Objective To evaluate the application effect of clinical pharmacy services in the secondary prevention of stroke. Methods Hospitalized stroke patients were selected in Taihe Hospital from June 2013 to August 2014. The patients meeting the inclusion criteria were paired and sequentially numbered, and randomly divided into observation group (n=100) and control group (n=102). The patients were treated routinely during the hospitalization. The clinical pharmacists conducted the drug education. The control group implemented the telephone follow-up for guiding compliance behavior one month after discharge. The observation group continued to perform clinical pharmacist-leading service projects. The medication compliance (Morisky scale), systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1C), serum total cholesterol (TC), low density lipoprotein-C (LDL-C) and relapse rate were compared three months, six months and twelve months after the two groups discharged. Results The medication compliance, SBP, DBP, HbA1C, TC, LDL-C and recurrence rate after hospital discharge were no statistically significant (P>0.05) three months after the two groups discharged, but statistically significant between the two groups (P<0.05 or P<0.01) six months and twelve months after the two groups discharged. Levels of SBP, DBP, HbA1C, TC and LDL-C in the two groups were both significantly lower than before (P<0.05 or P<0.01). The relapse rate of the observation group three months, six months and twelve months after they discharged was 2.00%, 5.00% and 15.00%, respectively, and that of the control group was 2.94%, 13.72% and 28.43%, respectively. Conclusion The pharmacy services in the secondary prevention of stroke can improve the patient medication compliance and better control the blood pressure, blood glucose and blood lipid levels, and reduce the relapse rate. It should be recommended in the clinical practice work.
Key words:
Clinical pharmacy
;
Stroke
;
Secondary prevention
;
Continuation of the service
表2
两组患者用药依从性、血压、糖化血红蛋白和血脂比较
Tab.2
Comparison of medication compliance, blood pressure, glycosylated hemoglobin and blood lipid between two groups of patients ヌ±s
组别
例数
服药依从性 评分
SBP
DBP
HbA1C /%
TC
LDL-C
mmHg
(mmol·L-1)
对照组
102
入组时
-
151.55±14.10
94.75±13.50
7.94±1.68
5.69±0.98
4.12±0.67
出院后3个月
6.88±1.38
118.50±17.35*1
90.60±9.25*2
6.70±0.53*2
4.92±0.73*2
2.84±0.79*1
出院后6个月
4.98±1.45
125.80±17.10*1
91.20±8.35*2
7.31±0.64*2
4.78±1.04*2
3.92±0.61*2
出院后12个月
4.87±1.94
138.60±17.50*2
92.30±9.75
7.72±0.67
5.13±0.82
3.14±0.66*2
观察组
100
入组时
-
153.85±13.65
95.65±11.10
8.13±1.36
5.78±0.82
4.08±0.74
出院后3个月
7.08±0.64
120.20±15.80*1
89.80±8.65*2
6.62±0.44*2
5.08±0.75*3
2.76±0.52*2
出院后6个月
6.76±1.32*3
116.30±16.90*1*4
84.10±7.35*1*4
6.36±0.83*1*4
4.29±0.58*1 *4
2.20±0.55*1 *4
出院后12个月
6.18±1.28*4
117.40±16.30*1*3
84.30±9.60*1*4
6.87±0.35*2*3
4.36±0.69*2 *3
2.27±0.63*1 *4
Compared with the same group at the enrollment,*1P<0.01, *2P<0.05;compared with control group, *3P<0.01,*4P<0.05
LARSSON BW,LARSSONG.Patients views on quality of care: do they merely reflect their sense of coherence?[J].J Adv Nurs,1999,30(1):33-39.
The aim was to explore the relationship between patients' perceptions of the quality of care and their sense of coherence. The sample consisted of 782 Swedish in-patients at a gynaecological, a medical, an orthopaedic, and a surgical department. The median age was 59 years and 55% of the patients were women. Data were collected using the Quality from the Patient's Perspective (QPP) Questionnaire and the Sense of Coherence Questionnaire. The QPP consists of 61 items designed to measure the following four quality dimensions: the medical-technical competence and the degree of identity-orientation in the actions of the caregivers, the physical-technical conditions and the socio-cultural atmosphere of the care organization. Each question is posed in two different ways in the QPP; one measures perceived reality of the item in question and one the subjective importance the patient ascribes to it. Results showed that patients' ratings of perceived reality covaried systematically with their sense of coherence. This was particularly the case on questions rated by experts to be more abstract and emotionally loaded. Patients' ratings of the subjective importance of the items were weakly related to their sense of coherence. The results are discussed in terms of negative affectivity and culturally shared ideals regarding quality of care.
MORISKY DE,KROUSEL-WOODM,WARD HJ.Predictive validity of a medication adherence measure in an outpatient setting[J].J Clin Hypertens (Greenwich),2008,10(5):348-354.
This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
BUSHNELL CD,OLSON DM,ZHAOX,et al.Secondary preventive medieation persistenee and adherenee 1year after stroke[J].Neurology,2011,77(12):1182-1190.
ABSTRACT Data on long-term use of secondary prevention medications following stroke are limited. The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry assessed patient, provider, and system-level factors influencing continuation of prevention medications for 1 year following stroke hospitalization discharge. Patients with ischemic stroke or TIA discharged from 106 hospitals participating in the American Heart Association Get With The Guidelines-Stroke program were surveyed to determine their use of warfarin, antiplatelet, antihypertensive, lipid-lowering, and diabetes medications from discharge to 12 months. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications except those stopped according to health care provider instructions. Of the 2,880 patients enrolled in AVAIL, 88.4% (2,457 patients) completed 1-year interviews. Of these, 65.9% were regimen persistent and 86.6% were regimen adherent. Independent predictors of 1-year medication persistence included fewer medications prescribed at discharge, having an adequate income, having an appointment with a primary care provider, and greater understanding of why medications were prescribed and their side effects. Independent predictors of adherence were similar to those for persistence. Although up to one-third of stroke patients discontinued one or more secondary prevention medications within 1 year of hospital discharge, self-discontinuation of these medications is uncommon. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions.
MAR,WANGC,ZHAOX,et al.A survey on compliance with secondary stroke prevention guidelines and follow up for the inpatients with atherosclerotic cerebral infarction/transient ischemic attack[J].Neurol Res,2008,30(4):383-388.
Abstract Poor compliance with evidence-based medicine guidelines could significantly influence the effect of stroke prevention strategies. The objective of this survey is to evaluate the current status of adherence to secondary prevention guidelines based on evidence-based medicine and related lifestyle modifications, both at hospital discharge and 90 days after discharge for inpatients with atherosclerotic cerebral infarction/transient ischemic attack (TIA) in Beijing. The survey enrolled patients with cerebral infarction/TIA, from seven hospitals in Beijing consecutively from 1 October 2006 to 1 May 2007, and was designed to record detailed information including ACEI/ARB, statins, anti-platelet agent therapy, carotid endarterectomy, angioplasty or stent, smoking and weight control behaviors. Seven hundred and eight cerebral infarction/TIA inpatients had been enrolled over the past 7 months from the year of 2006 to 2007. The proportion of patients with ischemic stroke that have not taken any anti-platelet agents, statins and ACEI/ARB were 0.4, 41.8 and 63.6%, respectively. Twenty-seven percent of the total patients have not followed the instructions on quitting tobacco. Five hundred and eighty-eight patients who are suitable to have drug therapy were followed up 90 day after discharge: 26.9% have not adhered to anti-platelet agents; 52.6% have not been treated by statins, and 59.4% have not had ACEI/ARB to lower blood pressure. Only 66.9% of the smokers have been instructed by clinicians on smoking cessation at the time of discharge. The current status of drug therapy and life modification for secondary prevention on ischemic stroke and TIA in Beijing, China, is still very challenging. Clinicians should pay more attention to the patients' adherence to secondary stroke prevention guidelines, to enhance the effectiveness of stroke prevention through filling the gap between the clinical practice and evidence.
A survey on compliance with secondary stroke prevention guidelines and follow up for the inpatients with atherosclerotic cerebral infarction/transient ischemic attack
, 左金梅
