关键词: 慢性病, 社区卫生中心, 药用制剂, 病人医护管理

Abstract: Objective　To study the impact of integrated management and intervention on drug usage in community patients with chronic diseases.Methods　From May 2016 to July 2017，242 patients with chronic diseases treated in the Changfeng Community Health Care Center，Putuo（hereinafter referred to as the "center"）in Shanghai City who met the study inclusion and exclusion criteria were enrolled in this research.Baseline patient data including diseases and drug usage were recorded.Patients provided informed consent，and inappropriate drug use in these patients was recorded using a management and intervention strategy.After 3 months of intervention，drug usage（the number of administered drugs，drug adjustment and reasons）in the patients was investigated when the patients were stable and compared with the baseline data.Results　Diseases recorded were as follows：200 cases（82.6%）had hypertension，122 cases（50.4%）had coronary heart disease，63 cases（26.0%）had diabetes，55 cases（22.7%）had stroke，13 cases（5.4%）had osteoarthritis，12 cases（5.0%）had osteoporosis and 8 cases（3.3%）had chronic obstructive pulmonary disease（COPD）.There was no significant difference in the number of diseases between male and female patients（P>0.05）.Patients aged 80 years and ≥85 years suffered more diseases than patients aged 60 years and <60 years，and patients aged 70 years suffered more diseases than patients aged 60 years，patients aged 80 years also had more diseases than patients aged 65 years（P<0.05）.The number of administered drugs after the intervention was less than the number before the intervention（P<0.05）.Changes in the number of administered drugs were as follows：overall（-23.8%），male（-22.4%），female（-25.0%）；diseases according to their absolute change rates were COPD（-45.0%），stroke（-37.9%），osteoporosis（-28.6%），coronary heart disease（-24.0%），hypertension（-21.9%），osteoarthritis（-14.3%）and diabetes（-7.1%）.Before and after intervention，the number of administered drugs in male and female patients were not significantly different（P>0.05）.The number of administered drugs after the intervention was less than the number before the intervention in both male and female patients（P<0.05）.The number of administered drugs in patients with hypertension，coronary heart disease，stroke，diabetes or COPD after the intervention was less than the number before the intervention（self-comparison）（P<0.05），and both osteoporosis or osteoarthritis showed no significant difference（P>0.05）.Of the 242 patients，the number of drugs administered increased in 9 cases（3.7%），the number of drugs administered decreased in 142 cases（58.7%）and no change in the number of drugs administered was observed in 91 cases（37.6%）.Of 151 cases whose administered drugs were changed，there were 206 drug adjustments；the most common reasons for adjustment included：95 items（46.1%）of disease release，67 items（32.5%）of repeat medication，18 items（8.8%）of adverse reactions，14 items（6.8%）of irrational medication，and 12 items（5.8%）of increasing medication due to treatment requirement.Conclusion　Community patients often have multiple diseases and are administered multiple drugs.Integrated management and intervention can reduce repeat and irrational medications.

Key words: Chronic disease, Community health centers, Pharmaceutical preparations, Patient care management