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目的探索临床药师对复杂用药老年患者的药学服务模式。方法临床药师参与1例复杂用药导致多发药物不良反应的老年患者的治疗,通过药物重整,完善治疗方案、提出药学建议,进行个体化的药学服务。结果与结论根据该患者实际用药需求,将其用药从30种精简为13种,且该患者的口腔溃疡、骨痛、肌痛等药物不良反应明显改善,整体病情好转。对复杂用药老年患者的药学监护及药学服务模式,可着重在精简用药、改善药物不良反应、提高患者依从性这3个方面。
Objective To explore the pharmacy service model of clinical pharmacists in elderly patients with complicated medication. Methods Clinical pharmacists participated in the treatment of one elderly patient complicated with multiple drug-induced adverse reactions. Through pharmacological reforming, perfecting the treatment plan, putting forward the pharmaceutical suggestions and carrying out individualized pharmacy services. RESULTS AND CONCLUSION: Based on the actual need of the patients, the medication was reduced from 30 to 13, and the patient’s oral ulcer, bone pain, myalgia and other adverse drug reactions improved obviously. The overall condition improved. Pharmacological care and pharmacy services for elderly patients with complex medication may focus on streamlining medication, improving adverse drug reactions, and improving patient compliance.