洪磊 林燕芳 蔡莉莉 周虹 林志强

[摘要]目的探討临床药师主导的老年2型糖尿病患者管理模式对改善血糖临床指标和药物不良反应的影响。方法选择2019年1—9月在福建医科大学附属泉州第一医院内分泌科住院的100例老年2型糖尿病患者作为研究对象，按照随机数字表法分为对照组（ n=50）和观察组（ n=50），对照组患者采用本院传统的慢性疾病管理模式，观察组患者在原来慢性疾病管理模式的基础上增加了临床药师的主动干预，包括药物重整、医嘱审核、用药咨询、用药教育、用药监护，对所有患者随访6个月，观察两组患者在干预前后空腹血糖（FPG）、餐后2小时血糖（2 h PG）、糖化血红蛋白（HbA1c）和低血糖等药物不良反应的变化情况。结果观察组患者干预后的 FPG、2 h PG、HbA1c 和药物不良反应总发生率低于对照组，差异有统计学意义（ P <0.05）。结论临床药师主导老年2型糖尿病管理可提高老年患者用药的有效性和安全性，为构建新的慢性疾病管理药学服务模式提供了参考。

[关键词]临床药师;老年;2型糖尿病;慢性疾病管理

[中图分类号] R587.1 [文献标识码] A  [文章编号]2095-0616（2021）22-0125-04

Analysis of the effect of clinical pharmacist leading management of elderly patients with type 2 diabetes

HONG  Lei   LIN  Yanfang   CAI  Lili   ZHOU  Hong   LIN  Zhiqiang

Department of Pharmacy， Quanzhou First Hospital Affiliated to Fujian Medical University， Fujian， Quanzhou 362000，China

[Abstract] Objective To investigate the influence of the clinical pharmacist leading management mode for elderly patients with type 2 diabetes （T2D） on improving the clinical indicators of blood glucose and the adverse drug reactions. Methods A total of 100 elderly T2D patients who were hospitalized in the endocrinology department of Quanzhou First Hospital Affiliated to Fujian Medical University from January to September 2019 were selected as the study subjects and divided into the control group （n=50） and the observation group （n=50） according to the random number table method. The control group used traditional chronic disease management mode of our hospital， while patients in the observation group also received active intervention of clinical pharmacist in addition to the original chronic disease management， including medication reconciliation， medical order review， medication consultation， medication education， and medication monitoring. All patients were followed up for 6 months to observe the changes fasting plasma glucose （FPG）， 2-hour postprandial blood glucose （2 h PG）， glycosylated hemoglobin （HbA1c）， and the hypoglycemia and other adverse drug reactions before and after intervention in the two groups. Results The levels of FPG， 2 h PG， HbA1c and total incidence of adverse drug reactions in the observation group after intervention were lower than those in the control group， with statistically significant differences （P <0.05）. Conclusion The clinical pharmacist leading management of elderly T2D patients can improve the effectiveness and safety of medication for elderly patients， and provide a reference for constructing a new chronic disease management pharmaceutical service mode.

[Key words] Clinical pharmacist; Old age; Type 2 diabetes; Chronic disease management

随着我国已进入老龄化社会，老年2型糖尿病患者数量日益增长。据统计，60岁以上的老年人群糖尿病患病率已接近或超过20%[1-2]，糖尿病及其并发症给患者的健康和社会的发展带来了沉重的负担。老年糖尿病患者具有并发症和伴发症多、症状不典型、低血糖风险高、共病用药多、自我管理能力差等特点，因此老年糖尿病患者的诊治亟需专业的医务人员全程化管理。而临床药师作为兼具药物知识和临床知识的医务人员，可以充当教育者和指导者，是为糖尿病患者提供慢性疾病管理的合适人选[3]。……