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临床药师对1例肥胖型糖尿病患者开展药物治疗管理的实践
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| 篇名： | 临床药师对1例肥胖型糖尿病患者开展药物治疗管理的实践 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在开展药物治疗管理（MTM）中的作用。方法：借鉴美国MTM实践模式，以1例慢性非传染性疾病（肥胖型糖尿病）患者为例，内分泌专业临床药师按收集患者信息、药物治疗回顾、制订药物相关治疗计划、直接与医师沟通相关的干预措施或建议患者咨询相关医疗服务人员、记录及随访等五个流程对其开展MTM。结果：临床药师收集该患者信息包括既往病史、家族史、过敏史及用药史等，确定不适宜的降糖药物治疗、肥胖所致阻塞性睡眠呼吸暂停低通气综合征和高血脂状态是该患者优先考虑的药物相关问题。针对患者为合并肥胖的2型糖尿病，临床药师建议患者将胰岛素类药物改为非胰岛素类药物，推荐使用利拉鲁肽；针对血脂水平控制不佳情况，建议患者在口服辛伐他汀基础上加用非诺贝特，患者的主治医师同意上述建议并调整处方。临床药师并就每种药物的重要性、总能量的摄入控制、营养均衡的膳食、体育锻炼等对患者进行用药教育。6个月后随访结果显示，患者血糖（空腹血糖5～7 mmol/L，餐后血糖8～10 mmol/L）和血脂（总胆固醇4.80 mmol/L，三酰甘油1.60 mmol/L，低密度脂蛋白3.05 mmol/L）得到有效控制，体质量也减轻了3 kg，但生活方式改善较差，主要与其工作性质有关，临床药师再次与其沟通强调了适当体育锻炼的重要性，患者同意继续随访。结论：临床药师可借助MTM服务模式，为慢病患者提供专业的咨询和服务，对提升医疗质量具有一定的价值。 |
| ABSTRACT： | OBJECTIVE： To explore the role of clinical pharmacists in medication therapy management （MTM）. METHODS： Referring to the practice model of MTM in the United States， taking a noninfectious chronic disease （obesity diabetes mellitus） patient as an example， clinical pharmacists of endocrinology specialty carried out MTM according to five processes， such as patient information collection， medication therapy review， the formulation of medication-related action plan （MRP）， interventions related to direct communication with physicians or advising patients to consult relevant medical service personnel， record and follow-up. RESULTS： The information of patients collected by clinical pharmacists included past medical history， family history， allergy history and medication history， etc. It was the top priority MRP for this patient to identify inappropriate hypoglycemic drug therapy， obesity-induced obstructive sleep apnea-hypopnea syndrome and hyperlipidemia. For obesity patients with type 2 diabetes mellitus， clinical pharmacists recommend that patients changed insulin drugs to non-insulin drugs， and liraglutide was recommended. In view of the poor control of blood lipid level， fenofibrate was recommended for patients on the basis of oral administration of simvastatin. The patient’s attending physician agreed with the above suggestion and adjusted the prescription. Clinical pharmacists provided medication education for the patients about the importance of each drug， control of total energy intake， balanced diet and physical exercise. The follow-up results after 6 months showed that blood glucose （fasting blood glucose 5-7 mmol/L， postprandial blood glucose 8-10 mmol/L） and blood lipid （total cholesterol 4.80 mmol/L， triglyceride 1.60 mmol/L， low density lipoprotein 3.05 mmol/L） of the patient were effectively controlled and body weight was reduced by 3 kg， but the improvement of lifestyle was poor， mainly due to the nature of his work. Clinical pharmacists once again communicated with him and emphasized the importance of proper physical exercise. The patients agreed to continue the follow-up. CONCLUSIONS： Clinical pharmacists can provide professional consultation and service for patients with chronic diseases by means of MTM service mode， which has certain value for improving medical quality. |
| 期刊： | 2019年第30卷第13期 |
| 作者： | 熊欢，吴行伟，郭西芮，熊祥樽，张佳颖，龙恩武 |
| AUTHORS： | XIONG Huan，WU Xingwei，GUO Xirui，XIONG Xiangzun，ZHANG Jiaying，LONG Enwu |
| 关键字： | 药物治疗管理；肥胖型糖尿病；临床药师；实践 |
| KEYWORDS： | Medication therapy management； Obesity diabetes mellitus； Clinical pharmacists； Practice |
| 阅读数： | 379 次 |
| 本月下载数： | 13 次 |
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