The Pharmaceutical Care Research In The Clinical Pathway Of Rheumatic Mitral Stenosis With Atrial Fibrillation

Objective:Evaluation of the influence of clinical pathway management combinated with pharmaceutical care path on success rate of anticoagulant treatment, occurring of drug related adverse events, readmission rate and medication adherence in hospitalized and discharged patients with rheumatic heart disease mitral stenosis associated in combination with atrial fibrillation. The study was to provide basis for the establishment of pharmaceutical care path.Methods:(1) Pharmaceutical care path of rheumatic heart disease mitral stenosis associated with atrial fibrillation was established to provide patients with pharmaceutical care and medication guide thoroughly.(2)124patients with rheumatic heart disease mitral stenosis associated with atrial fibrillation were incorporated in management of the "rheumatic mitral stenosis (medical treatment) clinical pathway" from January2012to June2014. All of them were randomly divided into control group (62cases) and pharmaceutical service group (62cases) with the method of random number table. Control group accepted clinical pathway management with the traditional medical care, while pharmaceutical service group accepted clinical pathway management and was provided with pharmaceutical care by clinical pharmacists. Patients received regular outpatient follow-up by clinical pharmacists and physicians.Outcome:Anticoagulant treatment success rate and drug safety during hospitalization. Anticoagulant treatment success rate, medication adherence and readmission rate in1month and3months after discharge.Results:(1) Compared with control group, the International Normalized Ratio (INR) success rate of pharmacy service group patients during hospitalization was higher, but no significant difference (P>0.05). Pharmacy service group patients INR<1.6or INR>3during hospitalization significantly reduced (P<0.01). For patients with below-standard admitted for the first time monitor INR, INR success rate of pharmaceutical service group patients increased significantly (P<0.05) during hospitalization; Bleeding or embolism events in pharmacy service group patients reduced, but no significant difference (P>0.05). Electrolyte disorder rate was significantly lower than the control group (P<0.05). Follow-up after discharge, INR success rate of patients and medication adherence with pharmaceutical services was significantly higher than control group (P<0.05), while readmission rate was significantly lower (P<0.05).(2) Hospital time, total hospitalization expenses, drug expenses and medicine proportion had no obvious difference between two groups (P>0.05).Conclusion:For hospitalized patients with rheumatic mitral stenosis with atrial fibrillation, the implementation of pharmaceutical care path management including standardized pharmaceutical care and pharmacy service, can obviously improve the anticoagulation efficiently, reduce the incidence of adverse events/adverse reaction, improve anticoagulant treatment success rate and medication compliance of patients discharged from hospital,and reduce the rate of readmission.