背景:慢性肾脏病(CKD)患者由于广泛的合并症和药代动力学变化而处于药物相关问题(DRPs)的高风险中。本研究旨在确定住院CKD患者的DRPs和可能的影响因素。并评价临床药师服务在浙江省某大型综合医院DRPs检测和干预中的效果,中国东部。
方法:经伦理委员会批准,这项前瞻性研究纳入了2020年1月至12月期间入住肾脏病病房的CKD患者.临床药师在住院期间对DRPs进行鉴定和干预。DRP使用欧洲药学监护网络(PCNE)DRP分类系统进行分类,所有数据均使用社会科学统计软件包(SPSS)26.0版进行统计分析。
结果:共纳入914例CKD患者,在420名(45.95%)参与者中观察到463名DRP;每名患者的平均DRP为0.51(标准偏差[SD],0.60)在药师干预前。治疗安全问题占比最高(43.84%),其次是治疗效果,占43.20%。药物选择是DRPs最常见的原因(60.26%),抗生素和心血管药物是与DRP相关的最常见药物(32.84%和28.66%,分别)。共有85.53%的药学干预建议得到遵循,84.23%的DRPs经临床药师干预后完全缓解。经历DRPs的患者比例下降到7.77%,药剂师干预后住院期间的平均DRPs为0.08(SD0.28)。DRP的重要影响因素是CKD4期,共病的数量,处方药的数量,单变量和多变量逻辑回归模型中的住院天数。
结论:DRPs在中国CKD住院患者中很常见。CKD阶段4,合并症的数量,使用多种处方药,住院时间延长是DRP的影响因素.即使是肾病病房里只有一名临床肾病药师,在这项中国单中心研究中,临床药师在促进CKD患者DRPs的识别和协助医师解决DRPs方面发挥了重要作用.
Patients with chronic kidney disease (CKD) are at high risk of drug-related problems (DRPs) because of extensive comorbidities and pharmacokinetic changes. This study aimed to identify DRPs and possible contributing factors in hospitalized patients with CKD, and evaluate the efficacy of the clinical pharmacist services in detection and intervention of DRPs in a large general hospital in Zhejiang Province, eastern
China.
With the approval of the Ethics Committee, patients with CKD admitted to the nephrology ward from January to December 2020 were enrolled in this prospective study. The clinical pharmacist identified and intervened the DRPs during hospitalization. The DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) DRP classification system, and all data were statistically analyzed using Statistical Package for Social Science (SPSS) version 26.0.
A total of 914 patients with CKD were included, with 463 DRPs observed among 420 (45.95%) participants; the average DRP per patient was 0.51 (standard deviation [SD], 0.60) before pharmacist intervention. Treatment safety accounted for the highest proportion of problems (43.84%), followed by treatment efficacy, accounting for 43.20%. Drug selection was the most common cause of DRPs (60.26%), and antibiotics and cardiovascular agents were the most common drugs associated with DRPs (32.84% and 28.66%, respectively). A total of 85.53% of pharmaceutical intervention recommendations were followed, and 84.23% of DRPs were completely resolved after intervention by the clinical pharmacist. The proportion of patients who experienced DRPs decreased to 7.77%, with an average of 0.08 (SD 0.28) DRPs during hospitalization after pharmacist\'s intervention. Significant contributing factors for DRPs were CKD stage 4, number of comorbid diseases, number of prescribed medications, and hospitalization days in both the univariate and multivariate logistic regression models.
DRPs are common among hospitalized patients with CKD in
China. CKD stage 4, the number of comorbidities, use of multiple prescription drugs, and extended length of hospital stay are contributing factors for DRPs. Even only one clinical nephrology pharmacist in the nephrology ward, clinical pharmacist can play an important role in facilitating the identification of DRPs in patients with CKD and assisting physicians resolve DRPs in this single center study in
China.