目的:探究欧洲医药保健网(Pharmaceuti-cal Care Network Europe,PCNE)分类系统用于评价肾移植受者他克莫司浓度波动药物相关问题(drug related problems,DRPs)的作用.方法:以门诊随访中出现他克莫司血药浓度波动、临床药师介入干预的肾移植受者为研究对象,利用PCNE(9.0)分类系统评价他克莫司的DRPs,并对存在DRPs的问题、原因、介入方案、介入方案的接受和状态进行分析.结果:本研究纳入2019年7月至2021年12月肾移植受者700例,发现1 014个他克莫司DRPs.DRPs的问题包括发生药物不良事件(P2.1,60.16％)和治疗效果不佳(P1.2,39.84％);原因主要包括剂量选择(C3,43％)、其他(C9,38.4％)和药物选择(C1,9.41％);临床药师从受者层面(I2,98.92％)和药物层面(I3,1.08％)积极介入;介入方案(A1.1+A1.3)的接受率达98.62％,完全执行(A1.1)率达72.09％;79.29％的DPRs被全部解决或部分解决(O1.1和O2.1).结论:临床药师可将PC-NE用于评价他克莫司治疗药物监测(therapeutic drug monitoring,TDM)相关 DRPs,助力 TDM 药学服务模式标准化,规范TDM异常结果解读和干预工作,促进安全合理用药.
Abstract
AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolim-us blood concentrations and clinical pharmacist in-tervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,inter-vention plans,acceptance and status were ana-lyzed.RESULTS:A total of 700 kidney transplant re-cipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16％)and poor treatment out-comes(P1.2,39.84％);The main reasons included dosage selection(C3,43％),others(C9,38.4％),and drug selection(C1,9.41％);Clinical pharmacists ac-tively intervened at the recipient level(I2,98.92％)and drug level(I3,1.08％);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62％,and the complete implementation rate(A1.1)reached 72.09％;79.29％of DPRs were fully or par-tially resolved(O1.1 and O2.1).CONCLUSION:Clini-cal pharmacists can use PCNE to evaluate tacrolim-us therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical ser-vice models,standardize TDM abnormal result in-terpretation and intervention workflows,and pro-mote safe and rational drug utilization.
关键词
肾移植/他克莫司/治疗药物监测/结果干预/欧洲医药保健网
Key words
kidney transplantation/tacrolimus/therapeutic drug monitoring/outcome interven-tion/Pharmaceutical Care Network Europe
维普
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