Training,Improvement And Evaluation Of Chronic Disease Medication Therapy Management Ability Of Community Pharmacists In The Medical Consortium

In 2009,the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Health System" was issued,marking the official opening of the new medical reform.The opinions proposed to optimize the domestic medical allocation through medical and health reform,solve the problem of difficult and expensive medical treatment for the general public,and point out the direction for promoting the construction and development of graded diagnosis and treatment in various regions.Both Europe and the United States have implemented a hierarchical diagnosis and treatment system.About 90%of patients’ first medical treatment occurs at the level of primary health care.Community pharmacists have played an important role in chronic disease management.Hospital pharmacists,community pharmacists and community physicians work closely to integrate medical resources,so that more patients have access to chronic care management(CCM)and reduce national medical costs.After several years of practice both domestically and internationally,the medical consortium,as a hierarchical diagnosis and treatment model,stands out among numerous hierarchical diagnosis and treatment models and has become the main mode for cities to carry out hierarchical diagnosis and treatment construction.This study relies on the hierarchical diagnosis and treatment service platform of Peking Union Medical College Hospital medical consortium,and the pharmacists at all levels of the medical consortium(including the pharmacists in the second and third level hospitals and community pharmacists)cooperate to carry out standardized drug treatment management(MTM)for patients with chronic diseases of type 2 diabetes,The aim is to explore and evaluate the role of medical consortium pharmacists in the management of chronic diseases and the promotion of graded diagnosis and treatment,and to evaluate the effectiveness of pharmacists’ participation in improving the management ability of community chronic disease drug treatment in the medical consortium.This topic first outlines the research background and significance of medical consortia grading diagnosis and treatment through policy review and literature research.At the same time,it briefly describes the current medical resources in Beijing and the construction of medical consortia at Beijing Union Medical College Hospital,as well as the current implementation status of medical consortia abroad.Then,taking type 2 diabetes as an example,it introduces the positive value of the graded diagnosis and treatment of the medical union in the management of chronic diseases such as diabetes.In the second part of the paper,the research on the management model of chronic disease medication involving pharmacists under the medical consortium of Peking Union Medical College Hospital was described.On the basis of the medical consortium of Peking Union Medical College Hospital,pharmacists in the pharmacy tried to establish a standardized drug treatment management(MTM)process for patients with type 2 diabetes.The trained and assessed hospital pharmacists trained the basic level pharmacists in the Medical Association on the knowledge and skills of type 2 diabetes disease,medication and patient communication,and developed a standardized diabetes MTM process.Medical consortium pharmacists standardize the management of included patients according to the system,and regularly follow up and record patient related information.In the third part of the paper,821 diabetic patients in the medical union of Peking Union Medical College Hospital and Hepingli Health Service Center were investigated on the use of hypoglycemic drugs with type 2 diabetes as the research object.The results showed that among 821 patients with type 2 diabetes,the first three hypoglycemic drugs were biguanides(65.4%)α-Glucosidase inhibitors(44.3%),insulin based preparations(27.6%);The dual hypoglycemic drug regimen is currently the most common medication regimen,which includes biguanides+ α-Glucosidase inhibitors(23.3%),biguanides+sulfonylureas(11.1%),biguanides+sodium glucose transporter 2 inhibitors(8.7%),and α-Glucosidase inhibitors+insulin(8.7%),etc;The most commonly used single drug treatment regimens are biguanides,accounting for 47.2%;At present,there are a variety of hypoglycemic drugs available.In this survey,there are a total of 10 categories and 36 types of hypoglycemic drugs used by patients.Among them,the top three oral hypoglycemic drugs with the highest frequency of use are metformin(65%),acarbose(35.6%),and daggliflozin(17.1%).The above results show that type 2 diabetes patients currently have the problem of repeated drug use and some combination drugs will lead to high risk of hypoglycemia.It is suggested that community pharmacists should cooperate with community doctors,hospital pharmacists and specialists to carry out targeted professional drug management services for diabetes patients to improve the treatment effect of diabetes patients.The fourth part of the paper investigated the situation of blood glucose control,medication,pharmaceutical service demand and medication compliance of type 2 diabetes patients in the community who were not involved in the management of medical union pharmacists.The results showed that patients without standardized MTM management by medical consortium pharmacists had a lower rate of meeting blood glucose indicators;The survey found that 95.5%of patients reported that they had not received pharmaceutical services provided by hospital pharmacists.A doctor in the community health service center managed about 300 diabetes patients and their families.Community pharmacists only gave medication tips to patients at the window when they dispensed drugs.They lacked long-term awareness of pharmaceutical management and service time for patients.However,patients with type 2 diabetes had the willingness to learn about diabetes independently.At present,most of them use the Internet Television programs,offline lectures,and other methods are used to understand medication knowledge,and there are relatively few patients who regularly self test their blood sugar.Therefore,there is a strong demand for high-quality pharmaceutical services in the community.Community pharmacists should be encouraged to actively participate in the community chronic disease management team,enhance communication with patients,and vigorously promote pharmaceutical services and the important role of pharmacists.The compliance survey results showed that only 13.0%of patients had good medication compliance,with most patients having moderate compliance and many patients having poor compliance.After statistical analysis,it was found that although patients with more types of medication did not significantly affect their overall score of medication compliance,patients with more types of medication were more likely to forget to take medication and had significant differences.It is recommended that pharmacists pay attention to patients with multiple medications and carry out comprehensive management.The fifth part of the paper evaluates the management ability of the medical consortium pharmacists by studying the blood glucose indicators,medical sinking indicators,cognitive level,patient satisfaction and other aspects of the standardized MTM service for type 2 diabetes patients 12 months later.The results showed that after 3,6,and 12 months of standardized MTM,the HbAlc,fasting blood glucose,and postprandial blood glucose values of patients were significantly reduced compared to before management(P<0.05);Although the HbAlc compliance rate increased after 3 months of management,there was no statistically significant difference(P=0.328).The HbAlc,fasting blood glucose,and postprandial blood glucose compliance rates after 6 and 12 months of management were significantly higher than before,and the difference was statistically significant(P<0.05).After 12 months of standardized MTM,the proportion of patients who went to tertiary hospitals for medication significantly decreased from 40.7%to 25.3%,with a total decrease of 15.4%;The proportion of patients who went to secondary hospitals for medical treatment was relatively stable,and the rate of patients who went to community health service centers/health stations for medical treatment increased from 11.1%to 20.3%at the highest.At the same time,due to the COVID-19,some patients purchased drugs through Internet diagnosis and treatment or online drug distribution;The average cognitive score of patients with diabetes related knowledge was 4.52 ± 0.66,and the cognitive situation was good;Through subgroup analysis,the proportion of cognitive impairment in older patients is higher than that in younger patients.This indicates that pharmacists should provide multiple,repeated,and detailed medication education for older patients to improve their medication compliance and improve treatment outcomes.In this study,the patient’s satisfaction score with pharmacist services was relatively high,at 4.94±0.23.The sixth part of the collection of papers found through a survey of the allocation of hypoglycemic drugs in 10 core hospitals and cooperative medical institutions within the medical consortium that core hospitals have obvious advantages in the allocation of hypoglycemic drugs,with more comprehensive types and quantities.However,cooperative hospitals have the problem of insufficient types of hypoglycemic drugs,and the differences may be due to uneven distribution of medical resources,differences in specialized needs,drug registration and market access Due to various factors such as differences in economic conditions and drug supply chains.To improve the effectiveness of patient medication,the key is to increase the accessibility of essential drugs in grassroots medical institutions.Therefore,the allocation of hypoglycemic drugs in core hospitals and cooperative hospitals should converge.The key factors to ensure that primary medical institutions can access essential drugs include unified clinical guidelines,information sharing and training guidance,integrated drug supply chains,and personalized treatment plans.To sum up,at present,some patients with type 2 diabetes have irrational drug use and different compliance.The intervention of medical consortium pharmacists in the standardized chronic disease management of type 2 diabetes can improve the blood sugar control level of patients with type 2 diabetes,urge them to use drugs rationally,and effectively guide patients to sink into the community to achieve a hierarchical cooperation mechanism for chronic disease management in the community,It has confirmed the important value of the medical consortium pharmacists in the management of chronic diseases and the implementation of the graded diagnosis and treatment system.They have played a positive role in promoting the implementation of the national graded diagnosis and treatment system as well as disease control and improvement at the individual level of patients.