三级医院团队与社会药房执业药师合作 管理糖尿病模式的探索

目的：社会药房的执业药师经过由三级医院构建的糖尿病管理团队的培训,对在本店配药的糖尿病患者进行管理,探讨社会药房执业药师的糖尿病管理模式。方法：经三级医院团队培训后的社会药房执业药师,对本店的糖尿病患者进行健康宣教及药学服务,患者随机分为对照组和试验组,试验组接受执业药师的药学服务,对照组未接受执业药师服务。结果：接受执业药师管理的患者前后体重指数（BMI）、收缩压（SBP）、空腹血糖（FPG）、餐后2小时血糖（2 h PPG）、糖化血红蛋白（HbA1c）、用药依从性都有明显改变,且腰臀比（WHR）、SBP、2hPPG、HbA1c、用药依从性等指标改善显著优于对照组,仅WHR、舒张压（DBP）无显著改善;未接受管理的患者,随访前后指标无显著差异。结论：经培训的社会药房执业药师在糖尿病管理工作中发挥着重要的作用,可明显改善糖尿病患者BMI、WHR、血压、血糖、用药依从性等指标;此模式为社会药房执业药师工作模式的探索提供了一种方案。     

三级医院团队与社会药房执业药师合作 管理糖尿病模式的探索

目的：社会药房的执业药师经过由三级医院构建的糖尿病管理团队的培训,对在本店配药的糖尿病患者进行管理,探讨社会药房执业药师的糖尿病管理模式。方法：经三级医院团队培训后的社会药房执业药师,对本店的糖尿病患者进行健康宣教及药学服务,患者随机分为对照组和试验组,试验组接受执业药师的药学服务,对照组未接受执业药师服务。结果：接受执业药师管理的患者前后体重指数（BMI）、收缩压（SBP）、空腹血糖（FPG）、餐后2小时血糖（2 h PPG）、糖化血红蛋白（HbA1c）、用药依从性都有明显改变,且腰臀比（WHR）、SBP、2hPPG、HbA1c、用药依从性等指标改善显著优于对照组,仅WHR、舒张压（DBP）无显著改善;未接受管理的患者,随访前后指标无显著差异。结论：经培训的社会药房执业药师在糖尿病管理工作中发挥着重要的作用,可明显改善糖尿病患者BMI、WHR、血压、血糖、用药依从性等指标;此模式为社会药房执业药师工作模式的探索提供了一种方案。     

从不同角度探讨社区药房开展糖尿病管理的态度及需求

目的 从社区药房管理人员、执业药师、糖尿病患者三个角度探讨社区药房开展糖尿病管理的态度及需求,为社区药房开展糖尿病管理服务提供参考。方法 设计3份分别针对社区药房管理人员、社区药房执业药师及糖尿病患者的调查问卷,在南京市选择药店对其糖尿病管理服务态度、认知情况、需求等情况等进行问卷调查并统计分析。结果 社区药房管理人员中,98.8%认为有必要提供糖尿病慢病管理服务,93.8%认为有必要配有糖尿病专科药师;所有社区药房执业药师均认为有必要定期接受糖尿病专业培训,87.8%认为有必要对糖尿病患者定期进行电话随访或家庭随访;糖尿病患者中,8.6%认为有必要定期回访询问其血糖的自我监测结果,无患者表示在其血糖经过治疗但未达标时,社区药房药师总是建议其调整治疗方案且给出建议。满意度方面,社区药房管理人员为6.3%,社区药房执业药师为5.8%,糖尿病患者为21.6%。结论 目前国内社区药店和执业药师对于开展糖尿病管理的态度是积极的,但满意度低。作为糖尿病管理服务的主要提供者执业药师,要不断提升自身的专业技能,最终获得患者的信任,提高满意度,为糖尿病患者提供更加专业的慢病管理服务。     

临床药师参与围术期患者血糖管理模式及成效

目的:探究临床药师参与围术期血糖管理的模式及成效.方法:选取2019年9月至12月参与围术期血糖管理与内分泌科会诊的高血糖患者,分为干预组与对照组.对照组仅作普通会诊.干预组由医生、药师、护士根据围术期高血糖管理流程进行管理;临床药师每日到患者床边查房,提供用药教育、咨询服务,记录患者饮食、用药、血糖及药物不良反应发生情况.管理结束分析干预前后血糖参数、达标情况、住院时间等.结果 与结论:干预组血糖参数及达标情况明显优于对照组,住院时间明显少于对照组.临床药师参与围术期血糖管理模式为其它慢病管理提供参考.     

三级医院团队与社会药房执业药师合作管理糖尿病成本-效果分析

目的 评价三级医院团队与社会药房执业药师合作管理糖尿病的成本-效果.方法 选取2017年2月1日至2018年7月31日在与南京大学医学院附属鼓楼医院糖尿病管理团队合作的南京百信药房和鼓楼大药房长期配药的2型糖尿病患者200例,按随机数字表法分为试验组和对照组,各100例.试验组患者由执业药师联合三级医院团队合作干预、随...     

临床药师干预对2型糖尿病患者合理用药及健康管理的效果

目的分析临床药师干预对2型糖尿病患者合理用药及健康管理的效果。方法选取85例2型糖尿病患者作为研究对象,在建立患者的病情档案后开展临床药师干预下的健康宣教以及用药指导。对比患者干预前后不合理用药情况以及血糖情况。结果干预后,患者用法用量不合理、药物选择不合理、重复给药、超适应证用药发生率分别为1.18%、0、1.18%、2.35%,均显著低于干预前的9.41%、7.06%、11.76%、10.59%,差异有统计学意义(P<0.05)。干预后,患者空腹血糖(FPG)(6.87±3.09)mmol/L、餐后2 h血糖(2 h PG)(8.19±3.68)mmol/L、糖化血红蛋白(Hb A1c)(5.54±3.38)%均显著低于干预前的(9.28±3.83)mmol/L、(13.87±4.39)mmol/L、(8.75±2.25)%,差异有统计学意义(P<0.05)。结论针对2型糖尿病患者开展临床药师干预下的健康宣教以及用药指导有利于提升合理用药率,改善患者的血糖水平。     

区域临床药师协同社区对2型糖尿病慢性病管理的效果

目的 评价区域临床药师协同社区开展2型糖尿病(type 2 diabetes mellitus, T2DM)慢性病管理并对患者进行药学干预的效果。方法 选取3个社区医院的T2DM慢性病管理患者100例作为研究对象,由临床药师和社区药师定期对患者进行面对面用药教育和健康宣教、电话/微信或社区门诊随访、加强用药监护、与患者及家属沟通交流和进行专题知识讲座等,对T2DM患者实施药学干预,将干预前后患者对自身疾病的认知水平、自我管理、用药依从性、血糖、血压和血脂等指标控制情况进行统计并分析。结果 区域临床药师协同干预后患者对糖尿病和降糖药的认知水平明显提高(P<0.05),患者自我管理水平和用药依从性明显改善(P<0.01),患者血糖、血压和血脂等指标控制情况明显好转(P<0.001)。结论 区域临床药师协同社区开展T2DM慢性病管理的药学干预模式,可为社区糖尿病慢性病患者安全、有效和合理用药提供保障,使患者更好地控制血糖,预防并延缓其并发症的发生,对促进社区糖尿病慢性病管理有积极作用。     

1例高血压合并糖尿病患者的药物治疗管理

患者,男性,58岁,因血压和血糖控制不佳来药学门诊就诊,既往患有高血压、糖尿病,临床药师通过药学问诊、用药评估、方案调整、用药宣教和药学随访等为患者提供药物治疗管理服务,并为患者建立药物治疗管理档案。经过药物治疗管理服务,患者动脉粥样硬化性心血管疾病各项危险因素控制达标,生活质量得到明显改善。     

药物重整对老年2型糖尿病患者慢病管理的效果评价

摘要：目的:评价临床药师主导的药物重整服务对老年2型糖尿病患者慢病管理的效果。方法:采用前瞻性随机对照方法,397例老年2型糖尿病患者随机分为干预组(200例)和对照组(197例),入组患者均接受2型糖尿病常规检查和治疗,在此基础上干预组患者由临床药师为其提供规范的药物重整服务。两组患者均随访至出院后6个月。比较两组患者出院3个月、6个月的血糖达标率[糖化血红蛋白(HbA1c)<7%患者比例]、用药依从性评分及用药依从性差的患者比例、出院180 d内再入院率以及住院期间相关经济指标。结果:两组患者随访过程中分别脱落19例和21例,总脱落率10.08%。干预组患者中57例(28.5%)存在至少1个用药偏差;潜在药物不良事件(pADEs)评分≥0.01患者比例为86.0%。出院后3个月、6个月时,两组患者的HbA1c水平均较入院时显著降低(P<0.05),且干预组HbA1c水平明显低于对照组(P<0.05);干预组血糖达标率和低血糖发生率均显著优于对照组(P<0.05或P<0.01)。干预组再入院率显著低于对照组(P<0.05)。出院后3个月、6个月时干预组用药依从性评分明显高于入院时和同期对照组(P<0.05或P<0.01);两组用药依从性差患者比例均逐渐减少,且干预组显著优于对照组(P<0.05或P<0.01)。两组患者住院时间、总住院费用、药品费用以及药占比等指标差异无统计学意义(P>0.05)。结论:临床药师主导的药物重整服务可显著改善老年2型糖尿病患者的血糖达标率和服药依从性,减少低血糖发生率和再入院率。     

临床药师糖尿病慢病管理模式的构建和成效评价

目的 评价临床药师开展糖尿病患者药学监护和管理的效果。方法 选取门诊406例成年糖尿病患者作为研究对象,由临床药师分发调查问卷,并定期做用药指导和健康教育等药学干预,通过对干预前后患者糖尿病用药相关知识的掌握情况、血糖及糖化血红蛋白的达标情况、治疗依从性、非预约门诊、急诊、住院情况等比较,并进行统计分析。结果 药学干预后患者对糖尿病及用药相关知识的掌握情况、治疗依从性、血糖及糖化血红蛋白达标情况均优于干预前,P<0.01;非预约门诊、急诊情况也优于干预前,P<0.05,有显著性差异。结论 临床药师开展糖尿病慢病管理,构建临床药师主导的慢病管理模式,有助于促进规范化治疗,提高患者依从性,促进合理化用药,达到控制血糖、减少并发症的目的。     

Clinical impact of a community pharmacy-based health and wellness introductory pharmacy practice experience

ObjectiveTo assess the clinical impact of an intensive community pharmacy-based Health and Wellness Introductory Pharmacy Practice Experience (IPPE) completed by second-year (P2) student pharmacists.DesignThe Health and Wellness IPPE was a 1-week rotation developed to provide P2 student pharmacists with opportunities to provide clinical services to patients within the community pharmacy setting. Student pharmacists administered immunizations, performed blood pressure screenings and blood glucose measurements, and provided education to patients under the guidance of licensed pharmacist preceptors.Setting and participantsSecond-year student pharmacists completing a required Health and Wellness IPPE rotation in the community pharmacy setting.Outcomes measuredStudent pharmacist interventions were assessed to determine the course’s clinical impact, and preceptors were surveyed regarding the feasibility of student pharmacists performing clinical services at their training sites.ResultsA total of 147 student pharmacists completed the IPPE at 89 community pharmacy training sites and administered 9392 injections, 90% of which were influenza vaccinations. Student pharmacists performed 3458 patient health assessments, including measuring patients’ blood pressure and blood glucose and reviewing patient education materials. Most preceptors indicated that core activities were feasible during the experience.ConclusionThis study found that implementing a concentrated IPPE focused on immunizations and health screenings allowed student pharmacists to enhance their clinical skills and fulfill a large public health need, improving patient outcomes. Future studies should explore utilizing student pharmacists in community pharmacy settings to expand clinical services offered beyond these 2 services, such as diabetes risk tests, influenza point-of-care testing, and smoking cessation counseling.     

试论执业药师在保障公众合理用药中的作用

目的：发挥执业药师在保障公众合理用药方面的作用。方法对合理用药的重要性及国内外执业药师职业发展情况进行资料收集、整理分析,提出发挥我国执业药师作用,保障公众用药合理安全有效的举措。结果我国在执业药师准入、执业管理、继续教育等方面均与国外有着较大差距,应通过完善制度、提升素质、提供药学服务等举措,使执业药师在保障公众合理用药方面发挥更大的作用。结论执业药师积极提升自身素质,为患者提供高质量的药学服务,做公众合理用药的保护者。     

凸显药学服务能力的执业药师职业资格考试改革尝试

目的：通过分析普通高等学校药学专业类项下,包括临床药学专业在内的各专业毕业生参加执业药师职业资格考试成绩,观察执业药师职业资格考试内容改革与执业药师具备药学服务知识和能力的契合程度。方法：提取2020-2022年度参加药学类执业药师职业资格考试的全日制本科学历药学专业类参考人员的考试成绩,进行统计分析。结果：在药学专业科目考试中,临床药学专业参考人员的成绩显著高于药学、药物制剂、药事管理等专业参考人员的成绩。结论：执业药师职业资格考试改革后,考试内容基本实现了面向患者安全用药的转移,凸显了临床药学的知识与技能,初步满足了药品监督管理对药学服务的要求。     

妊娠期糖尿病的药学服务及其临床效果分析

目的：探讨药学服务对妊娠期糖尿病用药依从、药物不良事件（ADE）、用药偏差、自我管理技能、血糖控制及妊娠结局的影响,为改善药学干预的安全性和有效性提供依据。方法：选取在进行胰岛素治疗的孕中期（24~28周）妊娠糖尿病孕妇为观察组,共计102例;据观察组75 g葡萄糖耐量试验（OGTT）血糖水平和异常项目数,按单纯随机分组和盲法分配方法,1：1匹配同期胰岛素治疗的102例妊娠糖尿病患者作为对照组;对照组进行传统医疗（常规治疗+饮食控制+运动疗法）;观察组进行传统医疗+药学服务的干预,时间持续至分娩和出院后24周。结果：与对照组相比,观察组在用药依从、药物不良事件（ADE）、用药偏差和自我管理技能等方面得到显著改善（χ²=4.140,4.412,7.257,4.408;P<0.05）;血糖控制满意率（87.3%）显著高于对照组（76.5%）（χ²=3.995,P<0.05）;孕妇剖宫产、妊高征、羊水过多、胎膜早破、早产、胎儿窘迫发生率及分娩新生儿中巨大儿、高胆红素血症、新生儿窒息率均显著低于对照组（P<0.05）,观察组产后6周和24周失访率（3.9%,6.9%）及糖代谢受损发生率（12.2%,18.9%）也显著低于对照组（14.7%,23.5%;20.9%,37.2%）（χ²=7.022,10.993,P<0.01;4.448,7.197,P<0.05）。结论：药学服务能显著有效改善妊娠期糖尿病患者用药依从、药物不良事件（ADE）、用药偏差和血糖控制及妊娠结局,药师应该更多提供和完善药学服务计划。     

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.     

Retrospective financial analysis of wellness center from an independent community pharmacy perspective.

OBJECTIVE: To determine the net financial gain or loss from health screening services provided to patients at an independent community pharmacy-based wellness center. DESIGN: Retrospective review of pharmacy wellness center records over a 24-month period. SETTING: A wellness center at one independent community pharmacy. PARTICIPANTS: Patients receiving one or more of nine different services (blood pressure [BP], blood glucose, body fat [BF], glycosylated hemoglobin [A1C], bone density [BD], total cholesterol/blood glucose, total lipid panel [TLP], total cholesterol/high-density lipoprotein, alanine aminotransferase) during a 2-year period. INTERVENTIONS: The services were performed and results recorded by a resident or staff pharmacist. MAIN OUTCOME MEASURES: Using a pharmacy perspective, net financial gains or losses were calculated for each of the individual services, for all of the services performed using the Cholestech LDX Analyzer, and for the wellness center as a whole. Sensitivity analyses were based upon a pharmacist, a pharmacy resident, or both a pharmacist and pharmacy resident each providing half of the total number of services over the 2-year period. RESULTS: A total of 1,181 pharmacy records for the selected services were reviewed for the specified time period. A net financial gain for the wellness center was achieved when the services were performed by a pharmacist, a pharmacy resident, or a pharmacist/pharmacy resident combination, respectively. Three of the individual services (BG, BF and TLP) and assays performed using the Cholestech LDX Analyzer had a net financial gain for each sensitivity analysis. Two of the services (BP and AIC) had a net financial gain only when a resident provided the service. One of the services (BD) had a net financial loss for all of analyses. CONCLUSION: Revenues for these services exceeded their costs from the wellness center perspective when they were performed by a pharmacist, a pharmacy resident, or a pharmacist/pharmacy resident combination.     

Examining the use of network meta-analysis in pharmacy services research: A systematic review

ObjectivesPharmacists play an important role in supporting the health care needs of the public, and various studies have examined the impact of pharmacy services on patient care. This systematic review aimed to describe studies evaluating the impact of pharmacy services by means of network meta-analyses.Data sourcesA systematic literature review of network meta-analyses examining pharmacy services was performed on PubMed, Embase, International Pharmaceutical Abstracts, and Cochrane Database of Systematic Reviews from database inception to November 30, 2018.Study selectionNetwork meta-analyses that examined the comparative effectiveness of pharmacy services (where pharmacists provide patient care to optimize patient outcomes) in any population, country, or setting.Data extractionData were independently extracted by 2 authors with the use of a standardized extraction form. The methodologic quality of articles was assessed with the use of the Cochrane Risk of Bias in Systematic Reviews tool.ResultsTwo network meta-analysis studies were identified. The first study compared 53 randomized controlled trials evaluating the effectiveness of transitional care services among discharged patients with heart failure. The study found that pharmacist interventions such as medication reconciliation, patient education, and medication optimization had little impact on improving the all-cause mortality and readmission rate in these patients. The second report compared 43 randomized controlled trials examining the efficacy of pharmacist-based diabetes educational interventions with or without pharmaceutical care on people with type 2 diabetes. It was reported that pharmacy services were effective in reducing glycosylated hemoglobin among people with type 2 diabetes, with larger effect sizes observed when these services involved a combination of 2 or more pharmacy services.ConclusionThis study demonstrated a paucity of studies using network meta-analysis techniques in evaluating pharmacist-provided services. This could be due to the lack of confidence in using this method, because network meta-analysis requires several additional assumptions that require careful consideration while performing the analysis.     

1992 National Clinical Pharmacy Services Study

Study Objective . To determine the extent of hospital-based clinical pharmacy services in 1992. Design . National survey with trend comparison to 1989. Setting . All 1597 United States acute care, general medical-surgical and pediatric hospitals with 50 or more licensed beds and one or more full-time pharmacists (43% of all U.S. hospitals). Measurements and Main Results . Fourteen clinical pharmacy services, carefully defined to indicate pharmacist proactive or concurrent patient care provision, were assessed to determine pharmacists' specific patient care responsibilities. The percentage of hospitals offering each of the services increased from 1989 to 1992, with greatest growth in management of adverse drug reactions (22% increase), pharmacokinetic consultations (14%), and drug therapy protocols (12%). The mean percentage of patients actually receiving clinical pharmacy services ranged from 0.2% for pharmacist participation on the cardiac arrest team to 36.1% for daily monitoring of drug therapy. Pharmacists conducted clinical research in 13% of all hospitals, averaging 3.9 ± 4.3 protocols per year with a total budget of $79,765 ± $128,641. Conclusions . Clinical pharmacy services continue to expand; however, even the most common direct patient care service is provided to a small number of inpatients.     

Are pharmacists and pharmaceutical care having an impact on diabetes?

This study sought to identify pharmacy services offered to patients with diabetes and demonstrate patients receiving pharmaceutical care services had better glucose control as measured by laboratory values and medication compliance. Two hundred randomly selected patients with diabetes were identified from a pharmacy benefits manager's database. Their pharmacists were mailed a survey requesting information concerning morbidity risk factors, concomitant disease states, concomitant medications, diabetes pharmacotherapy, blood glucose concentrations, and percent hemoglobin A1c values. Information concerning diabetes cognitive services offered was also requested. A statistically significant correlation between diabetes cognitive services and improved disease control was not demonstrated secondarily to the small number of responses returned with glucose control information. Our results indicate pharmacists must improve documentation of their services and the impact these interventions have on disease control in order to prepare for reimbursement for cognitive services.