Page 109 - 《中国药房》2022年17期

·药师与药学服务·

以药师为主导的全程化用药管理模式在风湿免疫性疾病中的实

践研究 Δ

1 #
刘剑敏 ，林奕凯 ，黄鹤归 ，黄 烨 ，范秋玉 ，杨惠琴 ，张韶辉 （1.武汉市第一医院药学部，武汉 430022；
1＊
1
1，2
1
3
3
2.湖北科技学院药学院，湖北 咸宁 437100；3.武汉市第一医院风湿免疫科，武汉 430022）
中图分类号 R95；R593 文献标志码 A 文章编号 1001-0408（2022）17-2147-05
DOI 10.6039/j.issn.1001-0408.2022.17.20
摘 要 目的 评价以药师为主导的全程化用药管理模式在风湿免疫性疾病中的应用效果。方法 选择2018－2020年在武汉市第
一医院风湿免疫科使用他克莫司或环孢素治疗的122例风湿免疫性疾病患者为研究对象。其中，对照组44例，采用传统监管模
式；观察组78例，采用以药师为主导的全程化用药管理模式，即由个体化药师和专科临床药师协同与主导，不仅参与药物治疗全
过程，还参与治疗药物监测（TDM）全过程，在对照组基础上强化了医药护三方分工协作，并从住院延伸到出院对门诊和住院患者
实施同质化监管。比较两组患者的用药日剂量、血药浓度达标率、问题标本（标本以例次计）发生率、平均住院日、出院6个月再入
院率、用药依从性评分、患者满意率。结果 对照组患者实施TDM 53例次，其中他克莫司监测18例次、环孢素监测35例次；观察组
患者实施TDM 123例次，其中他克莫司监测55例次、环孢素监测68例次。观察组患者他克莫司日剂量、环孢素日剂量、环孢素血
药浓度达标率、问题标本发生率、出院 6 个月再入院率、用药依从性评分、患者满意率均显著优于对照组（P＜0.05）。结论 以药
师为主导对风湿免疫性疾病患者实施全程化、同质化用药管理并提供精准用药指导，可以有效提高药物治疗效果，提升药学服务
质量。
关键词 个体化药师；风湿免疫性疾病；全程化用药管理；专科临床药师；药学服务

Practice and research on the whole course medication management mode led by pharmacists in rheumatic
immune diseases
LIU Jianmin ，LIN Yikai ，HUANG Hegui ，HUANG Ye 1，2 ，FAN Qiuyu ，YANG Huiqin ，ZHANG Shaohui 1
3
1
3
1
1
（1. Dept. of Pharmacy，Wuhan No.1 Hospital，Wuhan 430022， China； 2. School of Pharmacy， Hubei
University of Science and Technology， Hubei Xianning 437100， China； 3. Dept. of Rheumatology and
Immunology，Wuhan No.1 Hospital，Wuhan 430022，China）
ABSTRACT OBJECTIVE To evaluate the application effect of the whole course medication management mode led by
pharmacists in rheumatic immune diseases. METHODS A total of 122 patients treated with tacrolimus or cyclosporine in the
department of rheumatology and immunology of Wuhan No.1 Hospital from 2018 to 2020 were selected as the study subjects.
Among them，44 cases in the control group were under the traditional supervision mode；78 patients in the observation group
adopted the whole course medication management mode led by pharmacists，that was，individual pharmacists and specialist clinical
pharmacists cooperated and led，and not only participated in the whole process of drug treatment but also involved in the whole
process of therapeutic drug monitoring（TDM）. On the basis of the control group，the division of labor and cooperation among
medical， pharmaceutical and nursing parties were strengthened， and the homogeneous supervision was carried out for the
outpatients and inpatients from admission to discharge. The daily dose of medication，the rate of reaching the standard of blood
drug concentration，the incidence of problematic samples （the sample was calculated by the number of times），the average
hospitalization days，the re-admission rate within 6 months after discharge，the medication compliance score and the patient’s
satisfaction rate were compared between the two groups. RESULTS In the control group，53 times of TDM were performed，
including 18 times of tacrolimus monitoring and 35 times of
Δ 基金项目 国家中医药管理局“十二五”中医药重点学科建设项
cyclosporine monitoring；in the observation group，123 times
目（No.FM20123072）；湖北省“十三五”临床药学重点专科项目（No.鄂
of TDM were performed，including 55 times of tacrolimus
卫办通〔2019〕125号序号80）；中国药学会科技开发中心精准用药科技 monitoring and 68 times of cyclosporine monitoring. The daily
传播促进行动项目[No.CMEI2020KPYJ（JZYY）00301]
dose of tacrolimus，the daily dose of cyclosporine，the rate of
＊第一作者 副主任药师，博士。研究方向：医院药学、治疗药物监
测与药物基因检测。电话：027-85332034。E-mail：81683985@qq.com reaching the standard of cyclosporine blood drug
# 通信作者 副主任药师，博士。研究方向：临床药学、治疗药物监 concentration，the incidence of problematic samples，the rate
测。电话：027-85332276。E-mail：53685340@qq.com of re-admission within 6 months after discharge， the

中国药房 2022年第33卷第17期 China Pharmacy 2022 Vol. 33 No. 17 ·2147 ·