带状疱疹临床路径中药学监护路径的应用研究

发布时间：2018-05-26 04:00

本文选题：带状疱疹 + 临床路径　；参考：《山东大学》2016年硕士论文

【摘要】：目的：带状疱疹(Herpes zoster, HZ)是由水痘-带状疱疹病毒(Varicella-zoster virus,VZV)感染引起的皮肤病,为一种皮肤科的常见病。严重带状疱疹需住院治疗,病人痛苦大,住院时间长,费用高。为规范疾病诊疗、提高医疗质量、降低医疗费用,原国家卫生部自2009年起开展了临床路径管理工作。建立某些疾病诊疗的临床路径管理,其中包括带状疱疹的临床路径管理。由于各类疾病临床路径是由不同的医学专业学术组织建立的,因此对药物的合理使用缺乏规范的、有效的、明确的要求,因此有必要配合疾病临床诊疗的管理路径,建立与之相匹配的药学路径,国内外已有部分研究。本研究的目的在于建立与带状疱疹临床路径相匹配的药学监护路径,从而有效规范带状疱疹治疗过程中药品的使用,降低药物不良反应(ADR)的发生,改善用药依从性,降低药品费用,降低药占比,降低患者住院费用,缩短患者住院天数,提高患者满意度。方法：将入选病例分为试验组和对照组。对照组患者100例,为回顾性资料,患者仅接受临床路径管理相关的医、护服务,未接受临床药师的药学服务；试验组患者100例,除接受临床路径的医疗服务外,还由专业临床药师按照药学监护路径对其提供全程药学服务。研究指标包括住院费用、药品费用、药占比、治疗药物、用法用量、患者住院天数、ADR发生率、用药依从性、患者满意度等指标。结果：试验组与对照组相比住院天数降低2.75天(P0.05)；住院费用降低258.30元(P0.05)；药品费用降低724.69元(P0.05)；药占比降低8.46%(P0.05)；药品不良反应发生率降低(P=0.03)。结论：1.建立与临床路径相结合带状疱疹住院患者药学监护路径,可规范药物使用,促进合理用药。2.对带状疱疹临床路径管理的住院患者同时实施药学路径管理,可降低住院费用、药品费用和药占比,缩短住院天数,及时监测、处置药品不良反应。3.药学监护路径中临床药师介入药物治疗,可提高患者用药依从性,提高患者满意度,体现药师的工作价值。
[Abstract]:Objective: Herpes zoster (HZ) is a common dermatologic disease caused by varicella-zoster virus (VZV) infection. Severe herpes zoster needs hospitalization treatment, patient pain is great, hospital stay is long, cost is high. In order to standardize the diagnosis and treatment of diseases, improve the quality of medical treatment, and reduce medical costs, the former Ministry of Health has carried out clinical path management since 2009. Establish clinical pathway management for some diseases, including herpes zoster. Because the clinical pathway of various diseases is established by different medical professional academic organizations, there is no standard, effective and clear requirement for the rational use of drugs, so it is necessary to cooperate with the management path of clinical diagnosis and treatment of diseases. Some studies have been done on the establishment of a matching pharmaceutical path at home and abroad. The purpose of this study is to establish a pharmaceutical monitoring pathway that matches the clinical pathway of herpes zoster, so as to effectively standardize the use of drugs in the treatment of herpes zoster, reduce the incidence of adverse drug reactions (ADR), and improve drug compliance. Reduce the drug cost, reduce the proportion of drugs, reduce the cost of hospitalization, shorten the days of hospitalization, improve the satisfaction of patients. Methods: the selected cases were divided into experimental group and control group. For the purpose of retrospective data, 100 patients in the control group received only the medical and nursing services related to clinical path management, but not the pharmacists, while in the experimental group, 100 patients received the medical care of the clinical pathway. Professional clinical pharmacists also provide full pharmaceutical care according to the path of pharmaceutical care. The study included hospitalization cost, drug ratio, therapeutic drugs, usage dosage, the incidence of ADR, compliance and satisfaction with drug use. Results: compared with the control group, the days of hospitalization in the trial group were 2.75 days lower than those in the control group, the hospitalization cost was reduced by 258.30 yuan (P 0.05), the drug cost was reduced by 724.69 yuan (P 0.05), the proportion of drugs was decreased by 8.46% (P 0.05), and the incidence of adverse drug reactions was decreased (P 0.03). Conclusion 1. The establishment of drug monitoring pathway combined with clinical pathway in patients with herpes zoster can standardize drug use and promote rational drug use. The application of pharmaceutical path management to the in-patients with herpes zoster clinical pathway management can reduce the hospitalization cost, drug cost and drug ratio, shorten the hospitalization days, timely monitor and deal with adverse drug reactions. 3. In the path of pharmaceutical monitoring, clinical pharmacists intervention in drug therapy can improve the compliance of patients with drugs, improve patient satisfaction, and reflect the work value of pharmacists.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R752.12

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