This study explored whether clinical pharmacists can improve patients' medication compliance with the use of warfarin medication checklist and the correlation between them. A total of 147 inpatients discharged from Shanghai Tongren Hospital with warfarin from July 2018 to September 2019 were randomly divided into the control group and the intervention group by random number table, including 75 in the control group and 72 in the intervention group. There were no statistically significant differences in gender, age, marital status, drinking history, smoking history, department distribution, type of thromboembolic disease, comorbidity and combined medication between the two groups (P>0.05). The control group received routine warfarin medication education at discharge, while the intervention group received clinical pharmacist's assessment of bleeding risk and targeted medication education using warfarin medication checklist at discharge. The monitoring time and value of the international normalized ratio (INR) between the two groups during hospitalization and within 6 months after discharge were recorded, as well as warfarin-related adverse events. The Morisky Medication Adherence Scale was used to evaluate the medication compliance of patients in the two groups. Spearman correlation analysis was used to study the relationship between warfarin compliance and variables in the warfarin medication checklist. The intervention group had better follow-up regularity than the control group (χ²=34.3, P<0.001), and the medication compliance in the intervention group was better than that in the control group (χ²=38.6, P<0.001). There were significant correlations between warfarin compliance and duration of warfarin therapy (R=-0.275, P=0.027), number of comorbidities (R=-0.335, P=0.004), bleeding risk (R=-0.433, P<0.001). In conclusion, using warfarin medication checklist can improve patients' medication compliance. Patients' medication compliance was significantly negatively correlated with duration of warfarin therapy, number of comorbidities and bleeding risk. Clinical pharmaceutical care can improve the medication compliance of patients with warfarin, so as to improve the medication results, which may be helpful for the drug treatment of patients with chronic diseases.
本研究探索临床药师借助华法林用药清单是否能提高患者服药依从性以及两者之间的相关性。选取2018年7月至2019年9月上海市同仁医院出院带药华法林的147例住院患者，按照随机数字表法分为对照组和干预组，其中对照组75例，干预组72例。两组患者在性别、年龄、婚姻状况、饮酒史、吸烟史、科室分布、血栓栓塞性疾病种类、合并疾病及合并用药上，差异均无统计学意义（P>0.05）。对照组出院时进行常规华法林用药教育，干预组出院时临床药师使用华法林用药清单对其进行出血风险评估及有针对性的用药教育。记录两组患者住院期间及出院6个月内国际标准化比值（international normalized ratio，INR）的监测时间和数值，及华法林相关不良事件。采用Morisky服药依从性量表评估两组患者的服药依从性。采用Spearman相关分析研究华法林服药依从性与华法林用药清单中各变量之间的关系。干预组随访规律性优于对照组（χ²=34.3，P<0.001），服药依从性优于对照组（χ²=38.6，P<0.001）。华法林用药清单中华法林治疗时间（R=-0.275，P=0.027）、合并疾病种数（R=-0.335，P=0.004）、出血风险（R=-0.433，P<0.001）与华法林服药依从性之间存在显著相关性。综上，采用华法林用药清单能提高患者服药依从性。患者服药依从性与华法林治疗时间、合并疾病种数及出血风险呈显著负相关，临床药学服务可以提高患者华法林服药依从性，从而改善用药结果，可能对慢性疾病患者药物治疗有帮助。.