基于化疗相关问题建立药学监护路径

陈雅; 杨婷蓉; 赵华; 王莹

doi:10.6039/j.issn.1001-0408.2024.03.18

您当前的位置：

首页 >

文章列表页 >

基于化疗相关问题建立药学监护路径

药师与药学服务 | 更新时间：2024-02-07

- 基于化疗相关问题建立药学监护路径
- Establishment of pharmaceutical care pathway based on the problems related to chemotherapy
- 中国药房 2024年35卷第3期页码：368-373
- 作者机构：
  
  贵航贵阳医院药学部，贵阳　550009
- 作者简介：
  
  主管药师，硕士。研究方向：临床药学。E-mail：635959626@qq.com
- 基金信息：
  
  通用医疗科研基金项目(TYYLKYJJ-2022-037)
- DOI：10.6039/j.issn.1001-0408.2024.03.18
  中图分类号： R95;R979.1
- 纸质出版日期：2024-02-15，
  
  收稿日期：2023-06-24，
  
  修回日期：2023-12-23，
扫描看全文
陈雅,杨婷蓉,赵华等.基于化疗相关问题建立药学监护路径 ^Δ[J].中国药房,2024,35(03):368-373.

CHEN Ya,YANG Tingrong,ZHAO Hua,et al.Establishment of pharmaceutical care pathway based on the problems related to chemotherapy[J].ZHONGGUO YAOFANG,2024,35(03):368-373.
陈雅,杨婷蓉,赵华等.基于化疗相关问题建立药学监护路径 ^Δ[J].中国药房,2024,35(03):368-373. DOI： 10.6039/j.issn.1001-0408.2024.03.18.

CHEN Ya,YANG Tingrong,ZHAO Hua,et al.Establishment of pharmaceutical care pathway based on the problems related to chemotherapy[J].ZHONGGUO YAOFANG,2024,35(03):368-373. DOI： 10.6039/j.issn.1001-0408.2024.03.18.

摘要

目的

设计化疗相关问题药学监护路径并评估其是否有助于发现并干预化疗患者的药物相关问题（DRPs）。

方法

通过药学监护实践经验建立并实施化疗相关问题药学监护路径表与流程图。将该药学监护路径实施前后入住我院接受化疗的患者分为对照组（实施前，60例）与观察组（实施后，64例），提取对照组患者相关病历用以评估DRPs，对观察组患者进行化疗相关问题药学监护并提取DRPs。比较两组患者的基本情况、化疗情况、DRPs类别与干预情况、化疗所致不良反应、DRPs的欧洲医药保健网（PCNE）分类、DRPs发生时间、DRPs涉及的药物类别。

结果

两组患者的基本情况、化疗方案与化疗药物类别比较，差异均无统计学意义（

＞0.05）。对照组与观察组分别有46、37例患者发生DRPs。两组DRPs均主要发生在化疗期间，且主要为化疗前期。利用化疗相关问题药学监护路径，DRPs的识别率从对照组的52.17%显著提高至观察组的91.89%（

＜0.05），干预率从对照组的32.61%显著提高至观察组的72.97%（

＜0.05），不良反应发生率从对照组的28.33%显著降低至观察组的12.50%（

＜0.05）。对照组DRPs的主要问题类型为治疗有效性，主要涉及药物为辅助抗肿瘤药，主要发生原因为超适应证给予辅助抗肿瘤药；观察组DRPs的主要问题类型为治疗有效性和治疗安全性，主要涉及药物为止吐药，主要发生原因为预防化疗所致恶心呕吐用药不足。

结论

化疗相关问题药学监护路径的实施有助于临床药师更好地识别与干预化疗患者的DRPs，减少化疗所致不良反应的发生。

Abstract

OBJECTIVE

To design pharmaceutical care pathway for the problems related to chemotherapy， and to evaluate whether it contributes to the detection and intervention of drug-related problems （DRPs） in chemotherapy patients.

METHODS

The pharmaceutical care pathway table and flow charts were constructed and implemented by pharmaceutical care practice experience. The patients who were admitted to our hospital for chemotherapy before and after the implementation of the pharmaceutical care pathway were divided into control group （before the implementation，60 cases） and observation group （after the implementation，64 cases）， respectively； the relevant medical records of patients in the control group were extracted to evaluate DRPs， and pharmaceutical care of chemotherapy-related problems was performed for patients in observation group to extract DRPs. The basic condition， chemotherapy condition， DRPs classification and intervention status， adverse reactions induced by chemotherapy， PCNE classification of DRPs， occurrence time of DRPs， and drug classes related to DRPs were compared between 2 groups.

RESULTS

There was no statistical significance in the basic situation， chemotherapy regimen and chemotherapy drug category between the two groups （

＞0.05）. DRPs occurred in 46 and 37 patients in control group and observation group， respectively. In both groups， DRPs mainly occurred during chemotherapy， and mainly in the early stage of chemotherapy. Using the new pathway， the detection of DRPs significantly increased from 52.17% in the control group to 91.89% in the observation group （

＜0.05）. The successful intervention rate of DRPs was significantly increased from 32.61% in the control group to 72.97% in the observation group （

＜0.05）. The incidence of adverse drug reactions significantly decreased from 28.33% in the control group to 12.50% in the observation group（

＜0.05）. The main problem type of DRPs in the control group was treatment effectiveness， which mainly involved adjuvant antitumor drugs， mainly due to the use of adjuvant anti-tumor drugs for off-label prescribing； that of the observation group was treatment effectiveness and treatment safety， which mainly involved vomiting drugs， mainly due to insufficient medication to prevent nausea and vomiting caused by chemotherapy.

CONCLUSIONS

The implementation of the pathway helps clinical pharmacists to detect and intervene in DRPs among chemotherapy patients， and reduces the occurrence of chemotherapy-induced adverse reactions.

关键词

药学监护路径临床药师药学监护化疗相关问题

Keywords

clinical phar- macistpharmaceutical carechemotherapy-related problems

references

HEPLER C D，STRAND L M. Opportunities and responsibilities in pharmaceutical care[J]. Am J Hosp Pharm，1990，47（3）：533-543.

STRAND L M，MORLEY P C，CIPOLLE R J，et al. Drug-related problems：their structure and function[J]. DICP，1990，24（11）：1093-1097.

TOUKHY A，FAYED S，SABRY N，et al. The impact of an established pharmaceutical care pathway on drug related problems in an intensive care unit[J]. Am J Med Sci，2021，362（2）：143-153.

曾卫强，曲云婷，闫其星，等. 抗肿瘤药物药学监护路径的建立和应用[J]. 中国药房，2016，27（35）：5017-5020.

ZENG W Q，QU Y T，YAN Q X，et al. Establishment and application of pharmaceutical care pathway for the anti-tumor drugs[J]. China Pharm，2016，27（35）：5017-5020.

高君伟，程学芳，冯婷婷，等. 新型抗肿瘤药物不良反应分析及药学监护[J]. 上海医药，2022，43（增刊2）：140-158.

GAO J W，CHENG X F，FENG T T，et al. Analysis of adverse reactions of new anti-tumor drugs and pharmaceutical care[J]. Shanghai Med Pharm J，2022，43（Suppl 2）：140-158.

王玉霞. 探讨对新型靶向抗肿瘤药物的不良反应开展药学监护的方法[J/OL]. 临床医药文献电子杂志，2020，7（3）：152，181[2023-04-21].https：//wenku.baidu.com/view/d827de87bfeb19e8b8f67c1cfad6195f312be8a2?fr=xueshu &_wkts_=1706494538577https://wenku.baidu.com/view/d827de87bfeb19e8b8f67c1cfad6195f312be8a2?fr=xueshu&_wkts_=1706494538577. DOI：10.16281/j.cnki.jocml.2020.03.130http://dx.doi.org/10.16281/j.cnki.jocml.2020.03.130.

WANG Y X. To explore the method of pharmaceutical care for the adverse reactions of new targeted antitumor drugs[J/OL]. Electron J Clin Med Lit，2020，7（3）：152，181[2023-04-21].https：//wenku.baidu.com/view/d827de87- bfeb19e8b8f67c1cfad6195f312be8a2?fr=xueshu&_wkts_=1706494538577https://wenku.baidu.com/view/d827de87-bfeb19e8b8f67c1cfad6195f312be8a2?fr=xueshu&_wkts_=1706494538577. DOI：10.16281/j.cnki.jocml.2020.03.130http://dx.doi.org/10.16281/j.cnki.jocml.2020.03.130.

BLIX H S，VIKTIL K K，MOGER T A，et al. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams[J]. Pharm World Sci，2006，28（3）：152-158.

HERLEDAN C，CERFON M A，BAUDOUIN A，et al. Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer：a systematic review[J]. J Geriatr Oncol，2023，14（4）：101450.

陈雯，牟稷征，萨日娜，等. 中西医结合治疗肿瘤患者药学监护路径的构建[J]. 中国医院用药评价与分析，2020，20（5）：628-630，635.

CHEN W，MOU J Z，SA R N，et al. Establishment of pharmaceutical care pathway for tumor patients treated by integrative traditional Chinese and western medicine[J]. Eval Anal Drug Use Hosp China，2020，20（5）：628-630，635.

WANG Y P，ZHU J，SHAN L C，et al. Drug-related pro- blems in bariatric surgery：a retrospective study[J]. Obes Surg，2022，32（12）：3961-3972.

彭苗苗，张桂凡. 引入PCNE分类系统对消化内科药物相关问题进行探索与实践[J]. 中南药学，2022，20（11）：2683-2688.

PENG M M，ZHANG G F. PCNE classification system for drug-related problems in the department of gastroente- rology[J]. Cent South Pharm，2022，20（11）：2683-2688.

徐象威，周美红，陈银巧，等. 肺癌化疗药学监护路径对化疗患者健康行为及生活质量的影响观察[J]. 药物流行病学杂志，2020，29（4）：256-261.

XU X W，ZHOU M H，CHEN Y Q，et al. Influence of pharmaceutical care pathway on health behaviors and quality of life of lung cancer patients with chemotherapy[J]. Chin J Pharmacoepidemiol，2020，29（4）：256-261.

张立平，董华. 规范化药学服务对AECOPD患者临床治疗的干预效果评价[J]. 中国药房，2017，28（20）：2847-2851.

ZHANG L P，DONG H. Evaluation of intervention effects of standardized pharmaceutical care on clinical treatment of AECOPD patients[J]. China Pharm，2017，28（20）：2847-2851.

FOURNIER ROMAIN，KACHACHI SAFAA，MOUCHOUX CHRISTELLE，et al. From medication reconciliation to shared medication review：pilot study integrating support for community pharmacists within a pharmaceutical care pathway[J]. Annales Pharmaceutiques Francaises，2022，80（6）：950-960.

徐象威，周美红，朱佩祯，等. 肺癌化疗药学监护路径对肺癌患者癌因性疲乏和负性情绪的影响[J]. 中华全科医师杂志，2019，18（10）：987-991.

XU X W，ZHOU M H，ZHU P Z，et al. Influence of pharmaceutical care pathway on cancer-related fatigue and negative emotion in patients with advanced lung cancer undergoing chemotherapy[J]. Chin J Gen Pract，2019，18（10）：987-991.

姜文奇，巴一，冯继锋，等. 肿瘤药物治疗相关恶心呕吐防治中国专家共识：2019年版[J/OL]. 中国医学前沿杂志（电子版），2019，11（11）：16-26[2023-04-18]. https：//rs.yiigle.com/cmaid/1165461https://rs.yiigle.com/cmaid/1165461. DOI：10.3760/cma.j.issn.1671-7368.2019.10.016http://dx.doi.org/10.3760/cma.j.issn.1671-7368.2019.10.016.

JIANG W Q，BA Y，FENG J F，et al. Chinese experts’ consensus on the prevention and treatment of nausea and vomiting related to anti-cancer drug treatment：2019 version[J/OL]. Chin J Front Med Sci Electron Version，2019，11（11）：16-26[2023-04-18]. https：//rs.yiigle.com/cmaid/1165461https://rs.yiigle.com/cmaid/1165461. DOI：10.3760/cma.j.issn.1671-7368.2019.10.016http://dx.doi.org/10.3760/cma.j.issn.1671-7368.2019.10.016.

KARTHIKEYAN K，SUNIL V B，ALEX S M，et al. A study to assess the impact of pharmaceutical care services to cancer patients in a tertiary care hospital[J]. J Oncol Pharm Pract，2022，28（3）：588-597.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

1例鹦鹉热衣原体重症肺炎患者的抗感染治疗及药学监护

临床药师参与1例EB病毒性脑炎患者的药学实践