| ObjectiveBased on the concept of Clinical Pathway(CP)management,this paper explored the effectiveness of the pharmaceutical care pathway management model in Chronia Obstructive Pulmonary Disease(COPD)patients,which provides a reference for clinical pharmacists to participate in the Chronic Disease Management(CDM)of COPD patients.MethodsRandomized,controlled,prospective trials were used in the paper.According to the inclusion and exclusion criteria,200 patients with COPD who met the requirements of the Department of Respiratory and Critical Care Medicine from January to June 2018 in one Third Level 1st Class hospital were randomly divided into control group and experiment group,100 patients respectively.Patients in the control group received routine treatment by doctors and nurses.Patients in the experiment experimental group were monitored and managed by clinical pharmacists according to the requirements of the pharmaceutical care pathway for COPD patients besides routine treatment by doctors and nurses.The main contents of the pharmaceutical care pathway for COPD patients include:collection of medical history,evaluation of symptoms and establishment of targets in the acute exacerbation period(from about the first to third day in hospital);popularization of COPD knowledge,drug education and guidance on smoking cessation in the remission period(from about the fourth to sixth day in hospital);"three-day missionary method" to complete the guidance work for inhaled preparations in the stable period(from about the seventh to ninth day in hospital);self-management and lung rehabilitation exercise in the discharge period(from about the tenth day to discharge).Patients were followed up at 3rd,6th and 9th month after discharge.Analysis by comparison were conducted in the terms of inhalation preparation use score,medication compliance score,pulmonary function index,acute aggravation/hospitalization frequency,clinical effective control rate,adverse drug reactions(ADR)incidence and realization of the target treatment rate between the patients in the two groups at five time points(before in-patient,before discharge and 3rd,6th and 9th month after discharge).ResultsFor patients in the experimental group,at the five time points(before in-patient,before discharge and 3rd,6th and 9th month after discharge),the scores of Salmeterol/Fluticas were determined to be 10.96±2.26,14.45± 1.73,14.71 ± 1.51,14.83± 1.33,14.79± 1.41,respectively;the scores of Tiotropium Bromide 11.13±2.02,15.08± 1.34,15.21 ± 1.20,15.29± 1.16,15.22±1.23,respectively;the scores of Budesonide/Fomoterol 10.89±2.57,14.56± 1.81,14.56±1.33,14.67± 1.41,14.56± 1.74,respectively.The scores of the three inhalation devices were significantly higher than those of the same group before in-hospital and the control group after the implementation of the pharmaceutical care pathway,the differences were statistically significant(P<0.01).The compliance scores of patients in the experimental group before in-patient and 3rd,6th and 9th month after discharge were 5.65± 1.02,6.30±0.80,6.50±0.63,6.50±0.61,respectively.The scores after the implementation of the pharmaceutical care pathway were significantly higher than those before in-patient in the same group and control group.The differences were statistically significant(P<0.01).In the 9th month after discharge,the percentage forced expiratory volume in one second(FEV1%)of patients in the experimental group is(58.44±18.06)%,which were significantly higher than that in the same group before in-patient and control group at the same time.The differences were statistically significant(P<0.05).In the 9th month after discharge,11 patients had acute exacerbation ?2 times and 27 patients were hospitalized for?1 time in the experimental group,which were significantly less than patients in the same group 1 year before in-patient and patients in the control group at the same time.The differences were statistically significant(P<0.05).The effective clinical control rates of patients in the experimental group at 3rd,6th and 9th month after discharge were respectively 77.00%,80.00%and 85.00%,which were significantly higher than those of the control group.The differences were statistically significant(P<0.05).The ADR incidence in the experimental group was 3.00%in the 9th month after discharge,which was significantly less than that in the control group.The differences were statistically significant(P<0.01).In the 9th month after discharge,the realization of the target treatment rates of alleviating current symptoms,reducing future risks,returning to family and society,and normal life and work in the experimental group were 89.00%,87.00%,90.00%and 81.00%,respectively,which were significantly higher than those in the control group.The differences were statistically significant(P<0.05).ConclusionBy implementing the pharmaceutical care pathway for COPD patients,clinical pharmacists effectively improved the scores of inhaled preparation,medication compliance,effective clinical control rate,the pulmonary function index FEV1%and reduced the risk of acute aggravation and the incidence of ADR in the experimental group.The paper provided a reference for clinical pharmacists to participate in the CDM of COPD patients. |
PDF Full Text Request