药师在抗生素合理应用中的作用

《抗菌药物临床应用指导原则》要求在医疗服务中合理应用抗生素,但在具体医疗实践中存在着无指征的预防用药,抗菌药物品种、剂量的选择错误等不合理应用的情况。这就要求医院药师要深入临床,收集抗生素使用信息,认真分析总结,采取有效的干预措施,指导临床合理应用抗生素,规范医疗用药行为,提升药物治疗水平。     

Oferta de servicios de atención farmacéutica: clave para un nuevo modelo de servicios de salud

La colaboración interdisciplinar entre profesionales sanitarios es esencial para mejorar los resultados en salud de la población. Las capacidades que poseen los farmacéuticos les convierten en profesionales que pueden contribuir al control integral de la farmacoterapia en coordinación con otros profesionales de la salud. El Consejo de Europa aprobó la resolución CM/Res(2020)3 sobre implementación de la atención farmacéutica en el sistema sanitario para promover el uso apropiado y seguro de los medicamentos. Entre las actividades a realizar mediante el proceso de atención farmacéutica destaca la detección de problemas relacionados con la farmacoterapia como son las contraindicaciones, duplicidades, errores de prescripción, interacciones, etc. La intervención farmacéutica en ese ámbito requiere establecer un marco de colaboración interprofesional adecuado. En el presente artículo se comentan los aspectos a abordar para afrontar el cambio de modelo hacia una farmacia asistencial, con una mayor integración e implicación en el sistema, todo ello bajo el amparo del Consejo de Europa.Palabras clave: Atención farmacéutica, Servicios farmacéuticos asistenciales, Farmacéuticos, Farmacia comunitaria, Colaboración interprofesional, Atención primaria de salud     

Identifying the important outcomes to measure for pharmacy-led,clinical services within primary care: A nominal group technique approach

BackgroundThe introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures.ObjectivesTo develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology.MethodsA modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered.ResultOverall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures.ConclusionsThe five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology.     

Evaluating digital competencies for pharmacists

BackgroundDigital technologies are widely used in healthcare. In the UK, Health Education England developed a framework on digital capabilities so that healthcare professionals could determine their health literacy, evaluate their competencies and identify their learning needs. For pharmacists, specific digital capabilities were developed - Digital Capabilities for the Pharmacy Workforce.AimThe aim of this study was to explore the views of pharmacists on digital competency in the workplace and evaluate the suitability of the Digital Capabilities Framework for the Pharmacy Workforce for use within clinical practice.MethodologyA focus group of experienced pharmacists working within the NHS in the UK was conducted and thematic analysis of the content was undertaken.ResultsSeven pharmacy staff took part in an online focus group. They held senior positions across various London NHS hospitals and in community settings. From the content of the focus group, four themes were identified: Theme 1 - Use of digital technology, Theme 2 - Digital competency and training of the pharmacy workforce, Theme 3 - Assessment of digital competency and Theme 4 - Evaluation of the Digital Capabilities Framework for the Pharmacy Workforce. The pharmacists in this study suggested that the Digital Capabilities Framework could be used as a helpful assessment tool to ensure that all staff should have the appropriate digital skills and capabilities to fulfil their pharmacy role.ConclusionWith widespread use of digital technologies in practice, there is a need for formal digital technology training for pharmacists. The Digital Capabilities Framework has the potential to be utilised as an assessment tool to ensure pharmacy staff have the appropriate levels of digital skills to fulfil their clinical duties and make their service more efficient.     

Incorporation of pharmacist pre-surgical calls to improve medication history completion rates

BackgroundThe accuracy and timeliness of documenting a medication history is an important aspect to ensure appropriate medication reconciliation during transitions of care. Surgical patients often have their medication history recorded just moments before surgery which may be rushed, incomplete or missed entirely. Between January and May 2020, 76.7% of surgical patients admitted to our institution had a medication history completed by a pharmacist prior to surgery.ObjectiveThe objective of this work is to improve the pharmacist medication history completion rates for pre-surgical patients before surgery by integrating pharmacist-led medication histories into the pre-operative pathway.MethodsThrough interdisciplinary collaboration, the pre-operative pathway for surgical patients was evaluated for opportunities to complete medication histories days prior to their scheduled procedure. Plan-Do-Study-Act (PDSA) cycles were utilized to make incremental improvements in practice.InterventionsThrough an iterative process, the pathway for cardiovascular surgery (CVS) patients was modified to include a scheduled pharmacist phone appointment in the days leading up to their surgical procedure. Utilizing these phone appointments, pharmacists complete patient medication history reviews and share a feedback loop to cardiovascular and peri-operative health care providers.ResultsThe iterative PDSA cycles revealed challenges to completing pre-surgical medication history calls without advance notice. Patient responsiveness to pre-surgical medication history calls improved with the incorporation of scheduled phone appointments. Between January 18 and May 31, 2021, pharmacists completed 359 of 376 scheduled CVS appointments (95.5%), improving the medication history completion rates for cardiovascular surgery patients from 84.8 to 93.0% (p = 0.000025). The completion rate for all surgical patients also improved from 76.7 to 85.1% (p < 0.00001).ConclusionsIncorporating scheduled pharmacist medication history appointments as a part of the pre-operative pathway was shown to expand the capacity for pharmacists to complete medication histories for patients prior to surgery. By reducing pharmacist workload on the morning of surgery, fewer patients were admitted to surgery without having their medication history reviewed by pharmacy. Future investigation should be considered to evaluate the impact on patient outcomes.     

The Collaborative Care Model: Realizing healthcare values and increasing responsiveness in the pharmacy workforce

Healthcare values are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. However, their ability to honor these values is significantly determined by the nature of the system in which they work. The paper starts by presenting the prevailing pharmacist workforce model, the ‘Atomistic’ Model, in Scotland, in which core roles are typically separated into hierarchically disaggregated jobs focused on one professional ‘pillar’: Clinician/Practice Provider; Educator; Leader/Manager; and Researcher. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating, lacking a shared purpose. Key strategic flaws include suboptimal responsiveness to population needs, inconsistency/inequity of care, erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. The paper contrasts this with an emerging workforce vision, the Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, supports sustainability and succession planning. Horizontal skills integration (across practice, leadership/management, education, and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-‘pillar’ professional curricula across the career spectrum. Potential challenges also are discussed.     

我国执业药师的素质缺陷及对策

当前我国执业药师普遍存在临床用药知识欠缺，本文对导致我国执业药师这一素质缺陷的原因进行剖析，准确定位，并围绕执业药师定位配套进行执业药师考试、不能很好履行处方审核及指导合理用药的职责。探讨解决对策。提出我国执业药师制度必须重新注册、继续教育以及其他相关制度的改革。