Page 7 - 2019年9月第30卷第17期

Analysis of Medication Therapy Management at Home and Abroad
LIN Mao 1，2，3 ，CHEN Zhe ，ZENG Linan ，ZHANG Chuan ，FEI Haotian ，HUANG Liang 1，2，3 ，ZHANG Lingli 1，2
1，2
1，2
1，2
1，2
（1.Dept. of Pharmacy/Evidence-based Pharmacy Center， West China Second University Hospital， Sichuan
University，Chengdu 610041，China；2.Key Laboratory of Birth Defects and Related Diseases of Women and
Children， Sichuan University， Ministry of Education， Chengdu 610041， China；3.West China School of
Pharmacy，Sichuan University，Chengdu 610041，China）

ABSTRACT OBJECTIVE：To descriptively analyze the status quo of medication therapy management （MTM） at home and
abroad，and to provide reference for the development of MTM in China. METHODS：Retrieved from PubMed，Embase，Cochrane
Library，CNKI，VIP，Wanfang database，CBM，and simultaneously searched Google and Baidu，retrieve time from the database
establishment to March 2019，Chinese retrieval words：“medication therapy management”，English retrieval words：“Medication
therapy management”“Management”“Medication therapy”“Therapy management”“Medication”“Drug therapy management”，etc.
Domestic and foreign MTM literatures were included. Descriptive analysis was conducted in terms of literature publication，
research type distribution，disease distribution and the status quo of MTM literatures in women and children. The necessity and
feasibility of MTM in the field of women and children were analyzed. RESULTS & CONCLUSIONS：A total of 403 MTM related
literatures（344 foreign，59 domestic）were included. Among them，the foreign MTM literatures had 154 secondary researches and
190 original studies，clinical value，economic value and humanistic value of MTM were studied in repsects of service providers，
service objects，service processes，service effects and other parties. Domestic MTM literatures had 37 secondary researches and 22
original researches，which mainly introduced the US MTM，including implementation background，concept，elements，application
status，etc.；the significance and prospects of MTM in China were analyzed. Domestic and foreign MTM literatures mostly focused
on chronic diseases in the elderly，mainly endocrine and cardiovascular diseases，such as hypertension，diabetes，and kidney
disease. 11 studies about women and children MTM were included（women 5 studies and children 6 studies）；4 of them were
review，5 were cross-sectional studies，and 2 were case reports. The effects of women and children MTM were introduced in the
included literatures from the times of interventions，the number of drug-related problems prevention or improvement，the patient’s
clinical outcomes，etc. MTM studies have great differences between at home and aboard in terms of the number of literatures，
research types and contents. The researches focus on the field of chronic diseases in the elderly，and there is little literature on
MTM in the field of women and children. It is necessary to provide MTM services for women and children in the light of the
Millennium Development Goals proposed by the United Nations and the increasing problem of women and children medication. It is
suggested to use the MTM model to develop women and children chronic disease pharmaceutical service so as to promote the
transformation of pharmacists and improve the quality of pharmaceutical care.
KEYWORDS Medication therapy management；Women；Children；Pharmaceutical care

[4]
药 物 治 疗 管 理（Medication therapy management， MTM 实施 。截至 2018 年，美国医疗保险和医疗补助
MTM）是指具有药学专业技术优势的药师为患者提供 服务中心公布：医疗保险 D 部分（Medicare Part D）已覆
用药教育、咨询指导等一系列的专业化服务，从而提高 盖616个MTM项目，包括506个医疗保险优势处方药计
患者用药依从性、预防患者用药错误，最终培训患者进 划（Medicare advantage prescription drug plans，MA-
行自我用药管理，以提高疗效 [1-2] 。2003年，美国国会《处 PDs）、60 个独立处方药计划（Stand-alone prescription
方药物医疗保险，改进和现代化法案》（The medicare drug plans，PDPs）、50 个医疗保险和医疗补助联合计划
[5]
prescription drug，improvement，and modernization act， （Medicare-medicaid plans，MMPs） 。
MMA）第 423 条 D 项计划要求：医疗保险的提供者必须 经过十余年发展，MTM 模式在立法和操作规范上
[6]
要为其受保者提供MTM服务，以通过改进药物使用，优 基本成熟 ，研究表明 MTM 可显著提高患者依从性，减
[3]
化治疗效果，降低不良事件风险 。美国医疗保险和医 少药物相关问题（Drug related problem，DRP），改善患者
疗补助服务中心（Centers for Medicare & Medicaid Ser- 健康水平，降低医疗卫生经济资源消耗 [6-10] 。目前，国外
vices，CMS）规定必须向所有符合条件的受益人至少提 已就老年慢病的 MTM 服务开展大量研究，但妇儿领域
供以下服务：干预受益人和开处方者、审查年度综合药 研究较少。本文循证评价国内、外MTM研究现状，重点
物（An annual comprehensive medication review，CMR）、 探讨妇儿领域开展 MTM 的必要性和可行性，结合我国
审 查 季 度 目 标 药 物（Quarterly targeted medication re- 妇儿药学服务特别是慢病相关的药学服务模式现状，对
view，TMR）。2010 年，美国总统奥巴马签署《平价医疗 我国妇儿慢病领域药学服务工作提出建议，为提高妇儿
法案》（Affordable care act，ACA），进一步改进和完善 药学服务质量提供参考。

·2306 · China Pharmacy 2019 Vol. 30 No. 17 中国药房 2019年第30卷第17期