2019 年第 9 期 第 14 卷

基于PDCA模式的药师干预对心房颤动患者应用华法林的效果观察

Effect of pharmacist intervention based on PDCA mode on atrial fibrillation patients treated with warfarin    

作者：李政秦侃

英文作者：

单位：230061合肥，安徽医科大学第三附属医院药学部临床药学室

英文单位：

关键词：心房颤动；抗凝；药师干预；管理方法

英文关键词：

• 摘要：

• 【摘要】目的    探讨基于PDCA模式的临床药学干预对心房颤动患者进行抗凝治疗管理的效果。方法    选择2017年1月至2018年3月安徽医科大学第三附属医院服用华法林的心房颤动患者106例，采用随机数字表法分为观察组及对照组，每组53例。对照组由医生和护士负责华法林抗凝方案的实施，观察组在对照组的基础上，药师参与患者抗凝治疗方案的实施，开展个体化药学监护，参照PDCA循环管理模式构建药学干预模式。比较2组患者入院前及出院后6个月凝血指标、Morisky评分变化及抗凝相关不良事件发生率。结果    入院前，2组患者国际标准化比值（INR）、INR在治疗范围（2.0～3.0）内的时间(TTR)、TTR≥58%比例比较，差异均无统计学意义（均P＞0.05）；出院后6个月，对照组患者INR、TTR、TTR≥58%比例与入院前比较，差异均无统计学意义（均P＞0.05），观察组患者INR、TTR、TTR≥58%比例均明显高于入院前及对照组［（2.2±0.3）比（1.8±0.4）、（2.0±0.4），（61±15）%比（40±19）%、（45±15）%，69.8%（37/53）比32.1%（17/53）、45.3%（24/53）］，差异均有统计学意义（均P＜0.05）。入院前2组Morisky评分比较差异无统计学意义（P＞0.05），出院后6个月2组患者Morisky评分均较入院前增高，且观察组Morisky评分高于对照组［（7.1±0.7）分比（6.3±1.0）分］，差异均有统计学意义（均P＜0.05）。研究期间，观察组总抗凝相关不良事件发生率明显低于对照组［20.8%（11/53）比39.6%（21/53）］，差异有统计学意义（P=0.029）。结论    基于PDCA循环的临床药师干预以患者为中心，能有效改善心房颤动出院患者抗凝治疗的有效性，改善患者的依从性，降低患者不良事件的发生率。

• 【Abstract】Objective    To investigate the effect of clinical pharmacological intervention based on PDCA mode on anticoagulant therapy in patients with atrial fibrillation. Methods    From January 2017 to March 2018, 106 patients with atrial fibrillation who took warfarin in the Third Affiliated Hospital of Anhui Medical University were randomly divided into observation group and control group, with 53 cases in each group. The control group had warfarin anticoagulation guided by doctors and nurses. In observation group, clinical pharmacists participated in the implementation of anticoagulant therapy; individualized pharmaceutical care was applied according to PDCA mode. Coagulation indexes, Morisky score and anticoagulant adverse events were analyzed during 6 months of treatment. Results    Before admission, international normalized ratio(INR), time in therapeutic range（2.0-3.0）(TTR), rate of TTR≥58% showed no significant differences between groups(all P＞0.05). Six months after treatment, INR, TTR, rate of TTR≥58% showed no significant changes in control group（all P＞0.05）. In observation group, INR, TTR and rate of TTR≥58% after treatment were significantly higher than those before admission and those in control group［（2.2±0.3） vs （1.8±0.4）,（2.0±0.4）; （61±15）% vs （40±19）%,（45±15）%; 69.8%（37/53） vs 32.1%（17/53）, 45.3%（24/53）］（all P＜0.05）. There was no significant difference of Morisky score between groups before admission(P＞0.05). Six months after treatment, Morisky score significantly increased in both groups and it was higher in observation group than that in control group［（7.1±0.7） vs （6.3±1.0）］（P＜0.05）. During treatment, the total incidence of anticoagulant adverse events in observation group was significantly lower than in control group［20.8%（11/53） vs 39.6%（21/53）］（P=0.029）. Conclusion    Patient-centered pharmacist intervention based on PDCA mode can effectively improve the effectiveness of anticoagulant therapy, improve patients compliance and reduce adverse events in the management of atrial fibrillation.