有效的药物治疗管理可改善类风湿关节炎(RA)的关节功能及结构破坏相关的残疾/劳动力丧失。申请人通过开设上海首家药师门诊与社区专家工作室，开展药物流行病调研发现：RA患者自主调整剂量/漏服、药品服用方法不当及缺乏副作用监护等重要药物治疗管理问题；在所调查疾病中健康效用值最低，人均年直接医疗成本接近欧美。分级诊疗环境下患者转诊到基层后更缺乏规范的后续管理，科学性/标准化的药物治疗管理模式亟待建立。.本项目拟基于B-SMART管理新模式，开展医联体下RA患者药物流行病调查并建立电子用药档案；以套索回归分析构建依从性数学预测模型，通过危险分层确定重点监护对象，向基层延伸三甲医院药学服务；以临床结局/成本-效益为评价指标，通过随机对照实验评价新模式并持续改进，最终构建“药师参与的社区-三级医院联动的多元/个体/互联网化”的药物治疗管理新模式，推动RA等慢病分级诊疗的科学管理，减轻患者及国家经济负担。

Effective management of medication treatment can improve the joint function and structural of RA and avoid related disability/labor loss. The applicant initially opened the first pharmacist clinic in Shanghai and joined the community expert workshops. The applicant found major medication problems of RA patients were: the lack of adverse reaction monitoring, taking drug with inappropriate methods, self adjustment dose, missing dose, and even withdrawal. The health utility of RA patients in our hospital is the lowest among the surveyed rheumatic diseases; the annual direct medical cost per capita is close to that of Europe and America. In a graded diagnosis and treatment environment, the patient's referral to a community hospital is more likely to lack of standardized follow-up management. Thus, The scientific/standardized management model of drug treatment needs to be established urgently. In this project, we plan to: 1) further investigate the drug epidemiology of the community patients under the Medical Union, establish the compliance prediction model, and determine the key guardianship objects by risk stratification. 2) According to the prediction model built in the early stage, we adopted the B-SMART mode to take appropriate intervention measures for all kinds of drug problems and extend the outpatient clinical pharmacy services to the community hospital. 3) Use randomized controlled experiments to verify the effectiveness and continuous improvement of the new model with clinical outcomes and cost-effectiveness as the evaluation indicator. This project applies the B-SMART model to the RA, and constructs a pharmacist led community-tertiary hospital associated multi/individual/Internet management model. This study promotes the standardized treatment and follow-up management of RA and other chronic diseases to reduce the disease burden of patients and the state.