Construction And Effect Evaluation Of A Layered And Grid Pharmaceutical Service Model For Regional Rheumatoid Arthritis

Rheumatoid Arthritis(RA)is an autoimmune chronic polyarthritis for which there is currently no cure.With the development of the disease,there will be joint deformities,disability,and loss of labor,so it is also called "immortal cancer".RA patients must take medicines for life.Premature intervention can control the disease process of most patients.Rational drug management is very important to slow down the disease process,reduce adverse reactions,and reduce complications.Due to the lack of awareness of RA in primary medical institutions and the lack of specialized drugs,in the long run,many patients go to tertiary hospitals to adjust their drug regimens,which wastes time and money,and increases the burden on medical insurance.Therefore,it is urgent to establish a suitable new model of RA pharmacy care and promote patients to adapt to the hierarchical diagnosis and treatment system.The methods used in this study are as follows:1.Literature query,personnel interview and questionnaire survey were used to investigate RA patients who participated in hierarchical grid management,analyze the progress of RA patients’ disease course,and demonstrate the feasibility of hierarchical grid pharmaceutical care model for RA patients’ medication and process management.2.Build a layered and grid pharmaceutical service model,fix the composition of team members and clarify the division of labor,so as to orderly urge RA patients to treat and track their conditions;Build a full coverage training system for hierarchical grid pharmaceutical services,including online and offline teaching,recording training videos,and establishing a grid management We Chat group;Recruit RA patients into the group,establish disease files,and return visit at any time in case of special circumstances;Formulate the Chinese medicine administration plan for RA patients with different conditions;Establish a full and specialized two-way referral indication and management process,and conduct hierarchical management according to the disease degree of patients;Evaluate patients regularly,observe whether there are complications and keep records,and provide help at any time;Regularly hold RA health education activities to improve the knowledge of patients and their families about RA.3.Establish service model effect evaluation method.Including: evaluate the training effect of RA prevention and treatment knowledge for team doctors,patients and their families,conduct questionnaire tests before and after the training for the participants,and count the answers;Summarize and evaluate the general situation of RA patients;Before and after the management of RA patients to carry out their own before and after the control of the class experiment to evaluate the management of RA patients before and after the relevant behavior changes and adverse reactions;To analyze the influence of general condition,blood pressure,blood lipid,body mass index,course of disease,occupational status and other factors of RA patients under management on RA control;Statistical analysis was carried out,and SPSS13.0was used for statistical treatment,as well as the changes in the patient’s condition before and after taking traditional Chinese medicine.In conclusion:1.In this survey,Shanghai Guanghua Integrated Traditional and Western Medicine Hospital distributed 237 online questionnaires to RA patients,166 of which were recovered,and 143 were valid.Through the analysis of the questionnaire,the results showed that 29.3%of the surveyed RA patients had general or poor health;31.5% of RA patients were semi self-care or completely unable to take care of themselves,and 25.6% of RA patients were not good or very bad in disease control;Although the health status,living conditions and disease control status of most RA patients are relatively good,a considerable number of RA patients have not achieved good results in living conditions and disease control,which also requires hospitals to conduct hierarchical grid pharmaceutical service management for RA patients to control the disease.Among the health needs of the investigated RA patients,99.3% of RA patients need health education very much,93.3% of RA patients need diet guidance very much,94.7% of RA patients need exercise guidance very much,88.6% of RA patients need psychological counseling very much,which means that most RA patients have a high demand for health,It reflects the key of grid RA management service and further indicates that the layered grid pharmaceutical service model is feasible for the treatment of RA patients.2.The regional layered grid pharmaceutical service model for Rheumatoid Arthritis constructed in this project,with Shanghai Guanghua Integrated Traditional and Western Medicine Hospital as the regional pharmaceutical service center,has 7 specialists,5pharmacists,and 1 nurse to undertake the training and professional guidance of grid members.Some doctors Pharmacists,nurses and 822 highly motivated RA patients and their families served as grid members.The training was conducted for 10 times,including 2 national level continuing education projects of traditional Chinese medicine and 8 series lectures on treatment of wind related drugs.Training Under the guidance of professional Grade III A hospitals,systematically teach the basic knowledge of disease,medication management,sports,lifestyle,complications,psychology and self-management and other RA chronic disease management knowledge to grassroots community medical institutions,RA patients and their families as grid points,and the three community medical institutions,RA patients and their families independently manage the medication of RA patients.3.The results showed that after the hierarchical grid pharmaceutical service management,the drug compliance,health status and satisfaction with drug information of RA patients increased from 30% to 90%,and the overall compliance rate of ESR,CRP and DAS28 scores of RA patients increased from 20% to 50%.This shows that RA patients’ acceptance of medication management is also gradually improving.This significant change shows that the layered grid management model is an easy to promote and sustainable chronic disease drug management model,which can guide the grass-roots health managers to carry out the drug management practice of rheumatism.It provides guidance for RA pharmaceutical services in hospitals in various regions of China,and makes the management of chronic diseases of rheumatic immune diseases better developed in China.