| ObjectiveWith the improvement of people’s material level and the adjustment of diet structure,the global incidence of diabetes and the number of diabetic patients were increased rapidly.Diabetes has become the third largest non-communicable disease,with a heavy burden and threatening human health.Due to the weak health awareness of people and the shortage of medical resources,diabetes awareness rate,treatment rate,and control rate are low,and many diabetic patients are not well managed.As an expert in drug therapy,the emergence of clinical pharmacists has made up for the lack of diabetes treatment to a certain extent and promoted the rational use of drugs in the clinic.In this article,the clinical pharmacist participates in the closed-loop pharmacy service of the third-class hospital,the pharmacy service of the joint medical outpatient service and the management of diabetes and related chronic diseases in the M community.Method1.1412 patients with diabetes admitted to the department of endocrinology from January 2017 to December 2018 were hospitalized in closed-loop management.Pharmaceutical care was studied from the aspects of review and comment on hospital medical advice,monitoring and reporting of adverse drug reactions,drug genetic testing,comment on antibacterial drugs in hospital,and education of drug use in hospital.2.Clinical pharmacists participated in outpatient service of metabolic management center.From January 2018 to December 2019,160 patients were randomly selected from the 2941 patients with type 2 diabetes who were enrolled in metabolic management center.80 patients were in the intervention group of clinical pharmacists,and another 80 patients were in the control group so as to compare patients’ medication compliance and blood glucose.Patients regularly followed up for one year were chosen to compare laboratory indicator and medication after enrollment and 1 year later.These patients were divided into two groups according to blood glucose and weight control.The difference in drug use between the two groups was compared.3.Clinical pharmacists provided pharmaceutical care for diabetes and related chronic diseases twice a month in community.Patients with diabetes,hypertension,coronary heart disease,stroke or other chronic diseases who have lived in the M community for a long time were selected as study subjects.Questionnaires were used to know patients’ cognition of diseases and medication.Drug counseling was used to analyze the problem of drug use and drug reorganization was carried out.A series of lectures and free diagnosis activities on rational drug use for diabetes and other chronic diseases were held.Ward rounds were carried out among doctors and clinical pharmacists.Result1.Clinical pharmacists reviewed 305 unreasonable medical orders,which were significantly reduced compared with the previous year;73 cases of ADR were reported to the ADR monitoring system,and pharmaceutical care was provided.109 patients were provided with drug genetic tests,206 of which prevented the occurrence of serious adverse drug reactions and provided guidance for clinical medication.The intensity of antimicrobial use and the number of unreasonable orders of antimicrobial drugs decreased significantly compared with that of the previous year,and the use of antimicrobial drugs was more reasonable.Clinical pharmacists provided 1318 patients with medication education services so as to improve patient medication compliance.2.Clinical pharmacists participated in outpatient service of metabolic management center.After one year follow-up,the rate of glycosylated glycemia protein reaching standard was 75.0%,and the rate of medication compliance was 86.3%in the intervention group.In the control group,the rate of glycosylated glycemia protein reaching standard and medication compliance was 48.8%and 73.8%respectively.Fasting blood glucose,2-hour postprandial blood glucose,glycosylated hemoglobin,total cholesterol and triglycerides were significantly improved in patients who participated in metabolic management center.The use of biguanides,DPP-4 inhibitors and α-glycosidase inhibitors was found to be the highest among all patients followed up for 1 year.3.329 patients participated in the questionnaire.We found many errors in the cognition of disease and medication.Patients wanted to know about indications(65.0%),usage(64.1%),and side effects(46.5%)through the drug consultation.474 patients participated in the drug consultation.We found that side effects(18.3%),the main functions and efficacy of drugs(16.5%)and the duration of drug therapy(15.0%)were the highest.Drug selection and excessive use of Chinese medicines and health products were the main problems in drug reorganization.ConclusionClinical pharmacists participated in the management of patients with diabetes,and have made progress in pharmaceutical care.The awareness of doctors and patients on rational drug use has been improved.In this article,a complete closed-loop pharmaceutical care system for diabetes in hospital was established,which included full medical advice review,adverse reaction monitoring,drug genetic testing and medication education.Clinical pharmacists extended pharmaceutical care from wards to out-patient clinics to communities,reflecting the value of clinical pharmacists in pharmaceutical care for diabetic patients. |
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