The role of hospital and community pharmacists in pharmacovigilance

In this paper, we give an overview of the role pharmacists actually have and could have in collecting reports of adverse drug reactions (ADRs) and more widely in pharmacovigilance.In the literature, several ways are mentioned in which the pharmacist, both the community pharmacist and the hospital pharmacist, can contribute to the safe use of drugs. In addition to their responsibilities regarding drug dispensing and compliance, they can have a substantial role in ADR reporting.Especially, hospital pharmacists can play a significant role in ADR reporting because the most serious adverse drug events occur in hospitals, and ADRs account for a substantial proportion of hospital admissions.Community pharmacists, however, can also play an important role in ADR reporting. This is, for example, the case in the Netherlands where community pharmacists contribute substantially, both in numbers and in quality of ADR reports.The contribution of the pharmacist to pharmacovigilance should, however, not be limited to ADR reporting. The various pharmaceutical disciplines could also greatly enhance our understanding of the nature of ADRs. If those involved in pharmaceutical disciplines can rise to this challenge, they will significantly help deepen our insights into ADRs.     

临床药师在不良反应监测中的实践与体会

目的浅析临床药师在临床实践中开展不良反应监测的工作模式及体会。方法通过对4例典型患者进行药学监护,从正确认识药品不良反应、特殊剂型药物的规范服用、重症患者的用药调整及输液管理等诸方面,阐述临床药师在不良反应监测工作中的切入点。结果临床药师判断出与突发不良反应相关的药物,并采取积极抢救措施,减少了药源性损害。结论临床药师应重点着眼于不良反应报告与监测工作,收集安全性信息,提出相应的药物警戒建议,保障公众用药安全。     

临床药师系统干预对基层医院抗菌药物使用的效果分析

目的评估临床药师干预对基层医院抗菌药物使用的效果,为促进基层医院合理使用抗菌药物提供参考依据。方法以长沙市岳麓区某基层医院为研究对象,采用前后对照方法,对基层医院2012年8月至10月（干预前）291份病历和2013年3月至5月（干预后）301份病历抗菌药物使用的成本和效果进行分析。结果该基层医院抗菌药物使用合理率干预后由40%上升为93%（P〈0.01）,抗菌药物的使用率由＆gt;90%下降到〈55%,差异显著（P〈0.01）;抗菌药物使用强度由＆gt;85DDD下降至约40 DDD（P〈0.01）,达到卫生部规定的标准,抗菌药物人均费用明显降低。结论临床药师系统干预有利于提高基层医院抗菌药物的合理使用,效果明显。     

Evaluation of a training and communication-network nephrology program for community pharmacists

Objectives To assess the feasibility and impact of implementing ProFiL program to optimize community-pharmacist management of drug-related problems among chronic kidney disease patients followed in a predialysis clinic. The program comprises a training workshop, communication-network program and consultation service. Setting Forty-two community pharmacies, 101 pharmacists, and 90 chronic kidney disease patients attending a predialysis clinic in Laval (Canada). Patients were followed-up for 6 months. Method In a six-month, pilot, open, cluster-randomized controlled trial, community pharmacies were assigned to ProFiL or the usual care. Chronic kidney disease patients of these pharmacies attending a predialysis clinic were recruited. ProFiL pharmacists attended a workshop, received patient information (diagnoses, medications, and laboratory-test results) and had access to a consultation service. Their knowledge and satisfaction were measured before and after the workshop. The mean numbers of pharmacists’ written recommendations to physicians (pharmaceutical opinions) and refusals to dispense a medication were computed. Results Of the ProFiL pharmacists, 84% attended the workshop; their knowledge increased from 52% to 88% (95% CI: 29–40%). Most ProFiL pharmacists rated workshop (95%), communication program (82%) and consultation service (59%) as “excellent” or “very good”; 82% said the program improved the quality of their follow-up. The consultation service received 21 requests. ProFiL and usual care pharmacists issued a mean of 0.50 and 0.02 opinion/patient, respectively, (95% CI of the adjusted difference: 0.28–1.01 opinion/patient). Conclusion The results of this pilot study suggest that ProFiL can be implemented and may help community pharmacists intervene more frequently to manage drug-related problems. However, a larger-scale study with longer follow-up is necessary to evaluate the impact of the program on management of drug-related problems and its clinical relevance. Institution where the study was conducted: Centre ambulatoire, Centre de santé et de services sociaux de Laval. Information about presentation of the work as an abstract or poster: Abstracts of this study have been published in the proceedings of the 3rd Canadian Joint Therapeutics Congress of the Canadian Society for Clinical Pharmacology—Canadian Association for Population Therapeutics—Canadian College of Clinical Pharmacy (Toronto, Canada, May 2006), the Colloque 2006 of the Réseau québécois de recherche sur l’usage des médicaments (Quebec, Canada, June 2006), the 22nd International Conference of the International Society of Pharmacoepidemiology (Lisbon, Portugal, August 2006), and the North American Primary Care Research Group (NAPCRG) annual meeting (Vancouver, Canada, October 2007).     

肿瘤专科医院PIVAS合理用药及临床药师的作用

目的分析医院静脉药物配置中心(PIVAS)药物的使用情况与临床药师在安全用药中的作用。方法对医院2010年度PIVAS全年用药及各季度用药进行分析,并对562 915组输液医嘱进行审核。结果植物类抗肿瘤药物销售金额占55.50%,紫杉醇类药物各季度均占销售首位,鸦胆子油销售数量持续增加,其中679组医嘱存在溶媒选择、用量和给药剂量不当等不合理用药现象。结论药师可凭借PIVAS平台,积极开展临床药学工作,确保静脉用药安全。