药物重整结果分析与标准人工成本建立方法研究OA

Objective To investigate the working mode and cost-benefit of medication reconciliation implemented by clinical pharmacists.Methods A total of 101 patients with chronic obstructive pulmonary disease combined with type 2 diabetes mellitus admitted to the department of respiratory medicine of the hospital from September 2023 to August 2024 were selected and divided into the control group(50 cases)and the observation group(51 cases)according to the random number table method.The medication status,drug-related problem(DRP)and their influencing factors were analyzed,and targeted intervention measures were implemented for the patients in observation group.According to the actual hourly wage combined with standard time efficiency,or standard price combined with correction coefficient or base price,the calculation formula of labor cost(LC)of medication reconciliation was derived respectively,and then the benefit-cost ratio was calculated and compared to evaluate the intervention effect.Results Multivariate Logistic regression analysis showed that the number of comorbidities,in-hospital pharmaceutical knowledge level and the number of non-injection drugs were independent influencing factors for the occurrence of multiple(≥3)DRPs(P<0.05).A total of 380 DRPs were identified in all patients,and 380 targeted intervention plans were proposed one-to-one,including 188 plans(49.47%,without intervention)in the control group and 192 plans(50.53%)in the observation group.Among the intervention plans in the observation group,the main measure for medical staff was providing schemes(101 cases,52.60%),and the main measure for patients/family members/caregivers was oral education(58 cases,30.21%);the main intervention methods were drug withdrawal(171 cases,45.00%)and drug addition(86 cases,22.63%).After intervention,the change in pharmaceutical knowledge level of patients in the observation group was significantly higher than that in the control group(median value:2.00 point vs.0.00 point,P<0.05),while the incidence of secondary fungal infection(0 vs.12.00%)and cumulative defined daily doses[DDDs,(16.26±7.31)vs.(21.26±14.19)]were significantly lower than those in the control group(P<0.05).The average total time consumption of medication reconciliation per case was(47.94±5.88)min,with an average time efficiency of 0.74 point/min.The benefit-cost ratios of medication reconciliation for average hospitalization cost per case and total drug cost were 7.37 and 3.83,respectively.Conclusion The implementation of medication reconciliation by clinical pharmacists in the department of respiratory medicine can improve the pharmaceutical knowledge level of patients,and reduce the antibiotic use density and incidence of secondary fungal infection.In clinical practice,patients with multiple comorbidities,a large number of non-injection drugs and low pharmaceutical knowledge level should be taken as the key subjects of medication reconciliation.The establishment of LC for medication reconciliation in this study can provide reference for the formulation of charging standards for pharmaceutical services.