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目的探讨药师为哮喘和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者提供分级药学服务的模式。方法以我院哮喘和COPD患者为研究对象,结合哮喘和COPD临床指南,制定分级药学服务标准。收集患者256例,随机分成干预组和对照组,根据分级标准对患者实施不同级别的药学服务。将两组患者干预前、干预3个月后、干预6个月后的分级评分、用药依从性和肺功能指标(FEV1/FVC、FEV1%预计值)进行两组间的比较,观察不良反应发生情况,急性加重发作次数大于等于已发生情况以及临床有效控制率。结果与对照组相比,干预6个月后,干预组一级服务比例下降了25%;不良反应发生率减少了7.82%;急性加重次数大于等于发生率降低了7.81%;临床有效控制率提高了23.43%;FEV1/FVC、FEV1%预计值和用药依从性得到显著改善,差异具有统计学意义(P<0.05)。结论通过对哮喘和COPD慢性病患者实施分级药学服务,可以帮助药师在最短的时间内找到需要重点服务的对象,同时达到提高药学服务质量和临床疗效的目的。
Objective To explore the pharmacist’s mode of providing hierarchical pharmacy services for patients with asthma and chronic obstructive pulmonary disease (COPD). Methods Taking patients with asthma and COPD in our hospital as the research object, combined with the clinical guidelines of asthma and COPD, we formulated the standard of grade pharmacy service. 256 patients were collected and randomly divided into intervention group and control group, according to grading standards for patients with different levels of pharmacy services. The two groups of patients before intervention, after intervention for 3 months, after intervention for 6 months grading, medication compliance and lung function indicators (FEV1 / FVC, FEV1% of the expected value) were compared between the two groups to observe the adverse reactions Situation, the number of episodes of acute exacerbation is greater than or equal to the occurrence of clinical effective control rate. Results Compared with the control group, after 6 months of intervention, the proportion of primary service in the intervention group decreased by 25%; the incidence of adverse reactions decreased by 7.82%; the rate of acute exacerbations decreased by 7.81% or more; the effective clinical control rate (23.43%). The predictive value of FEV1 / FVC and FEV1% and medication compliance were significantly improved with statistical significance (P <0.05). Conclusion The implementation of hierarchical pharmacy services for patients with chronic asthma and chronic obstructive pulmonary disease can help pharmacists find those patients who need key services in the shortest time while achieving the goal of improving the quality of pharmacy services and clinical efficacy.