目的:心力衰竭(HF)患者存在药物相关问题(DRPs)的高风险。我们的目的是描述频率,类型,接受病例管理的台湾HF门诊患者中DRP的时间发生。
方法:在本研究中,我们纳入了2008年10月至2010年12月来自台湾三家医院HF诊所的141例患者.每个参与站点的护士病例经理在门诊就诊期间为患者注册了病例报告表(CRF)。DRP使用欧洲药物护理网络基金会(PCNE)分类系统进行分类,并在审查CRF并参与多学科团队讨论后由药剂师记录。
结果:对于141名诊所参与者,平均用药时间为17个月,和796DRP报告。最常记录的DRP是需要实验室测试(占总DRP的32.7%),其次是潜在的相互作用(29.6%),非过敏性副作用(13.3%),对健康和疾病的认识不足(9.5%)。最常引起DRP的药物是血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂,利尿剂,华法林,螺内酯,和β受体阻滞剂。在药物治疗的最初3个月,总DRPs的发生率最高。而每一类DRPs的发病率在不同的药物类别中显示出多种形式的随时间变化.
结论:在台湾,临床药师系统组织不好,尽管护士病例管理人员进行了密切的监测,但HF门诊患者的DRP患病率仍然很高。临床药师在该人群的长期药物治疗过程中检测潜在的DRPs中起着至关重要的作用。
OBJECTIVE: Heart failure (HF) patients are at high risk of having drug-related problems (DRPs). We aim to describe the frequency, types, and temporal occurrence of DRPs in Taiwanese HF outpatients receiving
case management.
METHODS: In this study, we included 141 patients from HF clinics in three hospitals in Taiwan from October 2008 to December 2010. Nurse
case managers at each of the participating sites registered
case report forms (CRFs) for patients during clinic visits. DRPs were classified using the Pharmaceutical Care Network Europe Foundation (PCNE) classification system and documented by pharmacists after reviewing CRFs and participating in multidisciplinary team discussions.
RESULTS: For 141 clinic participants, the average duration of medication use was 17 months, and 796 DRPs were reported. The DRPs most frequently recorded were the need for laboratory tests (32.7% of total DRPs), followed by potential interaction (29.6%), nonallergic side effects (13.3%), and insufficient awareness of health and disease (9.5%). The drugs most frequently causing a DRP were angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, diuretics, warfarin, spironolactone, and β-blockers. The incidence rates of total DRPs was maximal during the initial 3 months of medication treatment, whereas the incidence rates of each category of DRPs showed multiform changes over time among various drug classes.
CONCLUSIONS: In Taiwan where the clinical pharmacist system is not well organized, HF outpatients still had a high prevalence of DRPs despite intensive monitoring by nurse
case managers. Clinical pharmacists play critical roles in detecting potential DRPs during long-term medication treatment for this population.