| Objective: 1.To retrospectively analyze the drug use of peritoneal dialysis patients in our hospital,identify and evaluate the drug-related problems of peritoneal dialysis patients and carry out intervention.2.To explore and construct the workflow suitable for the medication therapy management service of peritoneal dialysis patients in our hospital,and lay the foundation for the medication therapy management of peritoneal dialysis patients in the later period.3.To implement whole-course medication therapy management services for peritoneal dialysis patients,observe the effect of medication management service on medication compliance,peritonitis infection rate,adverse reaction rate,readmission rate,blood pressure and blood glucose compliance rate,and disease-related knowledge awareness rate of peritoneal dialysis patients,and evaluate the implementation effect of MTM in peritoneal dialysis patients.Methods: 1.Retrospective study was adopted,and the medical records of peritoneal dialysis patients who were admitted in our hospital from January 2021 to January 2022 were collected.The drug-related problems(DRP)were classified by Pharmaceutical Care Network Europe-Drug-related Problems(PCNE-DRP V9.0)classification system.2.Combined with the five core elements of MTM proposed by American Pharmacists Association and National Association of Chain Drug Stores,the MTM service process suitable for peritoneal dialysis patients in our hospital was optimized and established according to the results of retrospective data study.3.Patients who met the inclusion criteria were randomly divided into control group and intervention group.The control group received routine medication guidance,while the intervention group was given medication therapy management services by clinical pharmacists.After intervention for 6 months,the blood biochemical indexes,medication compliance,peritonitis infection rate,adverse reaction rate,readmission rate,blood pressure and blood glucose compliance rate,disease-related knowledge awareness rate were compared between the two groups,and patient satisfaction was scored to evaluate the implementation effect of MTM in peritoneal dialysis patients.The data were analyzed by SPSS 27.0 software.Results: 138 patients were enrolled,and there were 81 males(58.70%)and 57 females(41.30%),with the mean age of(47.49 ± 12.46)years old;there were 2 ～ 10 kinds of diseases,with the average kinds of(5.14 ± 2.42).Among them,the majority of patients were 4 ～ 6kinds of diseases(98 cases,71.01%);the average course of disease was(4.38 ± 1.23);among them,57.97% of the patients had a course of 4 ～ 9 years;the main chronic diseases were hypertension(70.29%),renal anemia(61.59%),hyperglycemia(34.06%)and hyperlipidemia(32.61%).Antihypertensive drugs(70.29%),antianemic drugs(60.87%),calcium and phosphorus regulators(47.10%),nutritional drugs(42.03%),active vitamin D(36.96%),lipid regulators(28.26%)and hypoglycemic drugs(25.36%)were commonly used.Calcium channel blockers were the most commonly used antihypertensive drugs(65.22%),followed by β-receptor blockers(51.45%)and α-receptor blockers(39.86%).Among the 138 patients included,84 patients had DRP(60.87%),with a total of 110 DRP.Among them,there were 60 problems existed in "therapeutic effect P1"(54.5%;60/110),38 problems existed in "therapeutic safety P2"(34.5%;38/110),and the remaining 12 problems classified as "other P3"(10.9%;12/110).A total of 117 specific causes of DRP were identified,of which the most common cause was "patient-related C7"(43.6%;51/117),followed by "drug choice C1"(33.3%;39/117)and "dose choice C3"(23.1%;27/117).The results of potential risk rating of drug-related problems showed that DRP with level 1 risk were the most(accounting for 80%),followed by level 2 risk(accounting for 13.64%).The results of intervention and implementation of drug-related problems showed that 347 intervention measures were proposed by clinical pharmacists,of which 276(79.54%)were completely accepted and implemented.In the end,76(69.09%)of the 110 DRP were completely solved,20(18.18%)DRP were partially solved,13 DRP were not solved(11.82%),and 1 DRP(0.91%)was unknown.2.The service process mainly included the review and evaluation of previous drug treatment,the record of current drug treatment plan,the discovery of drug treatment problems,the formulation of monitoring plan,the follow-up evaluation,etc.According to the analysis results of influencing factors of DRP in the retrospective study,which peritoneal dialysis patients should receive MTM service were specifically proposed,namely medication therapy management should be carried out for patients with substandard blood pressure and blood glucose,poor blood lipid control,many complications and more than 5 kinds of drugs;the drug list and drug-related activity plan were formulated for the patients included in the study,and all the drug use and drug activities of the patients during MTM were systematically recorded,which increased the operability of MTM.3.120 patients were included in the MTM study,with 60 cases in control group and 60 cases in intervention group.There was no statistical difference in the basic data between the two groups.After MTM intervention for half a year,there was no significant difference in blood urea nitrogen and serum creatinine between intervention group and control group(P >0.05);Hb in intervention group was higher than that in control group,and heart rate decreased in the 3rd and 6th months after intervention.After the intervention of medication therapy management,the compliance of the patients in intervention group was significantly improved and the score was significantly higher than that in control group(P < 0.05);the incidence of ADR,peritonitis infection rate and readmission rate within 6 months in intervention group were lower than those in control group(P < 0.05).The compliance rate of blood pressure,blood glucose and calcium and phosphorus metabolism were higher than those in control group,and the awareness rate of disease-related knowledge in intervention group was effectively improved after MTM intervention.Patients had higher satisfaction with overall pharmaceutical care.Conclusion: 1.There are many problems for medication of peritoneal dialysis patients,and clinical pharmacists should find DRP and feedback to doctors for timely intervention,so as to improve clinical rational drug use.2.Medication therapy management for peritoneal dialysis patients can help patients understand more disease-related knowledge and medication knowledge,improve medication compliance and safety,and improve drug treatment effect and patient treatment outcome. |
PDF Full Text Request