Establishing The Pathway Of Pharmaceutical Care For Patients With Cerebral Infarction And The Study On Its Intervention

Objective:By establishing clinical pathway of pharmaceutical care for patients with cerebral infarction in clinic,clinical pharmacists take on standardized clinical pathway for patients with cerebral infarction.It can provide pharmaceutical care ideas for future clinical pharmacists.The clinical pathway is conducive to improve patients’ medical compliance,increase satisfaction,reduce the incidence of adverse drug reactions and decrease the probability of disease relapse in the process of giving pharmaceutical care for doctors,nurses and patients.Methods:The first step was establishing the methods of clinical pathway.We designed and established the pathway of pharmaceutical care for cerebral infarction patients.After the admission,pharmacists gave the score for patients based on their basic situation and determined their care levels.We divided the care levels into primary,secondary and tertiary care correspondingly.Pharmacists provided different care frequencies in regard to patients of different care levels and determined monitoring contents according to different phases at the same time.Monitoring contents mainly included physical status,drug using methods,medical compliance,adverse drug reactions,drug interactions,lifestyle and pharmaceutical care methods for special patients.Thus we established the pharmaceutical care pathway for patients with cerebral infarction.The second step was the experimental methods of clinical pathway.Cases’ access standards was hospitalized patients with cerebral infarction and we divided them intocontrol groups and experimental groups randomly.Experimental group patients were taken pharmaceutical care according to the approach of clinical pathway,while control group patients were not accepted clinical pharmacists’ medical intervention.First,clinical pharmacists took pharmaceutical care for patients in hospital and examined pharmacists’ intervention effects by indicators of medical compliance,incidence of adverse events,patients’ satisfaction.Afterwards,when patients were out of hospital,clinical pharmacists should give follow-up by telephone and evaluate pharmacists’ intervention effects by indicators of medical compliance outside the hospital,incidence of adverse events,laboratory indicators of self-monitoring and compliance of timely review,medication errors,relapse rates of cerebral infarction.Results:First,clinical pharmacists established the pathway of pharmaceutical care in clinical practice and provided standardized pharmaceutical services for patients with cerebral infarction.Second,clinical pharmacists collected 440 cases information of hospitalized patients with cerebral infarction,and divided them into control group and experimental group randomly.Control group had 220 cases,among them 1 case had ruled out so actually had 219 cases;the experimental group had 220 cases.Pharmacists conducted follow-up after patients discharged,and control group and experimental group had 60 patients participating in follow-up respectively.Effective comparison showed that the differences of patients’ general information of control group and experimental group(gender,age,medical insurance and job),pharmaceutical care groups and patients’ medications were not statistically significant(P>0.05).When the patients with cerebral infarction were in hospital,medical compliance rate of control group was57.53%,simultaneously experimental group was 92.24%;medical compliance of experimental group was increased significantly compared with control group(P<0.001).Adverse events incidence of control group was 66.21%,while experimental group was 20.45%;adverse events incidence of experimental group wasreduced compared with control group(P<0.01).For medical procedures’ satisfaction in control group,the proportion of satisfied people was 48.6% and dissatisfied people was5.1%;while in experimental group,the proportion of satisfied people was 68.5% and dissatisfied people was zero;the experimental group was higher than control group and the difference had statistically significance(P<0.001).The clinical pharmacists took follow-up on patients after they left hospital.Medical compliance outside the hospital of control group was 55.56%,while experimental group was 88.33%;medical compliance outside the hospital of experimental group was higher than control group(P<0.001).Medical error of control group was 45%,while experimental group was11.67%;medical error of experimental group was lower than control group(P<0.05).Adverse events incidence of control group was 48.33%,while experimental group was20%;adverse events incidence of experimental group was lower than control group(P<0.001).Laboratory indicators of self-monitoring and compliance of timely review for control group was 73.33%,while experimental group was 93.33%;laboratory indicators of self-monitoring and compliance of timely review for experimental group was higher than control group(P<0.05).The relapse rate of cerebral infarction for control group was 16.7%,while experimental group was 10%;the relapse rate of cerebral infarction for experimental group was lower than control group,but the difference did not have statistically significance(P>0.05).The clinical trials showed that after pharmacists’ pharmaceutical care and medical intervention,compared with hospitalized patients in control group,medical compliance and the proportion of patients’ satisfaction had increased obviously in experimental group,and the incidence of adverse events had decreased significantly after pharmacists’ intervention.Clinical pharmacists went on follow-up after patients left hospital,and the results showed that after pharmaceutical intervention,medical compliance outside the hospital,laboratory indicators of self-monitoring and compliance of timely review increased significantly;the incidence of adverse events and medical errors reduced obviously.The results showed that clinical pharmacists’ pathway of pharmaceutical care is feasible and necessary.Conclusions:Clinical pharmacists established the pathway of pharmaceutical care to patients with cerebral infarction.The pathway can provide reference model for clinical medication and experience for future pharmaceutical care.So the experimental data demonstrated that the clinical pharmacists’ interventions are effective.