Application Effect of Medication Therapy Management in the Standardized Treatment of Cancer Pain

doi:10.12114/j.issn.1007-9572.2019.00.559

Abstract

Abstract: Background　At present，some hospitals in China have achieved preliminary results in exploring the medication treatment management（MTM） methods and applying them to cancer pain management.However，the MTM model of cancer pain is still in the exploration stage.There are few empirical studies in the MTM of cancer pain，and the MTM model of cancer pain needs to be constructed.The mode of pharmacists' work and the effects in cancer pain management remain to be examined.Objective　To systematically evaluate the efficiency of clinical pharmacists in the use of MTM to participate in the standardized treatment of cancer pain，and to explore how clinical pharmacists use MTM to provide high-quality and efficient pharmacy services for patients with cancer pain.Methods　A total of 122 patients with tumor-related pain admitted to the Department of Oncology of Xingyi People's Hospital were enrolled from April 2017 to March 2018.And they were randomly divided into the experimental group（n=61） and the control group（n=61） by random number table method.In the control group，61 patients were routinely treated by doctors and nurses，and the other 61 patients in the experimental group were given MTM services（MTMs） by clinical pharmacists to provide a full-course pharmacy service on the basis of the control group.The Visual Analogue Scale（VAS） scores，clinical outcomes，medication adherence，and the incidence of adverse drug reactions between these two groups were compared.Results　After seven days of treatment，the VAS score of experimental group was lower than that of the control group（P<0.05）．The VAS scores of the two groups after seven days of treatment were lower than those before treatment（P<0.05）．There was no significant difference in the incidence of breakthrough pain between the experimental group〔54.1%（33/61）〕 and the control group〔59.0%（36/61）〕（P>0.05）．The remission rate of the breakthrough pain in the experimental group〔72.7%（24/61）〕 was higher than that in the control group〔47.2%（17/61）〕（P<0.05）．After two weeks of treatment，the effective rate of pain relief in the experimental group was 91.8%（56/61），which was higher than 63.9%（39/61） of the control group（P<0.001）．After two weeks of treatment，the medication adherence of the experimental group was superior to that of the control group（P<0.001）．There was no significant difference in medication adherence of the control group before and after two weeks of treatment（P=0.573）．The medication adherence of the experimental group after two weeks of treatment was better than that before treatment（P<0.001）．The incidence of constipation，nausea，vomiting in the experimental group were lower than that in the control group（P<0.05）．Conclusion　The application of MTM in the standardized treatment of cancer pain has improved the analgesic effect and medication adherence of patients with cancer pain，and reduced the incidence of adverse drug reactions.The multi-disciplinary team（MDT） treatment model of cancer based on MTM served by clinical pharmacists can effectively promote the development of disciplines，improve the level of diagnosis and treatment of cancer pain，improve the patient experience of medical treatment and further enhance patients' sense of gain.

Key words: Drug therapy, Cancer pain, Clinical pharmacist, Pharmaceutical services, Medication therapy management, Multidisciplinary treatment

摘要： 背景　目前，我国有部分医院在探索药物治疗管理方式并将其应用于癌痛管理中，取得了初步的效果，但癌痛药物治疗管理模式仍处于探索实践阶段，实证研究较少，运行模式有待构建，模式中药师的工作形式以及癌痛管理效果有待考察。目的　评价临床药师运用药物治疗管理参与癌痛规范化治疗的效果，探索临床药师如何运用药物治疗管理为癌痛患者提供优质、高效的药学服务。方法　选取2017年4月—2018年3月兴义市人民医院肿瘤科收治的122例肿瘤相关性疼痛患者，采用随机数字表法，将其分为试验组和对照组，各61例。对照组仅由医师及护理人员进行传统癌痛治疗，试验组由临床药师应用药物治疗管理模式全程化服务于癌痛患者。比较两组疼痛评分、疗效、用药依从性及药品不良反应发生率。结果　治疗7 d后，试验组疼痛评分低于对照组（P<0.05）；两组治疗7 d后疼痛评分均低于治疗前（P<0.05）。试验组〔54.1%（33/61）〕和对照组〔59.0%（36/61）〕爆发痛发生率比较，差异无统计学意义（P>0.05）；试验组爆发痛的缓解率〔72.7%（24/61）〕高于对照组〔47.2%（17/61）〕（P<0.05）。治疗2周后，试验组疼痛缓解有效率为91.8%（56/61），高于对照组的63.9%（39/61）（P<0.001）。治疗2周后，试验组用药依从性优于对照组（P<0.001）。对照组治疗前和治疗2周后用药依从性比较，差异无统计学意义（P=0.573）；试验组治疗2周后用药依从性优于治疗前（P<0.001）。试验组便秘、恶心、呕吐发生率均低于对照组（P<0.05）。结论　药物治疗管理在癌痛规范化治疗中的应用，使癌痛患者的止痛治疗效果得到了提升，提高了患者用药依从性，降低了药物相关不良反应发生率。基于临床药师药物治疗管理服务的肿瘤多学科诊疗模式，可有效促进学科发展，提升癌痛诊疗水平，改善患者就医体验，进一步增强居民获得感。

关键词: 药物疗法, 癌痛, 临床药师, 药学服务, 药物治疗管理, 多学科诊疗

LYU Tianyi,WU Yu'e,HU Rongchao, et al. Application Effect of Medication Therapy Management in the Standardized Treatment of Cancer Pain　[J]. Chinese General Practice, 2020, 23(17): 2142-2146. DOI: 10.12114/j.issn.1007-9572.2019.00.559.
吕天益,吴玉娥,胡荣超等. 药物治疗管理在癌痛规范化治疗中的应用效果研究[J]. 中国全科医学, 2020, 23(17): 2142-2146. DOI: 10.12114/j.issn.1007-9572.2019.00.559.

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