药学干预对心肌梗死出院患者用药依从性及预后的影响

doi:10.3969/j.issn.1004-583X.2021.01.004

摘要/Abstract

摘要：

目的探讨在急性心肌梗死(AMI)出院患者中开展药学服务干预的效果。方法选取我院心血管内科就诊的AMI出院患者140例,随机分为两组各70例,对照组仅给予常规医嘱,观察组在此基础上,由临床药师提供专业的药学干预。两组均随访12个月,比较Morisky用药依从性问卷(MMAS-8)评分、药物漏服率及预后情况。结果药学干预对用药依从性的影响差异有统计学意义(P<0.01);时间因素对用药依从性的影响差异有统计学意义(P<0.01);组别与时间的交互作用差异有统计学意义(P<0.01);干预3个月、6个月、12个月观察组漏服率低于对照组(均P<0.01);随访12个月,观察组AMI复发率(7.14%)、复住院率(8.57%)低于对照组(18.57%,21.43)(P<0.05)。结论在AMI出院患者中开展药学服务干预能够提高患者用药依从性,降低疾病复发率,改善患者临床预后。

关键词: 药学服务, 心肌梗死, 预后, 服药依从性

Abstract:

Objective To explore the effects of pharmaceutical services and interventions in discharged patients with acute myocardial infarction(AMI). Methods A total of 140 discharged patients with AMI treated in Cardiovascular Medicine Department of the Hospital were selected and randomly divided into two groups (70 cases in each group), routine medical advices were implemented for patients in the control group, professional pharmaceutical interventions were implemented for patients in the observation group on the basis of such advices implemented for patients in the control group. The patients in both groups were followed up for 12 months, score of Morisky Medication Adherence Scale 8-item version(MMAS-8), incidence rate of missed dosing and prognosis of patients in two groups were compared. Results The difference in the effect of pharmaceutical intervention on medication adherence was statistically significant (P<0.01);The difference in the effect of the time on medication adherence was statistically significant (P<0.01);The interaction was statistically significant between groups and time (P<0.01), the missed dosing of patients in the observation group in the 3 months, 6 months and 12 months after interventions were lower than those of patients in the control group(all P<0.01). AMI recurrence rate (7.14%) and rehospitalization rate (8.57%) of patients in the observation group after 12-month follow-up period were lower those of patients in the control group (18.57%, 21.43)(P<0.05). Conclusion The pharmaceutical interventions implemented on discharged patients with AMI can improve the medication adherence of patients, reduce the rate of disease recurrence, and improve the prognosis of patients.

Key words: pharmaceutical service, myocardial infarction, prognosis, medication adherence

中图分类号:

苏江波, 杨丽霞, 刘君奇. 药学干预对心肌梗死出院患者用药依从性及预后的影响[J]. 临床荟萃, 2021, 36(1): 21-24.

Su Jiangbo, Yang Lixia, Liu Junqi. Effects of pharmaceutical intervention on medication adherence and prognosis of discharged patients with myocardial infarction[J]. Clinical Focus, 2021, 36(1): 21-24.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.01.004

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I1/21

图/表 4

参考文献 22

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组别	例数	性别[例(%)]				年龄(岁)		病程(月)		BMI(kg/m²)		基础疾病[例(%)]
组别	例数	男		女		年龄(岁)		病程(月)		BMI(kg/m²)		高血压		糖尿病
观察组	70	31(44.29)		39(55.71)		63.28±5.24		2.17±0.58		23.58±1.17		31(44.29)		17(24.29)
对照组	70	34(48.57)		36(51.43)		64.13±6.67		2.04±0.65		23.24±1.36		28(40.00)		19(27.14)
t/χ²值		0.258				0.838		1.248		1.586		0.264		0.150
P值		0.611				0.403		0.214		0.115		0.608		0.699
组别	例数	文化程度[例(%)]			居住状况[例(%)]				医疗付费[例(%)]				口服药物种类[例(%)]
组别	例数	高中及以下	大专及以上		独居		非独居		医保		自费		1~3种		≥4种
观察组	70	58(82.86)	12(17.14)		5(7.14)		65(92.86)		64(91.43)		6(8.57)		41(58.57)		29(41.43)
对照组	70	56(80.00)	14(20.00)		4(5.71)		66(94.29)		67(95.71)		3(4.29)		45(64.29)		25(35.71)
t/χ²值		0.189			0.119				1.069				0.482
P值		0.664			0.730				0.301				0.487

组别	例数	性别[例(%)]				年龄(岁)		病程(月)		BMI(kg/m²)		基础疾病[例(%)]
组别	例数	男		女		年龄(岁)		病程(月)		BMI(kg/m²)		高血压		糖尿病
观察组	70	31(44.29)		39(55.71)		63.28±5.24		2.17±0.58		23.58±1.17		31(44.29)		17(24.29)
对照组	70	34(48.57)		36(51.43)		64.13±6.67		2.04±0.65		23.24±1.36		28(40.00)		19(27.14)
t/χ²值		0.258				0.838		1.248		1.586		0.264		0.150
P值		0.611				0.403		0.214		0.115		0.608		0.699
组别	例数	文化程度[例(%)]			居住状况[例(%)]				医疗付费[例(%)]				口服药物种类[例(%)]
组别	例数	高中及以下	大专及以上		独居		非独居		医保		自费		1~3种		≥4种
观察组	70	58(82.86)	12(17.14)		5(7.14)		65(92.86)		64(91.43)		6(8.57)		41(58.57)		29(41.43)
对照组	70	56(80.00)	14(20.00)		4(5.71)		66(94.29)		67(95.71)		3(4.29)		45(64.29)		25(35.71)
t/χ²值		0.189			0.119				1.069				0.482
P值		0.664			0.730				0.301				0.487

组别	例数	干预1个月	干预3个月	干预6个月	干预12个月
观察组	70	6.74±0.37	7.37±0.54	7.46±0.52	7.75±0.23
对照组	70	6.89±0.33	6.41±0.61	6.07±0.58	4.92±0.75
组间		F=15.362 P<0.01
时点间		F=14.368 P<0.01
组间·时点间		F=17.783 P<0.01

组别	例数	干预1个月	干预3个月	干预6个月	干预12个月
观察组	70	6.74±0.37	7.37±0.54	7.46±0.52	7.75±0.23
对照组	70	6.89±0.33	6.41±0.61	6.07±0.58	4.92±0.75
组间		F=15.362 P<0.01
时点间		F=14.368 P<0.01
组间·时点间		F=17.783 P<0.01

组别	例数	干预1个月	干预3个月	干预6个月	干预12个月
观察组	70	53(75.71)	44(62.86)	36(51.43)	29(41.43)
对照组	70	55(78.57)	59(84.29)	61(87.14)	63(90.00)
χ²值		0.162	8.266	20.978	36.649
P值		0.687	0.004	<0.001	<0.001