Pharmacy decision support: where is it? A systematic literature review

Objective: The objectives of this study were: to identify electronic decision supported systems that directly support pharmacists or pharmacy practice, in either the hospital or community settings; to ascertain the type of research in this area; and to identify any observable gaps for electronic decision support. Method: A systematic literature review of PubMed, journals with known publication of decision support, databases including the Cochrane Reviews Database, selected websites and conference proceedings was conducted. Criteria for inclusion were electronic decision support systems that: were in routine use; had been used or published since 1998; provided clinical support; were not embedded into medical instruments; and were used by pharmacists in the community or hospital setting. Key findings: Four publications met the criteria from 386 references. Of these, three described alerting systems for pharmacists, and one described the effect on pharmacist workflow of computerised prescribing. Investigation of selected websites revealed a further 20 pharmacy‐related projects. It was difficult to ascertain to what extent to these (unpublished) activities were occurring in countries outside Australia (the main practice setting considered), such as the UK and Canada. Conclusion: There is scant literature describing electronic decision support system activities specifically for pharmacy or pharmacists, in comparison to the substantial quantity of similar literature for healthcare in general. Electronic decision support activities are evident in the commercial environment for systems supporting traditional pharmacy roles. Selected conference proceedings and web‐based information indicate that activity is occurring in the area of pharmacy decision support, although for relatively simple systems. The emerging patient‐focused roles for pharmacists suggest that they may require similar knowledge and information to those of medical professionals. There is now a need to fully understand, define and support these pharmacist requirements, to enable appropriate decision support tools to be developed, and provide the opportunity for improved healthcare.     

Workload and its impact on community pharmacists' job satisfaction and stress: a review of the literature

Objective The objective was to identify, review and evaluate published literature on workloads of pharmacists in community pharmacy. It included identification of research involving the measurement of pharmacist workload and its impact on stress levels and job satisfaction. The review focused on literature relating to practice in the UK. Methods Electronic databases were searched from 1995 to May 2011. In addition, manual searches were completed for documents not available electronically. The findings were analysed with specific focus on research methodology, workload and its impact on pharmacist job satisfaction and stress levels. Key findings Thirteen relevant studies relating to workload in community pharmacy alone or in conjunction with job satisfaction and stress were identified. One utilised both qualitative and quantitative methods to identify differences in pharmacist workload in retail pharmacy businesses before and after the implementation of the 2005 English and Welsh community pharmacy contractual framework. This indicated that pharmacists spend most of their working day dispensing. The majority of studies suggested community pharmacists generally perceived that workload levels were increasing. Several also stated that increased workload contributed to increasing job‐related stress and decreasing job satisfaction. No studies reporting dispensing rates for community pharmacies in the UK were identified and there was limited evidence concerning time devoted to non‐dispensing services. One study investigated the differences between self‐estimated and actual workload. Conclusions Whilst there is a clear perception that the type and amount of work output expected from individual community pharmacists has been changing and increasing over the last few decades, pharmacists are viewed as continuing to remain based in the dispensary. The impact of such changes to the practice of community pharmacy in the UK is poorly defined, although links have been made to increasing levels of pharmacist job dissatisfaction and stress.     

我国药学会诊文献分析

目的:通过相关的文献分析,探讨我国药学会诊工作的发展状况和存在的问题,为临床药师从事药学会诊工作提供参考。方法:检索1989—2014年中国期刊网全文数据库(CNKI)、万方医学数据库、维普数据库药学会诊相关文献,利用Excel表格进行汇总分析。结果:共得到文献148篇,文献量呈逐年增长趋势,大部分文献发表在2009年以后,2009—2014年文献量共134篇,占总文献量的90.5%;个案实践体会类文献数量最大,占总文献量的55.4%,汇总回顾分析类文献近年来增幅较快;三级医院文献121篇,占总文献量的81.8%,明显高于二级医院;文献第一作者大部分具有中、高级专业技术职称,相对集中在江苏、广东、北京、上海、湖南、四川等经济较发达和医疗水平较高的区域;大部分文献发表在药学核心期刊上,中国科技核心期刊收录的文献占总文献量的62.6%;文献中涉及的案例会诊内容不广泛,主要以抗菌药物为主。结论:我国药学会诊工作起步较晚,前期发展缓慢,但从2010年后发展比较迅速,临床药师会诊工作的能力和水平逐年提高,药学会诊工作逐渐得到了医院管理层面和临床医师的支持和认可,但药学会诊工作的广度和深度均需加强,相关文献的研究水平有待提高。     

浅谈医院药师参与临床实践的必要性

本文针对目前医院临床药学工作的现状,分析和探讨了医,药两者之间相互作用,相互依存的紧密关系,阐述了医院药师参与临床实践的必要性。     

Intervention research to enhance community pharmacists' cognitive services: A systematic review

BackgroundPositive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery.ObjectivesTo: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas.MethodsEmpirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies.ResultsA total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used.ConclusionsThere is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.     

中药临床药师培训基地建设与人才培养的探索与实践

目的：探讨中药临床药师培训目标、培训模式以及培训方案,分析人才培养的局限性及不足,为各医院中药临床药师的培养提供参考。方法：梳理首都医科大学附属北京友谊医院中药临床药师培训具体内容,细化综合能力、药学及临床基本知识、临床药学技能培训和中药科研技能培训的方案及内容,强化中医基础知识在中药临床药学中的重要地位,不断完善中药临床药师基地建设和人才培养模式。结果：明确了学员的报名条件和培训目标,突出了药学、中药学和中医基础知识与临床的重要相互作用关系,并分析讨论基地建设与人才培养的局限性和不足。结论：中药临床药师是执行中药临床药学工作的主体,优化基地的培训体系和内容,丰富人才培养方案,解决问题与不足,本基地的工作内容可为中药临床药师的基地建设和人才培养提供参考。     

The influence of continuing professional development portfolio records on pharmacy practice

Objectives The aim of this study was to undertake an in‐depth investigation of the influence of continuing professional development (CPD) portfolios on pharmacy practice in the hospital setting. The objectives were to explore the views of pharmacists regarding the contribution of CPD records to professional practice and examine the influence of time and experience on pharmacists' views of recording professional practice. Method A qualitative design was used to explore the views of pharmacists over 12 months. Pharmacists were stratified according to years of practice in the UK National Health Service (NHS). The methods used involved semi‐structured in‐depth face‐to‐face interviews. The interviews were undertaken at three time points. The pharmacists were gathered into three focus groups to test the consistency of the interviews. A purposive sampling method used nine NHS Teaching and Non‐Teaching hospital pharmacists in the London area. Key findings The participants included four males and five females, who had been qualified for between 0.1 and 21 years. Three key themes emerged for how CPD records contribute to practice: (1) lack of contribution to practice, (2) tacit contribution and (3) mentality. Overall, the recording process made little if any change in professional practice. The more experienced participants were less likely to be able to explain any changes in practice and there were no consistent changes in the views expressed over time. Conclusions The contribution of CPD recording to enhancing practice in hospital pharmacists was difficult to demonstrate. This study has also illustrated the power relationships involving control mechanisms used by the NHS, and the UK pharmacists' regulatory body, which are discussed in the context of the Panopticon model of self‐regulated behaviour. Further research is needed to establish the value of CPD recording.     

Online information retrieval in pharmacy and related fields

Online information retrieval in pharmacy and related fields is described. Factors involved in determining whether to conduct an online search are discussed, including characteristics of appropriate and less suitable topics, advantages and limitations of online searching versus manual searching, and possible types of searches. The process of preparing for an online search, involving the determination of search vocabulary, relevant citations, important authors, time frame, special categories (such as language, publication type, and reviews), and the number of citations needed, as well as choosing a database, is explained. Sample search strategies on MEDLINE and IPA are illustrated to demonstrate the basic search commands and to compare file retrievals on the sample subject. Pharmacy-related bibliographic databases, general-interest databases, end-user search services, and full-text and numeric databases are profiled. Online database searching can be a cost-efficient and flexible alternative to manual literature searching for pharmacists. Although most online searching is currently conducted by librarian-search specialists, end-user searching is a growing trend, as is the availability of full-text databases.     

医疗机构药剂师任职技术(准入)条件的探讨

目的初步建立医疗机构药剂师任职技术(准入)条件的标准体系,为高等院校药学专业教育和医疗机构药剂师在职教育培养标准的设立提供依据,为有关部门制定各级技术职务资格标准提供参考,也为医疗机构药剂师各级技术职务考试、考核提供参考。方法参考国外医疗机构药学工作的发展趋势,结合我国医疗机构药学工作现状,提出医疗机构药剂师任职技术(准入)条件的标准体系。结果与结论从专业理论知识、工作经历与能力、教学和科研4个方面分别对药剂师、主管药剂师、副主任药剂师和主任药剂师提出了任职技术(准入)条件。职称越高,对药剂师组织管理能力、促进临床合理用药及从事相关科研能力的要求应随之提高。     

临床药师纳入病房药房管理的工作模式及实践

目的:探索临床药师的工作模式。方法:结合我院工作实际,采用实证案例研究的方法,从临床药师与病房药房药师相互配合的角度,总结临床药师切实可行的工作模式。结果与结论:将临床药师的编制纳入病房药房中,临床药师采用每天在责任科室参与临床实践、积累临床用药经验的同时,对需要会诊的其他科室的病例给予用药监护和回访的工作方式,为医师、护士和患者提供全程化的药学服务,并将临床实践延伸到临床药学的教学和科研工作中,由此形成的临床药师工作模式有利于保证患者用药安全、有效,实现药师自身的工作价值。     

医院药学与药学人才定位的探讨

目的:统一对医院药学、临床药学与药学人才的认识。方法:调查目前医院药学界与社会有关方面对医院药学和药学人才的认识,分析社会进步、科技发展对医疗卫生工作的要求,以及医院药学和药师的职责任务。结果与结论:对于医院药学、临床药学以及药学人才定位,医院药学界与社会有关方面需要认真探讨和统一认识,以利于医院药学的发展和药师作用的发挥,从而维护患者用药权益。     

我院药师进行静脉输注药物混合服务的工作现状与体会

药师参与静脉输注药物混合服务是药学工作由“传统调配型”向“以病人为中心”的服务型模式转变的一种有效方式。本以近3年来的工作实践为主要依据,分工作概况、体会、提示和展望3个部分,介绍我院药师进行静脉输注药物混合服务的工作现状与体会,同时为药师进行输液配置工作提供借鉴与参考。     

试论医院药剂科体制改革的重要性

医院药剂科的体制改革,有利于提高医院药剂工作的综合管理水平,理顺医药关系:有利于医院经济体制的改革;有利于药剂人员的培养和专业水平的提高,以及临床药学和药物研究工作的开展。     

Innovative nuclear pharmacy service. A comprehensive management plan for clinical investigations.

OBJECTIVE: To provide an overview of the investigational nuclear pharmacy service at the Medical University of South Carolina. DATA SOURCES: References were selected from published bibliographies of nuclear pharmacy and hospital pharmacy articles and from specific-topic searches of the MEDLINE computerized database (all languages, through 1992). STUDY SELECTION: Studies of clinical pharmacy functions that were considered relevant to the specialty practice of nuclear pharmacy were chosen. DATA EXTRACTION: Studies were reviewed for internal consistency and appropriateness. DATA SYNTHESIS: Data on the clinical impact of nuclear pharmacy services do not exist. CONCLUSIONS: Based on our experience in establishing an investigational drug service, we conclude that nuclear pharmacists should take an active role in clinical investigations. The outcomes of this kind of involvement are very rewarding.     

适应药学模式的发展,探索本科生实习改革

社会的发展促使医院药学工作模式、药师的工作内容发生变革，影响着药学专业毕业生的就业，反过来促进药学教学内容和模式的改革。毕业前实习阶段的教学关系到药学教育改革的成效。调查显示，药学专业本科毕业生在医院药房工作的比例较大，医院药学工作需要的不仅是科研型人才，更应该是综合型人才，才有利于药学事业的持续发展。为此，我们作了一些探索，改革了实习模式，实习分两个阶段，第一阶段让学生参加科研实践，学习科研工作的方法；第二阶段参加医院药学日常工作的同时进行调研，锻炼学生能力。新实习模式是科研实践和医院药学实践并重，强调科研工作的基本方法，培养学生独立工作解决实际问题的能力，培养学生爱岗敬业精神。通过五届毕业生的教学实践，初见成效。毕业学生能较快地适应工作，很快成为业务骨干。实习期的教育对学生思想和能力的影响是很大的。完善实习教育模式，当然还有许多路要走。     

医院药学未来发展趋势探讨

行业因服务社会而存在,未来医院药学的发展将主要集中在以下几个方面:(1)法律与制度的建立与不断完善,体现药师的专业价值;(2)人才培养与可持续发展;(3)医院药学服务模式的变革。医院药学工作者必须适应并满足医疗改革对医院药学行业的需求,展示药师可胜任新角色、在以患者为中心的多学科治疗团队中成为重要成员的能力和素质。     

Analysis of enquiries to the National Pharmacy Association following major changes to controlled drug legislation in the UK

Objectives The National Pharmacy Association (NPA) provides an advice service to community pharmacists in the UK, and keeps a database of the enquiries it receives. The aim of this research was to analyse the database for the period of October 2007 to March 2008 to gain an insight into how well pharmacists coped with legislative changes directly affecting pharmacy by identifying which changes generated the most enquiries during these 6 months and ascertaining in which months these queries were at their highest levels. Methods Anonymised telephone enquiries regarding controlled drugs (CDs) received by the NPA from pharmacists during a 6‐month period were reviewed and categorised according to the legislative change or other CD issue to which they related. A Poisson model was applied to determine whether there was a significant difference in the total number of CD queries generated each month. Key findings Altogether 6082 queries regarding CDs were received, of which 57% related to legislative changes. The three legislative changes that took place during the 6‐month period all generated a significant increase in numbers of queries around the time of the change. Queries regarding the new form of CD register comprised the largest single category. Conclusions Community pharmacists seek information regarding legislative changes when such changes come into force to a greater degree than when the legislation is drafted, consulted upon or enacted. The high number of queries received by the NPA does reflect that there was a difficulty in applying the various legislative changes in practice.     

医院药学城构建探讨

目的:建立医院药学城,促进硬件与学科和谐发展。方法:结合医院药学发展方向,设计本院药学城,并以理论分析其构建思路。结果:形成了以患者为中心的模式,有利于发挥药师团队作用及宣传医院药学,实现医院药学的高工效、低成本运行。结论:医院药学城为开展医院药学工作创造了良好的环境。     

临床药物治疗学教学效果调查和探讨

目的：评估由临床药师承担授课任务的本科临床药物治疗学教学效果,探讨高校与医院合作进行本科临床药物治疗学授课的教学方法。方法：临床药师组成教学团队,对华中科技大学同济医学院药学院2012级本科留学生进行临床药物治疗学全英文授课。采用问卷调查和文献研究方法,对教学内容和效果进行调研分析。结果：现阶段临床药物治疗学课程设置存在章节多、课时少的问题,学生自主学习和实践应用能力有待提高。结论：临床药师应结合医院临床药学工作,引入多元化的授课形式和考核方式,着重培养学生药学实践服务能力,提高临床药物治疗学教学质量。