Pharmaceutical care in chain pharmacies: beliefs and attitudes of pharmacists and patients.

OBJECTIVE: To discuss with pharmacists and patients with reactive airways disease their beliefs about pharmaceutical care and the pharmacist's role in health care, obstacles to providing pharmaceutical care in community pharmacies, and strategies to overcome these obstacles. DESIGN: Two focus groups of patients, two focus groups of pharmacists. PARTICIPANTS: Thirteen patients with reactive airways disease and 11 chain pharmacists. MAIN OUTCOME MEASURES: Qualitative reports on the pharmacist's role in health care delivery and obstacles to implementing pharmaceutical care programs. RESULTS: Pharmacists wished to provide pharmaceutical care, and patients were supportive of pharmacists' involvement in their health care. Both viewed counseling as an important role for pharmacists and believed that pharmacists should work with patients' physicians. Reported obstacles included lack of time, inadequate privacy, and pharmacists' lack of direct access to patients' physicians. Pharmacists and patients believed pharmacists should have access to patient-specific clinical data. CONCLUSION: Focus groups provided valuable information for designing pragmatic pharmaceutical care. The obstacles and possible solutions identified through the discussions represent fertile ground for designing innovative pharmaceutical care programs.     

Assessing the structure and process for providing pharmaceutical care in Veterans Affairs medical centers.

The structure and process used in providing pharmaceutical care to ambulatory care patients at nine Veterans Affairs medical centers (VAMCs) were studied. Institutions participating in the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) study were selected. To assess the level of pharmaceutical care services provided to ambulatory care patients, 10 critical domains were identified. Six instruments with questions related to each domain were then designed, including a clinical pharmacist survey and an outpatient pharmacist survey. Each center was assessed through three surveys and an onsite visit. The investigators used both direct observation and a consensus approach to score the level of ambulatory care pharmaceutical services provided. The clinics in which IMPROVE study patients would be seen were run by pharmacists (33%), physicians (44%), and multidisciplinary teams (22%). Of the 51 clinical pharmacists surveyed, 23 (45%) had prescribing authority via protocols, 14 (28%) had unrestricted prescribing privileges, and 14 did not have prescribing authority. The sites varied greatly in referral patterns, methods of identifying patients, and whether patient visits were scheduled or on a walk-in basis. There was a strong correlation between observed activities by clinical pharmacists and their self-reports and between observed activities by outpatient pharmacists and their self-reports. Activities reported by clinical pharmacists were moderately but not significantly correlated with consensus scores, and activities reported by outpatient pharmacists were poorly correlated with consensus scores. The structure and process for providing pharmaceutical care to ambulatory care patients at VAMCs were evaluated with surveys, direct observation, and a consensus-based scoring system.     

药师对1例转移性乳腺癌术后伴癌痛患者的药学监护

目的 通过参与1例癌症疼痛患者的药物治疗和药学监护过程,临床药师参与制订药物治疗方案,并提出合理化用药建议,同时对患者进行健康教育,以减少或避免药物不良反应的发生.方法 药师通过参与审方、发现问题,对不当处方及时干预,与医生沟通、更改用药方案,对患者进行健康教育等方式,参与患者的药学监护过程.结果 在药师的干预下,医生...     

The pharmacist’s active role in combating COVID-19 medication misinformation

Pharmacists listen to and dispel medication misinformation daily. Because of their accessibility, pharmacists have the opportunity during pharmacist-patient interactions to begin a dialogue with their patients and provide critical education to improve patient safety and public health. Current examples of pharmacists intervening with medication misinformation include addressing the antivaccination community, educating on the safety of generic drugs, and using evidence-based medicine for antimicrobial stewardship. However, combating medication misinformation in pharmacy practice with patients takes on many forms and can pose a number of challenges. Most recently during the coronavirus disease 2019 (COVID-19) pandemic, a concurrent infodemic has led to claims of pharmacotherapeutic superiority and efficacy unsubstantiated by scientific evidence. Misinformation and partisan politics have also created a distrust in COVID-19 vaccine development. In addition, rogue Internet pharmacies and companies have marketed new and unverified COVID-19 treatments and tests. Pharmacists must actively combat these instances of medication misinformation and educate their patients on how not to fall victim to convincing marketing and misinformation schemes. Pharmacists can help patients recognize misinformation by vetting sources of information and communicating how negative emotional information circulates. In addition, pharmacists combat misinformation with patients by providing accurate alternative explanations in patient-friendly language. Although it is easier to stay silent and let misinformation circulate, pharmacists must work with their health care team members to actively reject misinformation pertaining to medications, COVID-19 pharmacotherapy and vaccinations, and in any future public health crisis.     

Impact of pharmacists' directive guidance behaviors on patient satisfaction

OBJECTIVE: To determine the impact of directive guidance (DG) behaviors by pharmacists on patient satisfaction with pharmaceutical care services. DG behaviors are social support behaviors and include such activities as supplying information about medications and providing encouragement and feedback regarding drug therapy. DESIGN: Cross-sectional observational study using a self-administered survey. SETTING: Two university-affiliated ambulatory care clinics, two chain pharmacies, and one independent pharmacy. PATIENTS: One hundred sixty patients with a chronic disease (e.g., asthma, hypertension, diabetes). MAIN OUTCOME MEASURE: Patient satisfaction with pharmaceutical care services. RESULTS: A total of 160 completed questionnaires were collected from patients at 5 sites. Overall, patients patronizing ambulatory care clinics perceived higher rates of DG behaviors and were more satisfied with pharmaceutical care services, compared with patients in community pharmacies (P < .05). The hierarchical regression model was significant (F(13,112) = 4.9091, P < .001). DG behaviors explained 32.4% (P < .001) of the variance in patient satisfaction with pharmaceutical care services. CONCLUSION: Higher rates of DG behaviors by pharmacists are associated with greater patient satisfaction with pharmaceutical care services.     

原发性肾病综合征患者的药学监护要点

目的：探讨对原发性肾病综合征患者药学监护的要点.方法：原发性肾病综合征主要治疗药物包括糖皮质激素、环孢素、环磷酰胺等免疫抑制药;根据患者的病理生理状态,采取利尿消肿、降压等对症支持治疗,抗凝和抗血小板聚集、调脂等并发症治疗.通过实例,从药物特点、用法用量、不良反应、相互作用、用药注意事项等方面探讨药学监护方法.结果：通过实施药学监护,为临床提供了合理用药方案.结论：对原发性肾病综合征患者实施药学监护保证了临床安全、有效用药.     

Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers

We examined the impact of ambulatory care clinical pharmacist interventions on clinical and economic outcomes of 208 patients with dyslipidemia and 229 controls treated at nine Veterans Affairs medical centers. This was a randomized, controlled trial involving patients at high risk of drug-related problems. Only those with dyslipidemia are reported here. In addition to usual medical care, clinical pharmacists were responsible for providing pharmaceutical care for patients in the intervention group. The control group did not receive pharmaceutical care. Seventy-two percent of the intervention group and 70% of controls required secondary prevention according to the National Cholesterol Education Program guidelines. Significantly more patients in the intervention group had a fasting lipid profile compared with controls (p=0.021). The absolute change in total cholesterol (17.7 vs 7.4 mg/dl, p=0.028) and low-density lipoprotein (23.4 vs 12.8 mg/dl, p=0.042) was greater in the intervention than in the control group. There were no differences in patients achieving goal lipid values or in overall costs despite increased visits to pharmacists. Ambulatory care clinical pharmacists can significantly improve dyslipidemia in a practice setting designed to manage many medical and drug-related problems.     

开展社区药学服务的实践探讨

目的:探讨开展社区药学服务的途径和意义。方法:药师走出医院,深入社区,针对常见病、慢性病患者进行健康宣教和用药知识讲座,追踪重点患者并定期随访,提供社区药学服务。结果:药师通过多学科知识积累和沟通交流技巧学习,在药学服务实践中,根据患者的具体情况,进行针对性的用药咨询和宣教,指导社区患者了解饮食调整方法、药物作用机理和病程特点,帮助患者了解药物、战胜疾病。结论:开展社区药学服务,能够发挥药师职能,促进用药知识传播,有助于提升合理用药、提高公众健康和生活质量。     

妇幼专科医院患者药事服务权利需求调查分析

目的:了解妇幼专科医院门急诊患者对隐私保护、用药交代、服务效率等药事服务权利需求状况,为药事服务的完善提供参考。方法:设计问卷并调查门诊患者和急诊患者对药事服务权利的需求并对其进行分析。结果:门诊取药患者发放200份问卷,有效问卷178份;急诊取药患者发放70份问卷,有效问卷67份。患者最为关注的药事服务权利依次是用药交代、服务效率、隐私保护。结论:应针对不同类型患者的需求,平衡隐私保护与服务效率、用药交代的关系,优化服务流程,提升药事服务质量,更好地服务于患者。     

疼痛药学门诊工作模式与成效

目的：探讨临床药师针对门诊疼痛患者进行药学服务的工作模式及成效。方法：简述2种不同的疼痛患者门诊药学服务模式,并对药师独立的疼痛药学门诊患者的用药教育效果进行分析。选择2017年1月至6月在某院疼痛药学门诊就诊的患者198名填写问卷,临床药师对其进行药学照护和用药教育,对比患者教育前后的问卷得分情况。结果：患者用药教育前得分是3.18±1.98,用药教育后得分是12.56±2.24,结果有统计学差异（P<0.001）。结论：通过开设不同模式的药学门诊,临床药师在门诊疼痛患者的诊疗中发挥了积极的作用,为其他专科药学门诊的开展提供了新思路。     

婴儿痉挛症的药学监护要点

目的:为临床药师针对婴儿痉挛症患儿实施药学监护提供参考。方法:通过理论联系临床实践,形成对婴儿痉挛症的系统药学监护要点。结果与结论:临床药师通过对婴儿痉挛症患儿住院期间的药学服务及出院前用药教育,可提高患儿用药的安全性及有效性。     

中药师对艾滋病患者的临床药学服务

目的:总结我院中药师开展艾滋病患者临床药学服务的经验。方法:对我院中药师参与艾滋病患者救治的实践经验进行概括分析,从感性认识上升为理性认识。结果:运用专业知识开展中医药艾滋病临床服务,可以收到良好效果。结论:中药师要努力建立一个开放的新型药学服务模式,注重医患沟通,将心理治疗、人文关爱贯穿整个药学服务的始终,提高患者的用药依从性。     

重大突发性公共卫生事件下临床药学服务在贵州省医疗救治体系中的应用现状研究

目的：调查临床药学服务在贵州省医疗救治体系中的开展现状,为未来在重大突发性公共卫生事件中最大化发挥临床药学服务效能提供相关建议。方法：通过三甲医院药学部门负责人个人深入访谈及10家三甲医院的药师、医师和住院患者实地问卷调查,对贵州省临床药学服务的开展现状进行调研。结果：本次调查的药师主要以大专/本科学历、拥有初级职称的青年女性为主;药师对临床药学服务的了解度与药师的学历（P=0.002）以及是否参与过临床药学服务培训（P=0.004）之间密切相关;医师对重大突发事件应急预案的了解度高于药师（P=0.024）;参与过重大突发事件的药师比未参与过的在日常药学服务上涉及更多的用药监测（P=0.027）和治疗方案制定（P=0.014）服务;参与过重大突发事件的药师比未参与过的更肯定自我地位（P=0.032）和临床药学服务能力（P=0.031）;62.7%的医师表示与药师的整体合作情况较好,78.0%的患者表示对临床药学服务不太了解,89.0%的患者对药师提供的临床药学服务表示满意但对其信任度较低。结论：三甲医院药师在自我认识、相关知识能力水平、临床药学服务种类提供和公众认知度方面有待提升;建议完善药学教育结构,丰富药事咨询服务形式,健全药品供应协调机制,加强安全用药与不良反应监测以及应急科普宣传工作。     

跌打损伤用药“窗口指导”须注意的几个问题

目的:帮助药剂师掌握跌打损伤药物的药学服务内容,以便更快、更好地指导患者用药。方法:参照跌打损伤药品使用说明书和《临床用药须知》等相关资料,对80余种药物的注意事项进行分析,从用药时间、同患疾病、特别提示及常规提示4方面加以整理,归纳出用药指导时应注意的问题。结果与结论:药剂师要重视对跌打损伤患者进行用药指导的内容。     

咨询药师参与药品不良反应案例的分析实践与价值

摘 要 目的：通过药师参与药品不良反应案例的分析实践,体现药师在解决患者用药问题和用药风险防范中的价值。方法: 药师对4例药品不良反应咨询案例进行分析,并利用专业知识为患者给出合理用药建议。结果: 药师可以识别药品不良反应及用药风险,对患者家属解释用药后出现异常行为的原因,妥善处理发生严重药物不良反应的患者以避免医患纠纷,为发生药品不良反应预后的患者给出合理建议。结论: 药师在用药风险防范中发挥着重要作用,可以承担起药学监护的责任。     

Convergence of tuberculosis and diabetes mellitus: time to individualise pharmaceutical care

Objective To assess the feasibility of providing a pharmacist-led pharmaceutical care service to patients with tuberculosis and diabetes mellitus. Setting The study was conducted at a tertiary hospital in the northern region of Peninsular Malaysia. Methods Action research methodology was used. Main outcome measure Pharmaceutical care issues. Results The prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 15% (53/352). Out of 53 patients identified, 35 participated in the study. Patients?? ages ranged between 29 and 73 years (mean of 52 ± 10 years). The male: female ratio was 1.7:1. Pharmaceutical care issues identified by pharmacists were nonadherence, uncontrolled diabetes mellitus, adverse drug reactions and individual patient??s medication related problems. Pharmacists were able to intervene and resolve some of the pharmaceutical care issues. Conclusion Pharmacists played an important role in integrating the provision of care for tuberculosis and diabetes mellitus by providing individualised pharmaceutical care management. There still remains a need to address logistic barriers that impinged on the ability to conduct the pharmaceutical care service to its full potential.     

Effect of a Training Program on Community Pharmacists' Detection of and Intervention in Drug-Related Problems

Objective:To develop and present a pharmaceutical care training program for pharmacists, and to examine the ability of these pharmacists to provide pharmaceutical care in a community pharmacy setting.Design:Prospective, randomized study.Intervention:A 40-hour pharmaceutical care training program was developed and presented to pharmacists, and 1 ,078 patients were randomly assigned to receive either (1) traditional pharmacy services or (2) pharmaceutical care, consisting of initial patient work-up and follow-up with documentation in a patient record.Measurements:The study period was six months. Pharmacists documented problems identified, actions taken, and time required for all patients.Results:Pharmacists consistently identified and intervened to address problems in both study groups. Patients receiving pharmaceutical care were more than seven times as likely to have any problems identified (odds ratio [OR] 7.5; confidence interval [Cll 4.2-13.1), more than eight times as likely to have an intervention performed (OR 8.1 ; CI 4.7-14.2), and more than eight times as likely to have a drug-related problem identified (OR 8.6; CI 4.8-15.5) than were patients receiving traditional pharmacy services only. Time spent counseling patients was similar for the two groups.Conclusions:The training program proved to be an effective way to increase the number of problems identified and addressed by pharmacists.     

Complex pharmaceutical care intervention in pulmonary care: part B. Patient opinion and process survey.

OBJECTIVE: The IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigates and describes the results of complex pharmaceutical care interventions provided to selected pulmonary patients to improve their drug use. This paper describes the patients' opinions about the care provided and the results of the intervention. METHOD: Questionnaires investigating patients' opinions about provided pharmaceutical care were sent to 185 patients participating in the IPMP study after the intervention by their pharmacists had been finished. One year after the start of the intervention, patients were invited to a final consultation by their pharmacists to evaluate their drug use and their symptoms (n = 138). At this point in time pharmacists investigated the knowledge of the patients about the medication and their inhaler technique again. MAIN OUTCOME MEASURE: The influence of the intervention on patients' symptoms. Change in drug-related problems, knowledge and skills concerning pulmonary medication after intervention. Satisfaction of the patients with the provided pharmaceutical care. RESULTS: In total 141 out of 185 patients completed the questionnaire. Patients were satisfied with the intervention by their pharmacists and considered it important. The majority (67%) reported that they had learned more about their medication or the inhaler technique, resulting in significantly improved coping behaviour with their pulmonary medication compared with patients who valued the intervention as a nice conversation with their pharmacist only. Patients with improved ability to cope reported statistically significantly fewer symptoms compared with patients reporting no change in behaviour (chi-square test, P < 0.05). In the final consultation of 138 patients, pharmacists observed increased knowledge and skills and decreased drug-related problems. The patients concerned were pleased with the change in treatment and were more satisfied with their current medication as compared with their earlier reports. CONCLUSION: Patients can be influenced effectively by the tailored intervention of pharmacists resulting in improved ability to cope with pulmonary medication and in fewer reported adverse effects and symptoms. Patients attributed these results to the intervention of the pharmacists.