辅助生殖患者“CMO-PC”模式的构建与实践

    Construction and Practice of the “CMO-PC” Pharmaceutical Care Model for Assisted Reproductive Patients

    • 摘要:
      目的 探索西班牙“CMO-PC”能力(capacity)-动力(motivation)-时机(opportunity)-药学服务(pharmaceutical care)模式在医院辅助生殖药师门诊患者管理中的应用。
      方法 利用“CMO-PC”模式,以笔者所在医院辅助生殖药师门诊患者为服务对象,构建“患者分层评估-实施药学服务行动-利用远程药学服务,启发患者依从性共济管理”的临床实践工作模式。并对咨询病例进行回顾性分析。
      结果 2023年7月—2024年6月,利用“CMO-PC”模式累计管理患者350例,与前一年同期增加43.0%,建立患者档案163例(占比46.6%)。采用分层模型对患者的高危因素进行评估,其中优先级1级为42例次(12.00%),2级为95例次(27.14%),3级213例次(60.86%)。共实施药学服务行动497例次,包括提供备孕期用药咨询和指导16例次(8.12%);对辅助生殖患者进周期前院外使用药物进行重整,评估所使用药物对生育力的影响185例次(37.22%);对进周期后的特殊患者促排卵方案进行个体化制定27例次(5.43%);提供降调节药物、促排卵药物、诱发排卵药物、黄体支持药物的用药指导124例次(24.95%);移植前及移植后提供药物致畸风险评估以及环境因素暴露风险评估127例次(25.55%);妊娠后提供特殊疾病的治疗方案选择11例次(2.21%);在整个过程中,识别及处理辅助生殖药物不良反应7例次(1.41%)。通过微信、电话等渠道对患者实施远程药学服务19例次。
      结论 作为一种新型药学服务模式,“CMO-PC”模式可作为门诊药学服务的重要补充,帮助提升门诊药学服务效能,也为药事服务改革提供新思路。

       

      Abstract:
      OBJECTIVE  To explore the application of the “CMO-PC”(capacity-motivation-opportunity-pharmaceutical care) model in the reproductive pharmacy outpatient clinic.
      METHODS  The “CMO-PC” model was utilized to establish a clinical practice framework “patient stratification assessment, implementation of pharmaceutical care actions, and utilization of remote pharmaceutical care to inspire patient adherence through collaborative management” for patients attending the reproductive pharmacy outpatient clinic at author’s hospital. A retrospective analysis was conducted on consultation cases.
      RESULTS  From July 2023 to June 2024, a total of 350 patient consultations were managed using the “CMO-PC” model, representing a 43.0% increase compared with the same period of the previous year. Patient records were established for 163 cases(46.6%). A stratification model was used to assess high-risk factors, with 42 cases(12.00%) classified as prioridad 1, 95 cases(27.14%) as prioridad 2, and 213 cases(60.86%) as prioridad 3. A total of 497 pharmaceutical care actions were implemented, including 16 instances(8.12%) of providing preconception medication consultations and guidance; 185 instances(37.22%) of reorganizing medications used outside the hospital prior to the treatment cycle and assessing their impact on fertility; 27 instances(5.43%) of individualized protocol development for patients undergoing ovarian stimulation after the treatment cycle; 124 instances(24.95%) of medication guidance for down-regulating agents, ovarian stimulation medications, ovulation-inducing agents, and luteal support medications; 127 instances(25.55%) of conducting risk assessments for teratogenicity of medications and exposure to environmental factors before and after embryo transfer; 11 instances(2.21%) of selecting treatment plans for special diseases after pregnancy; and 7 instances(1.41%) of identifying and managing adverse drug reactions related to assisted reproductive medication. Remote pharmaceutical care were provided to patients 19 times through WeChat, phone calls.
      CONCLUSION As a novel pharmaceutical care model, the “CMO-PC” model can serve as an important supplement to outpatient pharmaceutical care, helping to enhance the effectiveness of these services and providing new insights for national pharmaceutical care reform.

       

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