Carry Out Home Pharmaceutical Care For Retired Elderly Patients Based On Clinical Pharmacy And Evidence-based Basis

Objectives: Using the clinical pharmaceutical knowledge and evidence-based medicine method to carry out home pharmaceutical care for retired officials.Exploring and establishing the pattern of home pharmaceutical service guardianship.Discussing the influence on therapeutic effect of pharmaceutical guardianship,and evaluating the role that clinical pharmacists play in pharmaceutical guardianship service and the home pharmaceutical care pattern in the elderly population and multiple chronic diseases.Methods: From August 2020 to February 2022,68 elderly patients with chronic diseases who had resigned or are retired officials guaranteed by a tertiary-grade A class hospital in Kunming were selected as the objects of guardianship.Based on the individualized situation of patients and the all-around needs of monitoring,three pharmacy monitoring service models are established respectively to promote the development of home pharmaceutical care.This includes: establishing a pharmaceutical care service model based on clinical pharmacy.Based on clinical pharmacy to implement the key and difficult case analysis intervention mode.The evidence evaluation model of therapeutic drug analysis is based on evidence-based methods.All patients were recorded in pharmacological monitoring established medication management file.Statistical analysis was performed to compare the data before and after monitoring,including patients’ Barthel index,medication knowledge,medication-related problems,Morisky questionnaire,statistics on the number of medication varieties,whether they were readmitted,the number of readmissions,the duration of readmission treatment,hospitalization costs,relevant pharmacoeconomic evaluations,disease conversion assessments,patient awareness,and satisfaction surveys,and many other evaluation indicators,thus to comprehensively and quantitatively assess the role played by home pharmaceutical care monitoring services in medical treatment.Results:（1）Model effect assessment: In the process of individual monitoring,pharmacists adjust the medication of patients,provide effective medication consultation,ensure the medication safety of patients,make the improvement of treatment compliance,and treatment efficacy,and effectively control the chronic diseases.The whole follow-up process of key and difficult cases can effectively improve the treatment effect of patients during hospitalization（an example---a typical patient with multiple diagnosed diseases and complex medications）.In the process of medication consultation for patients,the combination of evidence-based medicine and network pharmacology research techniques provides evidence to support the analysis of treatment regimens that are questionable or require scientific evidence during the monitoring process（Two examples of typical cases where evidence-based medicine and network pharmacology approaches were used to demonstrate the feasibility of treatment options）.（2）Quantitative analysis results of home pharmaceutical care:（1）Comparison of the number of drug-related problems: Drug-related problems（2.63±1.86）patients/time before intervention and after the intervention（2.07±1.53）patients/time indicating acceptance of the recommendations.The average number of drug-related problems after intervention（1.12±1.55）times was significantly lower than that before the intervention（5.26±5.18）times（P<0.05）.（2）Comparison of medication compliance score: The Morisky score after the intervention was significantly higher than that before intervention（P<0.05）in the groups of 8-9 months,13-14 months,and 16-18 months,and there was no statistical difference in the other groups.（3）Comparison of drug varieties: The number of long-term use of varieties after monitoring was significantly lower than the number of long-term use of varieties before monitoring（P<0.05）in the groups of 8-months,10-11 months,and 13-18 months,and there was no statistical difference in the other groups.（4）Comparison of hospital admissions: The number of hospital admission after monitoring was significantly lower than that before monitoring（P<0.05）in the groups of 16-18 months,and there was no statistical difference in the other groups.（5）Comparison of the length of stay in hospital: The length of hospital admission after monitoring was significantly lower than that before monitoring（P<0.05）in the groups of 16-18 months,and there was no statistical difference in the other groups.（6）Comparison of hospitalization costs: The hospitalization cost during the monitoring was significantly lower than that before the monitoring in the 11-month and 16-18 month groups（P<0.05）,and there was no statistical difference in the other groups.The total cost of hospitalization after monitoring was reduced by RMB 1,886,808.32 yuan compared with that before monitoring,and the average hospitalization cost decreased by RMB 30931.28 yuan.（7）Comparison of disease control: After the pharmaceutical care service,most of the patients showed improvement in disease control.（8）Awareness and satisfaction survey: According to the Survey on patient’s cognition degree and satisfaction,the recognition degree before the service work was low（31.15%）,but after service,the recognition degree was greatly improved（100%）,and the satisfaction rate was 100%.Conclusions: Home pharmaceutical care improves the therapeutic effect efficiently,stabilizes the therapeutic effect,reduces the occurrence of drug-induced adverse reactions or drug-injury events,delays the development of chronic diseases,reduces the risk of patient readmission and the risk of critical illness and the medical expenses caused by the patient’s readmission,as well as save the medical resources and medical costs of the national.Follow-up of key and difficult cases over the whole process can effectively improve the therapeutic efficacy of patients during hospitalization.Through the joint application of evidence-based medicine and network pharmacology research technology,home pharmaceutical care has been able to solve many clinical drug treatment problems and has played an effective value in pharmacological monitoring by conducting argumentative evaluation and research on treatment regimens that are controversial to patients or require scientific evidence.