中国临床药学杂志

目的 探讨医师-药师联合癌痛门诊服务模式在门诊癌痛患者管理中的应用效果。方法 制订医师-药师联合癌痛门诊的标准服务流程，应用该工作模式开展门诊癌痛患者管理实践。以2021年1月至2022年3月期间疼痛科/肿瘤内科接诊的接受阿片类药物镇痛治疗并建立门诊癌痛专用病历的成人癌痛患者作为研究对象，最终纳入100例患者，分为对照组和观察组，各50例。对照组接受常规的医师问诊和调剂药师的用药交待；观察组接受医师-药师联合癌痛门诊的标准服务流程，即在对照组基础上增加临床药师干预，干预时间为2个月。干预前（第1次评估）和干预后（第2次评估）以疼痛数字评分法评估疼痛程度，简明疼痛评估量表（BPI）评估疼痛对生活的影响，疼痛控制满意度评估表评估患者对疼痛管理的满意度。结果 与第1次评估比较，第2次评估时2组患者在过去24 h最剧烈疼痛和平均疼痛程度均有所缓解（P <0.05）；与对照组比较，观察组改善更加明显（P <0.01）。第2次评估时，观察组BPI 7个项目的评分均明显低于第1次评估，且低于对照组（P <0.01）；观察组的患者对疼痛管理的满意度第2次评估较第1次有明显提升（P <0.01），而对照组前后2次评估患者对疼痛管理的满意度差异无统计学意义（P> 0.05）。结论 医师-药师联合癌痛门诊服务模式有助于门诊癌痛患者的疼痛管理。经临床疼痛药师干预后，患者的疼痛程度、对疼痛管理的满意度及疼痛对生活的影响均有明显改善。

AIM To explore the application effect of service model of doctor-pharmacist joint cancer pain outpatient service model in the management of cancer pain patients in the outpatient department. METHODS The standard service flow of the doctor-pharmacist joint cancer pain clinic was established, and the practice of cancer pain patient management was carried out. Adult cancer pain patients who received opioid analgesia treatment and established outpatient special cancer pain medical records during January 2021 to March 2022 in the pain department/oncology department were selected as the study object. The 100 patients who met the inclusion and exclusion criteria were eventually included and divided into control group and observation group. The 50 patients in the control group received routine doctor's consultation and medication report from a dispensing pharmacists. The 50 patients in the observation group received the standard service process of physician-pharmacist combined cancer pain clinic, which added clinical pharmacist intervention on the basis of control group. The duration of intervention was 2 months. The pain control, the impact on life and the satisfaction of pain management before and after intervention were compared between 2 groups.RESULTS At the second assessment, both groups showed reductions in the most intense pain and mean pain severity over the past 24 h compared to the first assessment, and the observation group showed more significant improvements compared to the control group(P < 0.01). Scores of 7 items in Brief Pain Inventory(BPI) in the observation group were significantly lower than those in the control group(P < 0.01), and the satisfaction of patients in the observation group was significantly improved(P < 0.01), while there was no significant difference in the control group(P > 0.05). CONCLUSION The service model of doctor-pharmacist joint cancer pain clinic is helpful to the management of outpatient cancer pain patients. After the intervention of clinical pain pharmacists, patients' pain control, impact of pain on life and satisfaction with pain management are significantly improved.