Study On The Model Of Serious Illness Medical Insurance Pharmacy Service Based On The Pharmacy Service Of NSCLC Patients

Objective:This study hopes to use the experience of foreign drug therapy management service models to practice the "patient-centered" service concept and establish a new drug therapy management service model.Include patients with non-small cell lung cancer using EGFR-TKI,ALK-TKI,multi-target tyrosine kinase inhibitors and other drugs.Pharmacists provide drug treatment management services,optimize the rational use of drugs,and achieve control of medical insurance costs.During the follow-up process,the pharmacist found that patients using EGFR-TKI,ALK-TKI and other drugs had adverse reactions not listed in the instructions.Therefore,this study used data mining methods to conduct adverse drug reaction signal mining on the US FDA database.The obtained ADR signal is compared with the ADR in the instructions and the ADR found in the follow-up,and new ADR risk signals of the targeted drug are discovered,the potential ADR of the targeted drug is explored,and the safety of the targeted drug in clinical medication is improved.Methods:The pharmacist will participate in the review of medical insurance reimbursement as a partner,establish a drug treatment management service model for non-small cell lung cancer patients participating in medical insurance,and discuss the impact of drug treatment management services on medical insurance cost control and patient benefits.During follow-up,the pharmacist found adverse drug reactions that were not mentioned in the new instructions.Through data mining of the FDA database,he discovered new adverse reaction risk signals for targeted drugs for non-small cell lung cancer.In the follow-up of the patient’s drug treatment management services In combination with the discovered adverse reactions not mentioned in the instructions,new potential adverse reactions of targeted drugs have been discovered.The SPSS20.0 software was used for statistical analysis,and the statistical method used the non-parametric Krükal-Worris test method.Results:This study used non-small cell lung cancer as an example to establish a drug treatment management service model for lung cancer patients participating in major disease medical insurance.A total of 248 patients with advanced non-small cell lung cancer were enrolled.At the end of the study,168 patients had stable disease,6 The disease was partially resolved in one patient,medication was discontinued in 32 patients,and 26 patients died.The disease control rate was 70.16%.At the end of the first consultation,305 drug treatment problems were found,with an average of 1.23 per person,of which 49.84% were drug safety problems,followed by 34.10% of patient compliance problems.At the end of the period,patients had 48 medical treatment problems,with an average of 0.25 medical treatment problems per patient.The patient’s medical treatment problems were significantly reduced;after one year of research,the total score of the patient’s quality of life was also calculated one year ago and one year later.Scientific differences [80(72,92),112(93,122)],the number of patients with low compliance decreased by 39.47%;after a one-year pharmacist review of the data of patients applying for medical insurance for major illnesses,and MMS savings for 248 patients The cost was 2.0755.6 million yuan.During the follow-up,the pharmacist found that gefitinib and other drugs had multiple adverse drug reactions that were not mentioned in the instructions.Therefore,through the adverse reaction signal mining of the US FDA database,to observe whether there may be new adverse drug reactions of the targeted drugs.Finally,79 gefitinib ADR signals,182 afatinib ADR signals,276 erlotinib ADR signals,160 osimertinib ADR signals,157 crizotinib ADR signals,71 ADR signals were obtained.Letinib ADR signal,75 Seritinib ADR signal.Comparing the obtained ADR signal with the ADR in the manual and the ADR that appeared during the follow-up,it was found that there were 22 ADRs that were not mentioned in the manual but the data mining results showed positive signals and there were ADRs that appeared in the patients during the follow-up.For example,gefitinib may have 3 new ADRs for cold sores,pleural effusion,and ocular secretions,2 ADR risk signals for hyperpigmentation,cancer pain,and 7 ADR risk signals for the nervous system such as cerebral infarction.Alpha Tinib has three ADR risk signals for skin sensitization,cancer pain,and pain;osimertinib has three ADR risk signals for liver damage,vocal cord paralysis,and dry nasal cavity;crizotinib has vocal cord paralysis and two ADR risk signals for vocal cord disease.Risk signals,aletinib has ADR risk signals for two vascular diseases,thrombosis and pulmonary embolism.Conclusion:By providing medication management services to patients,patients’ medication problems are significantly reduced,and their quality of life and compliance are significantly improved,which reflects the clinical value of pharmacists providing medication management services.Through one year of drug treatment management services and outpatient review,the cost was saved by 2.0755.6 million yuan,which reflects that pharmacists have played an important role in participating in medical insurance control fees and promoting the rational use of medical resources.In addition,during follow-up and adverse reaction signal mining,potential adverse reaction risk signals of multiple drugs were found,prompting doctors and pharmacists to closely monitor ADR during clinical drug treatment,especially some potential ADRs.