药物重整;临床药师;药学服务
medication errors;medication reconciliation;clinical pharmacist;pharmaceutical care

Abstract:

Keywords:

基金项目(Foundation): 中国药学会全国医药信息网2021年科普研究项目[CMEI2021KPYJ(JZYY)00217]

作者(Authors): 柴东燕;劳海燕;赵成龙;段红艳;冯静;马培志;
CHAI Dongyan;LAO Haiyan;ZHAO Chenglong;DUAN Hongyan;FENG Jing;MA Peizhi;Department of Pharmacy,Henan Provinical People's Hospital;International Medical Center of Henan Province;Department of Pharmacy,Guangdong Provincial People's Hospital;Department of General Practice,Henan Provincial People's Hospital;

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