Pharmaceutical care and its relationship to prescribing behaviour of general practitioners

Objective To study the correlation between pharmaceutical care and prescribing routines of general practitioners (GPs).Methods Cross-sectional study; 201 pharmacies, 408 general practices, The Netherlands, 2000/2001. The variation in prescribing behaviour was characterised using 20 validated prescribing indicators based on general practice guidelines. The general construct ‘adherence to guidelines’ served as the dependent variable and was formed by summing the scores of the prescribing indicators. Four possible determinants of the variation were determined on the basis of survey questions: the construct ‘the pharmacist’s attitude towards pharmaceutical care’, and three partial constructs derived from the pharmacist’s care-providing function: the care for the individual patient, the cooperation with general practitioners and the registration of the care provided. A multiple linear regression analysis was then performed.Main outcome measure The weighted score for the prescribing indicators.Results The weighted average score for the prescribing indicators was 65% (SD 3.7). The response rate to the survey was 71%. The pharmacist’s attitude to pharmaceutical care, as well as the degree to which the pharmacist provided care for the individual patient, the degree to which he cooperated with the general practitioner and the degree to which he registered the care provided were not correlated with the ‘adherence to guidelines’ by the general practitioner with whom the pharmacist frequently cooperated.Conclusion Variations between general practitioners in the quality of prescribing, as measured by their adherence to guidelines, were not correlated with pharmaceutical care by the pharmacist with whom they cooperated on a day-to-day basis.     

The influence of learning environment on trainee pharmacy technicians' education and training experiences

Background

In Great Britain (GB), pharmacy technicians (PTs) are registered professionals, with their education and training regulated; little is known about this or the learning environment in which it takes place.

Quality of prescribing for schizophrenia: Evidence from a national audit in England and Wales

The National Audit of Schizophrenia (NAS) examined the quality of care received in England and Wales. Part of the audit set out to determine whether six prescribing standards, set by the national clinical guidelines for schizophrenia, were being implemented and to prompt improvements in care. Mental Health Trusts and Health Boards provided data obtained from case-notes for adult patients living in the community with schizophrenia or schizoaffective disorder. An audit of practice tool was developed for data collection. Most of the 5055 patients reviewed were receiving pharmacological treatment according to national guidelines. However, 15.9% of the total sample (95%CI: 14.9–16.9) were prescribed two or more antipsychotics concurrently and 10.1% of patients (95%CI: 9.3–10.9) were prescribed medication in excess of recommended limits. Overall 23.7% (95%CI: 22.5–24.8) of patients were receiving clozapine. However, there were many with treatment resistance who had no clear reason documented as to why they had not had a trial of clozapine (430/1073, 40.1%). In conclusion, whilst most people were prescribed medication in accordance with nationally agreed standards, there was considerable variation between service providers. Antipsychotic polypharmacy, high dose prescribing and clozapine underutilisation in treatment resistance were all key concerns which need to be further addressed.     

医学影像专业本科阶段人才的培养

随着现代医学的发展,医学影像学在医学领域中的作用越来越大,医学影像专业本科阶段人才的培养显得尤为重要。本科阶段需从牢固专业思想,培养学习方法与思维技巧,加强影像与临床、病理相结合,理论联系实际,学以致用及基础理论知识积累的重要性教育,注重“能力”“人文关怀”素质培养等方面进行引导,这样才能使他们将来更好地适应社会、服务临床,成为优秀医学影像专业人才、乃至医学领域中佼佼者。     

调剂差错与处方差错的原因分析及防范

目的：探讨药品调剂差错与处方差错的原因和防范措施。方法对安徽省立医院门诊药房的74例调剂差错与51例处方差错进行回顾性分析。结果74例调剂差错中,排名前3位的分别是易混淆药品25例（33．8％）、药品数量错误22例（29．7％）、药品给错患者18例（24．3％）、相邻位置错误、打印机出错、用法用量错误等。51例处方错误中,剂量与用法错误15例（29．4％）,药物相互作用与配伍禁忌13例（25．5％）,重复用药9例（17．7％）,电脑操作错误5例（9．8％）,其他原因5例（9．8％）,用药与诊断不相符3例（5．9％）,剂型与给药途径不合理1例（2．0％）。结论建立调剂差错登记与处方差错登记制度,定期分析差错原因,采取相应的干预措施是提高医院药学服务的有效方法。     

The potential role of computerisation and information technology in improving prescribing in hospitals

For physicians, prescribing of drugs is one of the most common actions in daily practice. In the continuum prescribing, dispensing, administration and use of drugs, failures may occur and can lead to patient harm. The use of computerised physician order entry systems is subject to much discussion regarding medication error reduction. This commentary analyses the issues where such systems can contribute to improved care.     

Understanding the causes of prescribing errors from a behavioural perspective

IntroductionWhile many attempts have been made to reduce prescribing errors (PEs), they persist. PE is not in itself a behaviour, but a consequence of a prescribing behaviour. Interventions aimed at prescribers should focus on understanding prescribers' behaviours.ObjectivesThe aim of this study was to use the capability, opportunity, motivation - behaviour (COM-B) model to explore the behaviours that could have caused PEs made by senior doctors in a speciality paediatric inpatient ward.MethodsA qualitative approach was used to investigate prescribers' behaviours in a 26-bed paediatric oncology ward. Error data were collected over a two-month period and were presented during focus groups with prescribers, which were audio-recorded and transcribed verbatim. Thematic analysis was used to identify contributory factors to errors, which was used to identify sources of behaviours using the COM-B model.ResultsBehaviours related to prescribers' capabilities were: prescribers' improper use of the software because of insufficient skills, and prescribers' inability to prescribe correctly because of lack of knowledge. Behaviours related to opportunities in the environment were: prescribers' inability to make an informed decision because of poor access to patient information, inability to properly complete a task because of heavy workload and interruption, and having to re-check doses frequently because of frequent change in patients' weight and surface area. Those related to motivation were: prescribers unquestioningly following recommendations and not communicating with other specialists because they over-trusted them or feared a negative reaction, and prescribers inability to complete a task because of other competing and preferable tasks at the same time.ConclusionEmploying COM-B helped in identifying causes of PEs from a new perspective. Future work could focus on mapping identified sources of behaviour and errors against appropriate intervention functions and policies in order to design more successful interventions.     

上海市部分医疗机构药房托管调研与可行性分析

目的:探讨上海地区医疗机构推行药房托管的可行性,为药品零差率改革、药剂科向临床药学转型做出有价值的探索。方法:通过实地调研上海市7家不同类型医院药剂科和1家著名药品流通企业,访谈相关负责人,并对医院药剂科工作人员进行现场非随机抽样问卷调查,使用统计学软件Statwing进行数据分析。结果:共回收得到93份有效问卷,尽管某医院药房托管改革成效显著,但大多数被调查者对医院药房托管持否定态度,认为医院药房托管目前对临床药学的发展弊大于利。结论:未来全面药品零差率和发展临床药学的形势下,药房托管值得探索和尝试,应在法律上明确药房托管中各方的权利和责任,规范流通市场,保障患者权益。     

Career choice motivations of medical students and some characteristics of the decision process in Hungary

The changed circumstances of medical work, raises the question of how socio-economic changes over the last few decades has affected the professional socialisation of medical students. This paper explores the career choice motivations of medical students, as well as some characteristics of the process of making that choice and their effects on professional socialisation. The study was carried out with a self-administered questionnaire with 503 students in general medicine, randomly selected from two Hungarian Medical Schools. More than half of the students contemplated becoming a doctor as early as in their childhood. Their final decision was typically made in high school. Significant differences can be demonstrated in professional socialisation between those individuals identifying with the profession in early childhood and others turning to the profession later. Altruistic motivations were the most significant career choice reasons. In conclusions, the medical career choice must have deeper roots, yielding to an evolutionary psychological analysis as well, one aspect of which is altruism.     

从药学学科发展和就业流向看药学生职业道德教育

面对药学学科发展的新特点和药学生就业流向新趋势,加强药学生职业道德教育,应从药学专业教学、社会实践活动、药学生自我教育和同伴教育等环节,全方位形成共识,提高药学生的职业道德素质,促进药学生职业发展.     

患者参与医疗决策期望量表的编制策略及条目筛选

目的编制适用于中国的患者参与医疗决策期望量表。方法采用德尔菲法建立初始条目池,对370例患者进行测评后,采用￡检验法、相关分析法、因子分析法等6种方法联合对条目进行筛选,建立量表测试版。结果编制了含12个条目的患者参与医疗决策量表,此量表与预期的理论构架相符,分为信息需求（3个条目）,交流需求（6个条目）,决策需求（3个条目）3个维度。结论患者参与医疗决策期望量表具有良好的内容效度,其所含的条目具有良好的敏感性、独立性和代表性。     

《药剂学》课程“片剂”的说课设计

说课是推动教师职业素质发展的动力,是提高教师备课质量的有效方法。片剂是药剂学固体剂型中应用最为广泛的剂型之一,为提高该章节的授课效果,笔者分别从说教材、说教学方法、说学法、说教学反思等方面进行说课设计,以达到利用学生已掌握的知识,调动其学习兴趣,培养学生自主学习的能力,加深学生对知识的全面理解和掌握的教学目的 。     

Pharmacist perceptions of competency: Identifying priority areas for a competency program development at an academic medical center

Background

Competency-based education models can serve as valuable resources for providing quality continuing education and professional development in healthcare. However, competency development programs can be stifled by scarce stakeholder involvement and insufficient recognition of resource challenges. Engaging pharmacists in program development can inform program design and prioritization of needs.

慕课时代下中药药剂学教学的机遇与挑战

慕课席卷全球,掀起了高校教育改革的热潮.本文对慕课时代下中药药剂学教学的发展进行了概述,包括慕课的特点、中药药剂学的教学现状、如何将慕课融入中药药剂学课程、慕课面临的机遇和挑战.