摘要
目的基于ECHO(经济-economic、临床-clinical、人文-humanistic结局)模型,从经济、临床及人文结局多维度评价药师自主研发的高血压药物治疗管理路径软件在真实世界中的应用效果,为优化药物治疗管理(MTM)服务提供依据。方法采用前瞻性随机对照试验,纳入2023年7月至2024年6月在上海市浦东新区公利医院接受MTM服务的120例原发性高血压患者,随机分为干预组(软件辅助MTM,60例)和对照组(人工记录MTM,60例)。比较两组的成本-效用、血压和血脂控制率、用药依从性、患者满意度、药师服务时间及药物相关问题(DRPs)解决情况。结果干预前,两组患者的年龄、性别、体重指数(BMI)、合并症数量、基线血压/血脂水平及达标率、用药依从性评分等比较,差异无统计学意义(P>0.05),具有可比性。干预6个月后,干预组EQ-5D效用值(0.88±0.07 vs.0.84±0.04)、血压控制率(96.67%vs.81.67%)、血脂控制率(98.33%vs.83.33%)、Morisky用药依从性量表评分(7.75±0.25 vs.6.50±1.25)和患者满意度评分(33.20±1.80 vs.31.50±2.10)均高于对照组(P<0.01),平均服务时间短于对照组[(26.18±2.28)min vs.(40.66±4.45)min,P<0.01],DRPs解决率高于对照组(98.57%vs.87.41%,P<0.05)。干预组增量成本-效果为-26755.83元/QALY,提示软件具有成本-效益优势。结论高血压药物治疗管理路径软件可提升药学服务效率,改善经济、临床及人文结局,具有较高的临床应用价值。
Objective To evaluate the real-world effectiveness(economic,clinical,and humanistic outcomes)of a pharmacist-developed hypertension medication therapy management(MTM)pathway software based on ECHO model,and to provide evidence for optimizing MTM services.Methods A prospective randomized controlled trial was conducted,enrolling 120 patients with primary hypertension who received MTM services in Gongli Hospital of Shanghai Pudong New Area from July 2023 to June 2024.Patients were randomly assigned into an intervention group(n=60,MTM assisted by the software)or a control group(n=60,conventional manual MTM).The data were compared between the two groups,including cost-utility,control rates of blood pressure and lipid,medication adherence,patient satisfaction,time of pharmacist service,and the identification and solution of drug-related problems(DRPs).Results Before intervention,there were no significant differences between the two groups in age,gender,BMI,number of comorbidities,baseline blood pressure/lipid levels and their control rates,or medication adherence scores(P>0.05),indicating comparability.After 6 months of intervention,the EQ-5D utility value(0.88±0.07 vs.0.84±0.04),blood pressure control rate(96.67%vs.81.67%),lipid control rate(98.33%vs.83.33%),Morisky 8-item adherence score(7.75±0.25 vs.6.50±1.25),and patient satisfaction score(33.20±1.80 vs.31.50±2.10)in the intervention group were higher than those in control group(P<0.01).The average service time of intervention group was shorter than that of control group[(26.18±2.28)min vs.(40.66±4.45)min,P<0.01],while the DRPs solution rate was higher than that of control group(98.57%vs.87.41%,P<0.05).The incremental cost-effectiveness ratio(ICER)of intervention group was–26755.83 CNY per QALY,indicating that the software had a cost-effectiveness advantage.Conclusion The hypertension MTM pathway software significantly enhances the efficiency of pharmaceutical care,improves economic,clinical,and humanistic outcomes,and demonstrates considerable value in clinical application.
作者
刘艳辉
骆岩
吕君瑶
林彦馨
李文艳
Liu Yanhui;Luo Yan;LüJunyao;Lin Yanxin;Li Wenyan(Department of Clinical Pharmacy,Gongli Hospital of Shanghai Pudong New Area,Shanghai 200135,China)
出处
《实用药物与临床》
2025年第12期899-903,共5页
Practical Pharmacy and Clinical Remedies
基金
上海市浦东新区卫生健康委员会科技项目经费资助(PW2021A‑37)。
关键词
高血压
药物治疗管理
路径软件
ECHO模型
随机对照试验
Hypertension
Medication therapy management(MTM)
Pathway software
ECHO(economic,clinical,and humanistic outcomes)model
Randomized controlled trial
