构建我国医院药学服务体系的评价指标体系

目的：构建一套用于评价我国医院药学服务体系建设水平的指标体系。方法：在SPO医疗服务质量评价理论模型的基础上根据国内外药学服务评价理论和方法构建第一级和第二级指标，随后采用借鉴德尔菲法原理的专家调研构建第三级指标，并运用层次分析法（AHP）确定各级指标下各项目权重，完成指标体系构建。结果：研究构建出了一套包含3个一级指标、9个二级指标和34个三级指标的我国医院药学服务评价指标体系。结论：我国医院药学服务体系的发展应将药学服务团队建设、服务规章制度设计和最终临床产出的提升作为首要任务。     

临床药学服务质量评价体系的建立探索

目的:为评价我国临床药学服务质量提供参考。方法:采用文献研究法,基于服务质量理论、医疗服务质量理论和绩效理论,从管理学角度对临床药学的定义、特征进行分析,比较相关理论中各种质量评价方法在临床药学服务质量评价和考核中的适用性,优选适当评价方法构建临床药学服务质量评价体系。结果与结论:临床药学服务质量评价体系可以"结构-过程-结果"法为基本框架,采用层次分析法、SERVQUAL服务质量评价法、360度绩效考核法等方法设计具体指标。该评价体系可用于考察临床药师制实施效果,为在全国推行临床药学工作提供充分证据。     

基于结构过程结果(SPO)模型的药学服务评价研究概述

摘要：药学服务是药师所提供的以患者为中心,以提高生活质量为目的药物治疗相关服务。由于我国药学服务尚处于较低水平,迫切需要构建一个科学客观的评价体系,用于提高药学服务质量。结构过程结果(SPO)模型是国外较为常用的理论模型,可以为我国构建服务评价体系提供一定理论依据。本文通过详细介绍SPO模型,综述国内外针对药学服务的结构评价、过程评价及结果评价的研究,以期为促进我国药学服务发展、建立评价体系提供参考。     

评价农村药店药学服务质量的标准体系研究

目的：制定评价农村基层药店药学服务质量的指标体系,规范基层药店的执业行为。方法：从农村基层药店药学服务的现状和农村基层百姓对药学服务的需求调查分析入手,运用文献研究和专家咨询相结合的方法,构建基层药店药学服务质量评价指标体系。采用专家打分构建权重判断矩阵,利用层次分析法确定各指标的权重值。结果：最终形成由6个一级指标、18个二级指标、40个三级指标组成的评价基层药店药学服务质量指标体系。结论：评价指标经过一致性检验,内容效度较好,可作为监督管理部门对基层药店的药学服务质量进行量化考核和评价的参考。     

医院药房管理与药学服务质量的相关性研究

目的:探讨医院药房管理与药学服务质量的相关性.方法:选取2016年3月~2017年5月我院药房工作情况,针对药房管理和药学服务质量开展调查和分析,比较药房药学服务质量管理工作前后患者服务满意度.结果:开展药房服务质量管理工作前患者服务满意度明显低于开展药房服务质量管理工作后,P<0.05,差异有统计学意义.结论:在医院药房管理过程中开展药学服务质量管理工作能够有效提高患者服务满意度,减少药学服务出现的差错,同时降低药物应用不良反应发生率.     

从执业药师角度浅谈社会药房开展慢病服务的障碍与建议

目的 探讨社会药房药师开展慢病药学服务的障碍及建议。方法 通过在线问卷调查及与社会药房药师一对一访谈调查其开展慢病药学服务的障碍与建议。结果 共有167名社会药房药师参与了问卷调查,缺乏与其他医疗专业人员的有效沟通（67.07%）和缺乏政府政策支持（65.27%）是药师认为最大的障碍;共选择了16名社会药房药师进行定性访谈,缺乏公司政策、法律保护、公众认知、与其他医务工作者的合作及专业能力是主要障碍;相应的,公司考核体系的改革、政府继续教育的投入及个人专业能力的提升等是药师认为可以促进药学服务落地的因素。结论 社会药房药师应不断提升自身专业素养以应对开展慢病药学服务所面临的挑战,政府、企业管理层应发挥更大作用以促使药学服务开展得更加规范和深入。     

基于质量功能展开技术与卡诺模型优化慢病药学服务模式及效果评价

目的 应用质量功能展开（QFD）技术与卡诺（KANO）模型结合的方法,即QFD-KANO法,优化慢病药学服务模式,提高药学服务质量。方法 应用QFD-KANO法分析慢病诊疗过程中医师、护理人员、药师、患者的需求,针对核心需求对现有的慢病药学服务模式进行优化,比较优化前后药学服务效果。结果 慢病药学服务模式优化后,处方的平均前置拦截审核时间由10.0min降至1.5min,药品使用不合理率从0.34%降低到0.19%,每季度接受用药教育的患者例数从768例增加至每季度2301例,每季度血药浓度监测解读例数从135例提高至215例,医护技三位一体药学服务覆盖率从10.00%提升至17.00%,慢病患者满意率从92.44%提升至97.89%。结论 QFD-KANO法有助于挖掘慢病药学服务中医师、护理人员、药师和患者的核心需求,能够优化慢病药学服务模式,提升药学服务质量。     

对社会药房药学服务3个层次的探讨

目的 :为社会药房提高药学服务质量提供参考。方法 :运用专业化服务营销原理将药学服务分为3个层次 ,并对各层次的内容进行分析和探讨。结果与结论 :药学服务的3个层次是紧密结合的统一体 ,社会药房应做好每一层次的工作 ,以提高核心竞争力     

药房药学服务质量化管理中构建品管圈的可行性研究

<正>在医疗环境不断优化的今天,医疗机构间的竞争也日益激烈,而医疗服务质量成为医疗机构之间竞争的关键因素,拥有良好医疗服务水平的医疗机构更易在竞争中脱颖而出。要想提高医疗机构医疗服务质量,就必须提高相应的质量管理水平,进而从根本上提升医疗服务质量。药房药学服务是医疗服务的重要组成部分,其直接影响了医院整体医疗服务水平,而药房药学服务质量也是考核医疗机构综合水平的重要指标,因而必须提升药房药学服务管理水平,构建一套针对性的、高效的药学服务质量化管理模式~([1])。品管圈是一类现代质量管理模     

成都市社会药房慢病管理服务现状调查研究

目的:为社会药房开展慢病管理服务提供参考。方法:设计《成都市社会药房慢病管理服务现状调查问卷》,采用配额抽样法,于2018年5-7月抽取成都市5个主城区的社会药房(每家药房发放1份问卷),对其基本情况及慢病管理服务开展情况、慢病管理服务的认知情况、慢病管理服务面临的挑战情况等进行问卷调查并提出改进建议。结果与结论:共发放问卷272份,回收有效问卷252份(有效回收率为92.65%)。共189家(75.00%)社会药房开展了慢病管理服务,其中112家(59.26%)开展时间为1～3年,87家(46.03%)设立了服务专区,68家(35.98%)配备了专职专员,54家(28.57%)配备了兼职人员,且多为执业药师,116家(61.37%)药房针对相关工作人员的培训次数主要为1～2次/年。开展的慢病管理服务项目包括基础指标检测(176家,93.12%)、建立健康档案(142家,75.13%)、合理用药指导(163家,86.24%)等;调查认为慢病管理服务的实质性收益包括改变患者健康状态(163家,86.24%)、提升患者对药房及工作人员的信任度(141家,74.60%)、改善患者生命质量(129家,68.25%)等;50%以上的药房面临着驻店执业药师数量有限(102家,53.97%)、难以组建专业团队(112家,59.26%)、患者对慢病管理服务缺乏信任(101家,53.44%)等挑战。成都市社会药房慢病管理服务处于积极探索初期,可为患者及药房带来诸多收益,有利于医疗卫生政策的推进,但同时存在部分薄弱环节。建议相关政府部门加大政策法规的支持力度;社会药房不断提升自身专业化水平;依托"互联网+"优势,满足公众多样化的药学服务需求;加大宣传力度,提升慢病患者的认知度和参与度。     

临床药学服务对社区高血压、冠心病慢病患者的影响

摘 要 目的：对临床药师参与社区高血压、冠心病慢病管理的影响进行评价。方法: 设计社区慢病患者的临床药学服务管理方案,建立社区高血压、冠心病慢病患者用药档案,对患者安全用药认知及慢病用药情况进行调研。针对不合理用药情况及生活习惯等给予两次药学干预,提出药学意见。评价患者用药依从性、药学意见接受度、血压等改善情况,并对患者用药费用及保健品费用进行分析评价。结果: 患者用药依从性明显提高,高血压达标率上升,患者对临床药学服务满意度较高,对药学干预意见的接受度明显提高;患者用药总费用无明显变化,但保健品费用明显下降。结论: 临床药师进入社区开展慢病用药管理是扩大临床药学影响的有效路径,能提高慢病患者用药合理性、安全性,对促进社区慢病管理有积极作用。     

山东省社会药房慢性病管理现状调查研究

目的 调研山东省内社会药房开展慢性病管理的现状,为提高管理水平提供参考。方法 选择山东省5个地市155个社会药房为研究对象,问卷调查慢性病管理的人员配备、服务项目和阻滞因素等;分地市选取1 155例慢性病患者为研究对象,调研患者对药房慢性病管理的认知、需求、参与和认可情况。结果 社会药房主要围绕高血压(90.5%)、糖尿病(87.5%)和慢阻肺(75.2%)等慢性病开展服务,管理项目主要有用药指导(90.3%)、健康教育(89%)和生化指标检测(85.8%),阻滞性因素是缺少专业管理人员(61.3%)、患者依从性差(52.9%)和对药房缺少信任(48.4%)。患者对慢性病的认知度(65.2%)低,参与药房管理的积极性低(56.5%);期望药房建立慢性病管理专区(57.7%),检测生化指标(56.2%),提供用药指导(50.8%);73.6%的患者信任药房的管理,满意度为86.7%。结论 慢性病管理在一定程度上满足了患者的疾病康复需求和健康管理需求,但仍面临多重挑战,社会药房需要利用好各类利好政策,从发展方向、发展路径和发展模式上大胆创新、不断探索。     

Pharmacists’ experience of a diabetes risk-assessment service and analytical quality control in community pharmacies – A focus-group study

BackgroundHealthcare services such as diabetes risk-assessment are increasingly common in community pharmacies. Knowledge of community pharmacists’ experiences of such services could ease the implementation of a larger-scale service.ObjectivesTo explore Norwegian pharmacists’ experience of a diabetes risk-assessment service, including analytical quality control, in a community-pharmacy setting.MethodsThree focus-group interviews were conducted in Norway between August and September 2017. Systematic text condensation was used, an analytic approach well suited for thematic content analysis across interview data. Fourteen pharmacists took part, recruited from a project offering a diabetes risk-assessment service, including measurements of Glycated hemoglobin A1c (HbA1c), in Norwegian community pharmacies.ResultsThe pharmacists emphasized the importance of using their knowledge and skills to promote good health. They considered offering this service as being compatible with their role as pharmacists. As communication is an essential part of their work, the pharmacists evaluated their communication skills as being good. Nevertheless, how to communicate the offering of this service was seen as a challenge, for instance recruiting participants and communicating in an understandable and professional way. Inclusion of the whole pharmacy staff as a team was experienced as an important success factor for implementation of a risk-assessment service. Analytical quality control was perceived as being a natural part of their job and a manageable task.ConclusionsOffering a diabetes risk-assessment service is in line with the way a selected group of Norwegian community pharmacists perceived their professional role. However, they were uncomfortable recruiting participants, and expressed the wish for more support from the pharmacy chain. Our results add performance of analytical quality control as part of the ongoing development involving expansion of pharmacists' professional role. Future implementation studies may also benefit from giving both the pharmacy staff and customers sufficient time to familiarize themselves with the new service before measuring effects.     

Service quality in community pharmacy: An exploration of determinants

BackgroundAlthough various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs’ understanding of service quality and its determinants.ObjectivesThis study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality.MethodsStructured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants’ perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers.ResultsFrom the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management.ConclusionsThe study indicates that the extent to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers.     

Factors associated with the intensity of government remunerated and unremunerated service provision in community pharmacies

BackgroundMany community pharmacies provide medication and disease state management services with and without specific remuneration. Availability of these services is often reported, however little is known about factors influencing the intensity of their provision.ObjectiveTo investigate factors associated with the intensity of provision of selected government remunerated and unremunerated community pharmacy services in Western Australia (WA).MethodsA questionnaire was mailed to a random sample of 421/628 (67%) community pharmacies in WA. The first dependent variable was intensity of government remunerated MedsCheck and Diabetes MedsCheck service frequencies per month. The second was the intensity of the sum of government unremunerated asthma screening, blood glucose testing, cholesterol testing and smoking cessation disease state management service frequencies per week. Principal Component Analysis defined attitudinal components influencing service provision. Linear regression with bootstrap confidence intervals determined variables associated with intensity of provision of the selected services. The variables were: pharmacist; pharmacy setting characteristics; and, attitudinal factors.ResultsThe questionnaire yielded a response rate of 49.2%. Attitudinal components that facilitated service provision were: general practitioners (GPs) willingness to collaborate; pharmacists are capable and ready; and pharmacists require further training. Staff capability and low return on investment were barriers to increased service provision. The intensity of government remunerated services was independently associated with pharmacies having pharmacy interns, fewer dispensary technicians, and being capable and ready to provide the services. Higher intensity of the provision of the unremunerated disease state management services was independently associated with the intensity of provision of MedsCheck and Diabetes MedsCheck services.ConclusionsImproved pharmacy workflow, achieved by the availability of pharmacy interns, and pharmacists being capable and ready, were important factors in the intensity of MedsCheck and Diabetes MedsCheck services. Intensity of the provision of government remunerated services facilitated a higher prevalence of disease state management services provision.     

A qualitative case study exploring the implementation of pharmacist care planning services in community pharmacies

ObjectivesTo describe the comprehensive annual care plan (CACP) process and to conceptualize how remunerated CACP services were implemented by community pharmacists.DesignA comparative, multiple case study approach with data comprising document review, observation, and semistructured interviews.Setting and participantsPharmacists, pharmacy technicians and staff, and student pharmacists from 4 different community pharmacy sites in Alberta, Canada, including independent, franchise, and corporate chain pharmacies. In addition, patients and other health care providers were included in the interviews.Outcome measuresConstructivist grounded theory was used to understand how care planning services were implemented in the real-world context of community pharmacies and how pharmacists provided CACPs within their practice.ResultsBetween May 2016 and January 2018, a total of 77 interviews and 94 hours of observations were completed at the 4 pharmacy sites, and 61 documents were collected. The CACP service required adaptation of the workflow at each of the sites. However, pharmacists and other pharmacy staff recognized benefits of the service with respect to pharmacists’ role expansion. The overarching grounded theory concept was changing the status quo. The following 4 themes emerged representing how the service was implemented: engaging patients, professional development and learning from experience, creating a supportive environment, and building community connections.ConclusionThis study found that practice change or changing the status quo was needed to implement remunerated care planning services in community pharmacies. The results of this study may be of interest to community pharmacists, pharmacy managers, and policy makers who are implementing remunerated care planning services in other jurisdictions.     

医院药剂科生产效率描述性指标评价方法的建立

目的 探讨建立能够客观、简便地评价药剂科生产效率的方法。 方法 分析25家军队医疗机构药学部门的投入产出数据,构建药剂科生产效率描述性评价指标。 结果 建立以年人均药品收入、每张床位年均药品收入、人均日调配处方量作为经济产出效率指标,以临床药师服务时数作为改善型效率指标和人均用药差错防范评分作为防范型效率指标的描述性评价方法。 结论 经济产出效率指标具有局限性,质量产出效率指标量化方法需要进一步规范和完善。     

Existing arrangements for monitoring community pharmacies in England: Can they have a role in the revalidation of pharmacists?

BackgroundMaintaining and regulating professional competence in health care is a growing concern. Tasked with developing a system of revalidation for pharmacy professionals, the pharmacy regulator in Great Britain commissioned a series of studies to evaluate existing sources of evidence as potential contributors to the revalidation process.ObjectivesTo explore the utility of existing regulatory inspections and service commissioners' contract monitoring processes in the community pharmacy sector as sources of evidence of the fitness to practice of pharmacists in England.MethodsThirteen semistructured telephone interviews conducted with representatives of the regulatory Inspectorate and community pharmacy commissioners.ResultsInterviewees described current processes for inspecting and monitoring community pharmacy premises and the services they provided. Their focus was primarily on the pharmacy and not on the pharmacist. Views were given as to how the roles of the Inspectorate and service commissioners might be developed to incorporate aspects of revalidation. Particular issues were raised in relation to the revalidation of self-employed locum and independent owner pharmacists.ConclusionsExisting inspection and contract monitoring processes have little utility in providing evidence of the fitness to practice of individual community pharmacists in England. However, there may be potential for the Inspectorate and service commissioners to develop a role in revalidation, particularly for locum pharmacists and/or independent pharmacy owners. Moreover, they may take a role in providing the infrastructure required to support the process of revalidation for community pharmacists. Current financial pressures and restructuring in the National Health Service, however, are obstacles to the development of revalidation processes.     

老龄化背景下居家药学服务开展现状及建议

目的 探讨老龄化背景下如何进一步提升居家药学服务质量。方法 总结近年来我国居家药学服务发展历程，分析当前居家药学服务开展的现状与局限。结果 我国的居家药学服务已从早期的各地区自主探索阶段逐步成熟规范，但其质量提升仍受多个瓶颈的制约，建议从加大药学服务普及力度、拓宽合理用药宣传渠道、优化药师队伍配置等方面加以改进。结论 促进居家药学服务质量提升对社区居家患者具有重要意义，需要多方共同致力完善。