1、药物治疗管理服务 医院药师的主战场浙江大学医学院附属二院药剂科周权，颜小锋 办公电话： 0571-87784615全天候电话： 13588758501电子邮件： 何为 “药物治疗学 ”？Pharmacotherapeutics，是研究 临床治疗实践中合理用药策略 的一门学科。着重研究两方面问题： 如何正确选用药品和制定给药方案 ? 如何正确使用药品 ?What is Medication Therapy Management (MTM)? MTM is a group of services designed to help patients get the most benefit from
2、 drug therapy.药物治疗管理 服务 Medication Therapy Management Service (MTMS). The Mission of MTMS:To assist patients with multiple chronic conditions with the management of drug therapyTo reduce drug-related adverse events and improve overall patient outcomesA sample conversation between a pharmacist and a
3、nursePharmacist: Did you know that our pharmacy is offering something called medication management services?Nurse: No, what is that?Pharmacist: We call it MTM. We actually sit down with patients like Mrs. who are taking 10 or more medications and have 4 or more disease states, and help resolve their
4、 drug problems. We help them manage side effects. We help them with cost savings and formulary issues, and things of that nature. If we are resolving these issues, they are going to stop calling your office. The patient will be feeling better and doing better. MTMS include but are not limited to the
5、 following, according to theindividual needs of the patient:a. Performing or obtaining necessary assessments of the patients health status;b. Formulating a medication treatment plan;c. Selecting, initiating, modifying, or administering medication therapy;d. Monitoring and evaluating the patients res
6、ponse to therapy, including safety and effectiveness;e. Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events;MTMS include but are not limited to the following, according to theindividual needs of the patient:f. Docu
7、menting the care delivered and communicating essential information to the patients other primary care providers;g. Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications;h. Providing information, support services and resources des
8、igned to enhance patient adherence with his/her therapeutic regimens;i. Coordinating and integrating medication therapy management services within the broader health care-management services being provided to the patient.药物治疗管理的最大卖点 患者急需多重疾病多重用药多科、多医、多院就诊不依从性该用药不用药 ， 不该用药去用药，用了药又没有把药用好 患者愿意接受 MTMS医院
9、药师从药品为中心要勇于转换到以药物治疗为中心。案例患者情况：双侧颈动脉粥样斑块，颈动脉狭窄（ 74%）77y糖尿病高血压心绞痛血脂： LDL 115mg/dl 前列腺增生房颤射频消融术后退休机关干部、经济条件可。服用药物： D860+二甲双胍，血糖控制可。 非洛地平片 1片 bid，每晚 100mg阿司匹林，间断性服用高特灵，消心痛片。近来自感头晕、人不舒服熟悉 “药物治疗过程 ”对于药师来说，非常重要 评估疗效和 ADR。决定继续、调整或终止治疗方案明确诊断确定药物 治疗目标确定治疗方案，设置 药物治疗监测计划药物调配、启动药物治疗药物治疗管理服务 药师首先应对诊断有一定了解正确的诊断是在综合分析各种临床信息的基础上做出的，包括患者主诉、详细的病史、体格检查、实验室检查等。直接与药物治疗方案制定有关 ; 要清楚患者当前存在的问题以及最重要的问题。
