Study On Community Comprehensive Intervention Of Mild Cognitive Impairment Based On Medication Therapy Management

Objective: Dementia is one of the diseases with the highest prevalence among the elderly.As the aging of the population intensifies,dementia has brought a heavy burden to the family and society.Due to the irreversibility of dementia and there is no effective cure,a large number of guidelines recommend the early prevention of dementia.Mild cognitive impairment(MCI)is a disease between normal aging and dementia,and it is also the key to secondary prevention of dementia.The incidence of dementia in elderly MCI patients is significantly higher than that of ordinary people.Therefore,the early intervention of elderly MCI has become a research hotspot of related scholars at home and abroad.At present,there are a large number of literatures on MCI intervention methods,but most of them only focus on non-drug interventions,there are few studies on the combination of evidence-based research and empirical research.Therefore,this study established an MCI community comprehensive intervention path based on literature research and Delphi expert correspondence,and carried out clinical verification.Based on previous studies,this study included Medication Therapy Management(MTM),laying the foundation for the development of a more comprehensive MCI standardized management path in the future.Methods: First,this study searched and screened the relevant literature of MCI intervention research at home and abroad,and used the Cochrane tools to evaluate the risk of bias.The initial indicators of the MCI intervention path were extracted through literature analysis.Then,a questionnaire was prepared and distributed to the experts according to the initial indicators,and the indicators of the MCI community intervention path were formed by the integrated analysis of the results of expert feedback.Finally,the MCI intervention operation manual was generated based on the path entry,and the patients were randomly divided into two groups.The intervention group was given MCI intervention management based on health education in the control group.A follow-up evaluation was conducted in 0 and 3 months,and data analysis was completed.The chi-square test was used for qualitative data,and the t-test or rank-sum test was used for quantitative data.Results:(1)Thirty studies were included in the literature study,with a total of2708 MCI cases,of which the sample size was at least 20 cases and at most 555 cases.Quality analysis showed that most studies were low-risk biased.(2)This study evaluated the reliability of expert consultation from several aspects: expert positivity,expert opinion concentration,expert opinion coordination,and expert authority,all of which obtained high values,indicating that the result of the inquiry is reliable.Finally,an MCI community management path consisting of 80 entries was formed.(3)Twenty-one MCI patients in 3 community hospitals were included in the empirical study.The difference in general information between the two groups was not statistically significant.Independent sample t-test or rank-sum test showed that the differences in the scores of the Mini-Mental State Examination(MMSE)and the number of drug treatment problems between the two groups after the intervention were statistically significant(P<0.05).There was no statistically significant difference in the scores of the Montreal Cognitive Assessment(MOCA)Scale,Function Activity Questionnaire(FAQ)and Patient Health Questionnaire-2(PHQ-2)between the two groups.A paired-sample t-test or rank-sum test showed that the scores of MMSE,MOCA,and Morskyy Medication Compliance Scale(MMAS-8)in the experimental group before and after the intervention were statistically significant(P<0.05),and there was no statistical difference in the FAQ and PHQ-2 scores.After the intervention,the chronic disease treatment goal achievement rate of the intervention group increased significantly.Conclusion: This study combined evidence-based and empirical research,created a new MTM-based comprehensive community intervention path for MCI,and applied it to the management of elderly MCI patients in the community,effectively promoting cognitive function,treatment compliance and effectiveness of elderly MCI patients.However,the effect of the intervention on social independence and depression needs long-term follow-up observation.Compared with the previous MCI intervention strategy,the intervention path of this study is more comprehensive and systematic,which will help improve the level of diagnosis and treatment of cognitive impairment and expand the knowledge system in this field.