| Objective To study the effect of pharmacist intervention on the pain of cancer pain patients in outpatient department,evaluate the role of pharmacist in cancer pain treatment team,and provide the basis for finding the cut-in point of pharmacist’s work and exploring the new mode of pharmacist’s work in the future.Methods According to the random number table method,100 patients with cancer pain,48 males and 52 females,were divided into trial group(N=50 case)and the control group(N=50 case).Both groups completed their first survey and assessment before pharmacological intervention,including filling out a general situation questionnaire and a brief pain assessment scale(BPI)as baseline data.The control group received routine medical advice,dispensing pharmacists the basic medication advice,pharmacists do not carry out drug education and the whole process of follow-up intervention in the control group.Patients in the trial group received pharmacists who provided whole-course pharmacological interventions in addition to routine medical advice.The full range of interventions includes:I.Cancer pain awareness assessment and medication mission:For the first time,when establishing a special history of cancer pain in outpatient clinics,the pharmacist provided Cognitive assessment of cancer pain and attention to drug use a missionary pamphlet.One time not less than 20 minutes face to face cancer pain medication evaluation education.II.The telephone intervention:The pharmacist followed up the patients in the treatment group by telephone for more than 10 minutes once a week.III.Every 15th the outpatient visit intervention.IV.Three home visits to intervene.V.Establish bidirectional communication platform between pharmacist and patient.After 8 weeks of intervention,the two groups were evaluated for the second time,including brief pain assessment scale and PS score.Within 8 weeks,the total oral morphine consumption,the total oral morphine consumption and the opioid related adverse reactions were collected in both groups.Results ①Before intervention,the general situation and clinical data of the control group and the treatment group were analyzed by chi-square test.The results showed that gender(X2=0.160,P=0.689),tumor type(X2=0.160,P=0.689),age group(X2=0.184,P=0.668),Marriage(x2=0.344,P=0.558),level of education(X2=0.0519,P =0.975),PS score(X2=0.087,P=0.957).There was no difference in the distribution between the two groups and there was no statistical significance.The general and clinical data between the two groups were consistent and the baseline was comparable.②Afterintervention,the results of covariance analysis of the two groups showed that the most severe pain score and the average pain score were significantly different between the two groups(P<0.05).The most severe pain score in the treatment group,the average pain score improved more significantly.③After intervention,the results of covariance analysis of the two groups showed that,there was no difference between the treatment group and the control group in comparing the effects of pain on walking ability,normal work,relationship of others,and interest in life(P>0.05).The effects of pain on daily life,mood and sleep were significantly different between the two groups in the second survey(P<0.05).The effect of pain on daily life,mood and sleep in the treatment group was better than that in the control group.④After intervention,,the PS scores of the two groups in the second survey were compared by Mann-Whitney statistical method.The PS score of the treatment group was better than that of the control group,and there was statistical difference between the two groups(P=0.017).The improvement of PS score in the treatment group was better than the control group.⑤The adverse reactions in the two groups were compared and found that nausea and vomiting were(X2=0.437,P=0.509),dizziness(X2=0.154,P =0.695),delirium(X2=0.344,P =0.558),lethargy(X2=0.102,P=0.749)were not significantly different between the two groups(P>0.05),whereas constipation(x2=6.895,P =0.009)and urinary retention(x2=5.741,P =0.017).There were differences in the distribution between the treatment group and the control group,and the incidence of constipation and urinary retention in the treatment group was significantly lower than that in the control group.⑥The consumption of long-term opioid equivalent oral morphine and immediate release oral morphine were compared between the two groups.It was found that the effective oral morphine consumption of the treatment group was significantly higher than that of the control group(2643.2 ±2512.15 VS 1159.2 ± 801.52,P<0.001).There was no difference in total oral morphine consumption between the two groups(9.60 ±23.980 VS 3 ± 12.49,P=0.104).Conclusion Pharmacist holistic intervention can significantly improve the most serious pain score,the average pain score,improve the impact of pain on daily life,mood,sleep and other aspects of the impact and improve the PS score of patients with cancer pain.It can significantly reduce the incidence of adverse reactions of constipation and urinary retention,increase compliance of patients,and increase the equivalent oral morphine consumption of long-acting opiates,but the consumption of immediate release oral morphine is not significantly improved.The pharmacist’s whole process intervention initially realized the practical purpose of improving the analgesic effect and ensuring the safety of drug use.It proved that pharmacists could play an important role in the standardized treatment of cancer pain and to a certain extent improve the overall quality of life of cancer pain patients. |
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