Effect Of Pharmaceutical Care Based On Medication Reconciliation On Cardiovascular Chronic Diseases Management

Objective:To investigate the effect of pharmaceutical care based on medication reconciliation on cardiovascular chronic diseases management,and to construct a basic model of medication reconciliation-based pharmaceutical care for the management of chronic cardiovascular diseases.To provide basis and reference for further promoting the application of pharmaceutical care based on medication reconciliation in chronic disease management.Methods:The chronic disease patients who visited the cardiovascular medicine department in certain tertiary hospital,from January to December 2018,were selected and divided randomly into experimental and control groups.The patients in the control group were provided with routine medical diagnosis and treatment services,while the patients in the experimental group were provided with medication reconciliation-based pharmaceutical care by clinical pharmacists on the basis of control group.Medication reconciliation mainly includes:obtainment of the information of drug use before admission in detail and comprehensively firstly,comparison between the list of drug use and the newly issued medical orders at beginning and when the patients’ medical orders changed such as discharge and transfer further,examination of drug use inconsistency and presentation of the medication reconciliation list,Some safety and economic indicators were used to evaluate the impact of medication reconciliation on management of chronic cardiovascular diseases.The safety indicators included:the inconsistence rate of drug use,the readmission rate,the incidence of pharmaceutical adverse events and the medication compliance.The cost of drug use,drug proportion,drug cost per month and cost-benefit ratio were adopted as economic indicators,x 2 test was used in statistical data analysis.Results:221 patients were enrolled and devided into the experimental group(n=109)and the control group(n=112).There were no significant differences in the general clinical data between the two groups(P>0.05).1.The Impact of medication reconciliation on safety of management of chronic cardiovascular diseases:Incidence of inconsistency of drug use at discharge in the experimental group(12.84%)was reduced comparing with that of the control group(27.68%)(P<0.05).,in which the difference was significantly effective.Incidence of adverse events related to drug use during hospitalization and one month after discharge in the experimental group was lower(2.75%,5.50%)than that of the control group(8.04%,17.86%)(P<0.05).The re-hospitalization rate in the experimental group(3.67%)was lower than that of the control group(6.25%)within one month after discharge,but there was no significant difference(P>0.05).The compliance of drug use at discharge,one week after discharge(21.1%in the experimental group,13.39%in the control group)and one month after discharge(19.27%in the experimental group,8.93%in the control group)was significantly improved(P<0.05,P<0.05),in which the difference was significantly effective.2.Impact on economic:In-patient drug expenditure in experimental group(4301.49±2995.92 yuan)was lower than that in the control group(4800.96±1996.52 yuan),but there was no significant difference(P>0.05).Drug proportion in the experimental group(24.91±14.83%)was lower than that in the control group(28.39±16.20%),but there was no significant difference(P>0.05).The drug costs per month at discharge(378.20± 120.50 yuan in the experimental group vs 572.35± 112.95 yuan in the control group)and one month after discharge(394.20± 117.30 yuan in the experimental group vs 608.70± 131.35 yuan in the control group)were significantly reduced in the experimental group comparing to the control group(P<0.05,P<0.05),in which the difference was significantly effective.The benefit-cost ratio of pharmaceutical care in the experimental group was 1.21 and 134(>1),respectively,which was economical.A total of 111 interventions were proposed by clinical pharmacists and 88 interventions among them were adopted by clinicians,with a success rate of 79.28%Conclusions:Pharmaceutical care based on medication reconciliation in the management of chronic cardiovascular diseases can improve the safety of drug use and the long-term compliance of drug use in patients with chronic diseases,and reduce drug use cost in long-term outside the hospital,with significantly cost benifit.This research was based on the feasibility and necessity of medication reconciliation in the management of chronic cardiovascular diseases,which was worth to be promoted.Pharmaceutical care model for chronic cardiovascular disease management was established,which mainly included identification and screening,information acquisition,medication reconciliation,drug education and drug follow-up.