广州市荔湾区网格化社区慢性病管理模式研究

目的 探索网格化管理模式对社区慢性病管理的意义.方法 本中心自2011年开始实施社区卫生服务网格化管理,比较网格化管理实施前、后居民健康档案的建档指标、慢性病管理指标和社区居民的满意度.结果 实行网格化管理后,居民健康档案的建档指标以及慢性病管理指标明显上升,社区居民的满意率明显提高.结论 通过网格化管理可以有效提高社区慢性病管理工作的质量,提高社区居民的满意度.     

Involvement and practice of community pharmacists in maternal and child health services: A systematic review

IntroductionCommunity pharmacists are pivotal in the provision of Maternal and Child Health (MCH) services, yet level of involvement, practice and barriers and facilitators in providing these services is largely unknown.ObjectiveThe objective of this review is to summarize available evidence on the involvement and practice of community pharmacists in MCH services.MethodsSeven electronic databases (PubMed, CINAHL, ProQuest Health, Cochrane library, Scopus, Embase, and Web of Science) were searched for articles published in English since inception of the database to November 30, 2019. Papers were included if they assessed involvement and practices of community pharmacists in maternal and child health services. Full articles identified and included for the final analysis were assessed for quality using the Mixed Method Appraisal Tool (MMAT) (2018) by all authors and data were extracted by one author and cross-checked by all authors.ResultA total of 2830 articles were identified. Following the assessment against the inclusion criteria, 14 full text articles were included for the final analysis. In eight studies, community pharmacists were reported to have involvement in maternal health services, in terms of providing breastfeeding guidance, counselling about the benefit of vitamins during pregnancy, provision of emergency contraception advice, and responding to illness symptoms such as back pain. In three studies, community pharmacists were providing advice in managing acute diarrhea in children. Medication use services and counselling about medication for children were also reported in three studies. Perceived consumer attitudes, problem with insurance coverage, lack of time among pharmacists and lack of incentives for the services provided were reported by pharmacists as the main barriers to service provision.ConclusionCommunity pharmacists were involved in various MCH services in community pharmacy settings. However, the extent of practices was not as per the joint International Pharmaceutical Federation (FIP)/World Health Organization (WHO) guidelines on good pharmacy practice in some services such as management of diarrhea.     

社区医生对慢性阻塞性肺疾病的认知及管理

目的探讨社区医生对慢性阻塞性肺疾病(COPD)的认知及管理。方法 1300名社区医生用问卷方法调查社区医生对COPD的认知。结果调查医生中对COPD定义及危险因素答题评分及格人数最多为832(64.00%);30~40岁之间的社区医生答题评分及格人数最多为307(64.09%),与其他学历差异有统计学意义(P<0.05);本科以上学历社区医生答题评分及格人数最多为92(93.88%),与其他年龄段差异有统计学意义(P<0.05)。结论在日后的培训和考核过程中,必须加强对社区医生的技术指导和工作督导作用,从总体上提高COPD防控水平。     

太原市迎泽区2型糖尿病患者自我管理现状调查及干预研究

目的调查社区2型糖尿病患者糖代谢指标情况、糖尿病知识掌握情况及自我管理水平的现状,并对采用自我管理模式干预后作出评价。方法采用"中国2型糖尿病病人自我管理情况调查问卷"进行调查分析自我管理现状。将428例社区2型糖尿病患者随机分为同伴教育模式管理组(试验组)216例和社区常规教育管理模式组(对照组)212例。对照组按照社区常规教育管理模式对糖尿病患者进行健康教育、发放健康教育宣传资料进行干预;试验组采用自我管理模式,由教育者组织糖尿病患者进行自我管理课程的学习,定期开展各项主题活动,并有针对性地进行干预。比较干预3、6个月后,2组患者的评价指标即糖代谢指标达标率、糖尿病知识水平达标率和自我管理得分等方面的变化情况。结果 1干预前2组患者的糖代谢指标达标率、糖尿病知识掌握达标率、自我管理水平得分比较,差异无统计学意义(P>0.05);干预后3、6个月,2组患者的糖代谢指标达标率、糖尿病知识掌握达标率、自我管理水平得分均有上升,但试验组比对照组上升率大,差异均有统计学意义(P<0.05)。2从糖尿病患者自我管理的各个分量表中得出,在干预前,干预后3、6个月,试验组和对照组的药物依存性平均分最高,监测依存性平均分最低。结论糖尿病自我管理模式明显优于社区常规教育管理模式。采用自我管理模式的方式进行教育,能使患者的自我管理水平明显提高。在糖尿病自我管理的4项内容中,告知患者自我监测的重要性是医护人员健康宣教的重点。     

Effects of a management technician on structured working in Dutch community pharmacies

OBJECTIVE: To study the effects of 'stepwise working with the help of a management technician' on structured working with regard to patient education in a sample of Dutch community pharmacies. METHODS: The intervention program provided the management technician with knowledge, tools and skills needed for the organisation of patient education activities in her community pharmacy. Twenty-eight pharmacies were selected for the study. After matching, each pharmacy was randomly assigned to either the experimental or control group. In the pharmacies of the experimental group, a technician was selected to become the management technician. MAIN OUTCOME MEASURES: Pharmacy technicians were assessed by means of written questionnaires at baseline and immediately after the intervention (12 months). The outcomes were the variables that were directly targeted by the intervention, and included technicians' perception of the availability of policy plans, support for patient education activities towards their implementation, evaluation, and provisions for continuity. RESULTS: After 12 months, the following indicators for structured working were noted to have increased in the experimental group compared to the control group: the technicians in the experimental group more often reported an awareness of policy plans, less lack of continuity of activities, support and evaluation for implementing patient education activities. We also observed that the control group had a higher baseline level and the effects on support and evaluation showed differences between pharmacies. The observed increases were more pronounced in pharmac higher exposure to the intervention, and in the case of support and evaluation relevant in this more exposed group. CONCLUSION: We found indications for effects of the intervention program, especially in the pharmacies with increased exposure. However, results could be influenced by regression to the mean, as the control group started with a higher mean than the experimental group. We conclude that technicians' participation in the management of patient education activities appears to be effective when she has a minimum of hours to spend on this task in her pharmacy.     

COVID-19 pandemic: The role of community pharmacists in chronic kidney disease management supportive care

The COVID-19 pandemic is putting enormous pressure on healthcare systems worldwide and various countries are struggling to flatten the curve to prevent their healthcare system from becoming overwhelmed. Studies have shown that people with chronic kidney disease (CKD) are at increased risk of COVID-19 infection and mortality. However, the interruption of routine care and support due to the current challenges with healthcare providers, facilities, and essential medicines due to this pandemic is adversely affecting people with CKD. This is because poor management of this disease leads to negative health outcomes. In order to maintain good health, this vulnerable group of patients rely heavily on the extended role of the community pharmacists in chronic disease management. This paper highlights the extended role of the community pharmacists in CKD management supportive care during the COVID-19 pandemic.     

Factors associated with comprehensive medication review completion rates: A national survey of community pharmacists

BackgroundCompletion rates for medication therapy management (MTM) services have been lower than desired and the Centers for Medicare and Medicaid Services has added MTM comprehensive medication review (CMR) completion rates as a Part D plan star measure. Over half of plans utilize community pharmacists via contracts with MTM vendors.ObjectivesThe primary objective of this survey study was to identify factors associated with the CMR completion rates of community pharmacies contracted with a national MTM vendor.MethodslRepresentatives from 27,560 pharmacy locations contracted with a national MTM vendor were surveyed. The dependent variable of interest was the pharmacies' CMR completion rate. Independent variables included the pharmacy's progressiveness stratum and number of CMRs assigned by the MTM vendor during the time period, as well as self-reported data to characterize MTM facilitators, barriers, delivery strategies, staffing, selected items from a modified Assessment of Chronic Illness Care, and pharmacist/pharmacy demographics. Univariate negative binomial models were fit for each independent variable, and variables significant at p < 0.05 were entered into a multivariable model.ResultsRepresentatives from 3836 (13.9%) pharmacy locations responded; of these, 90.9% (n = 3486) responses were useable. The median CMR completion rate was 0.42. Variables remaining significant at p < 0.05 in the multivariable model included: progressiveness strata; pharmacy type; scores on the facilitators scale; responses to two potential barriers items; scores on the patient/caregiver delivery strategies sub-scale; providing MTM at multiple locations; reporting that the MTM vendor sending the survey link is the primary MTM vendor for which the respondent provides MTM; and the number of hours per week that the pharmacy is open.ConclusionsFactors at the respondent (e.g., responses to facilitators scale) and pharmacy (e.g., pharmacy type) levels were associated with CMR completion rates. These findings could be used by MTM stakeholders to improve CMR completion rates.     

Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice

BackgroundThe central goals of MTM align with those of the Chronic Care Model (CCM). However, reliable and valid assessments are needed to estimate the extent to which components of MTM care delivery are consistent with the CCM. The Assessment of Chronic Illness Care (ACIC) is a 34-item scale for administration in primary care offices to estimate the extent to which chronic care delivery aligns with the six elements of the CCM. The ACIC appears to be responsive for care delivery interventions aimed at improving various chronic illnesses. However, the potential value of the ACIC as a measure for evaluating MTM delivery is unknown.ObjectiveA modified and abbreviated version of the ACIC could be a useful evaluation tool for pharmacist-provided medication therapy management (MTM). The objective of this study was to assess the construct and criterion-related validity, and internal consistency, of the abbreviated (12-item) “MTM ACIC.”MethodsThe abbreviated MTM ACIC was administered to pharmacists employed at 27,560 community pharmacies. Construct validity and internal consistency were estimated through principal components analysis, item-to-total correlations, and Cronbach's alpha estimate of internal consistency. To assess criterion-related validity, a univariate negative binomial model estimated the association between ACIC scores and pharmacy-level MTM completion rates.ResultsA one-component model accounted for 64% of the variance, and Cronbach's alpha was 0.95. Scores on the abbreviated MTM ACIC were associated with MTM completion rates (rate ratio: 1.02; 95% CI: 1.01 to 1.03).ConclusionThe abbreviated MTM ACIC exhibited acceptable construct and criterion-related validity and internal consistency and could serve as a valuable tool for evaluating chronic illness care within the MTM setting.     

Effect of quality chronic disease management for alcohol and drug dependence on addiction outcomes

We examined the effect of the quality of primary care-based chronic disease management (CDM) for alcohol and/or other drug (AOD) dependence on addiction outcomes. We assessed quality using (1) a visit frequency based measure and (2) a self-reported assessment measuring alignment with the chronic care model. The visit frequency based measure had no significant association with addiction outcomes. The self-reported measure of care—when care was at a CDM clinic—was associated with lower drug addiction severity. The self-reported assessment of care from any healthcare source (CDM clinic or elsewhere) was associated with lower alcohol addiction severity and abstinence. These findings suggest that high quality CDM for AOD dependence may improve addiction outcomes. Quality measures based upon alignment with the chronic care model may better capture features of effective CDM care than a visit frequency measure.     

The management of asthma in adult patients in the community pharmacy setting: Literature review

BackgroundAsthma poses a public health concern, with an estimated 235 million people currently living with the condition globally. The provision of evidence-based, patient-centred services for adult asthma patients in community pharmacy which involves collaboration across the multidisciplinary team could improve their asthma control.ObjectivesA literature review was conducted to examine the evidence of asthma management in community pharmacy setting.MethodsFive databases were searched to identify relevant articles published before February 2021. Screening of the potential studies was performed to remove articles that did not comply with the inclusion criteria. Relevant data from all included studies was collected using a data extraction form to ensure consistency throughout the review.ResultsTwenty studies were included in the review; all were conducted in community pharmacy settings in the period of 2001–2020, in different countries. The studies included randomised controlled trials, controlled trials and observational studies. Several successful community pharmacy-based services that were provided to asthma patients to improve their asthma management were highlighted in this review. These interventions consisted of one or more components and included: patient education, inhaler technique improvement, patient counselling, self-management plans, development and provision of asthma action plans and referral to other health care practitioners. None of the studies involved medication or dosage changes by community pharmacy.ConclusionsThe evidence discussed in this review showed that community pharmacists are well-placed to deliver services to asthma patients and many studies were conducted in the community pharmacy to improve asthma control in adult patients. However, further research could be conducted to explore further opportunities for community pharmacy to enhance asthma patients management of their condition.     

A systematic review of community pharmacy initiatives to improve treatment of depression and pain: Focus on types of programs and patient-reported outcomes

IntroductionDepression and pain are common, disabling, mutually exacerbating conditions. Many patients living with these conditions present to community pharmacies on a regular schedule to purchase both prescribed and over-the-counter medications. Community-pharmacy based programs have been developed to improve depression and pain outcomes.MethodsThe PRISMA guidelines were utilized to answer the following question: In patients with depression and/or pain, what is the effect of the existing community pharmacy programs on depression and/or pain outcomes. Queried databases included Pubmed, EMBASE, and PsychINFO. DistillerSR was used to organize the screening, abstraction, and review of data. All potential articles were evaluated by two authors, and conflicts were discussed to achieve resolution. In addition to primary outcomes, sources of potential bias and quality indicators were abstracted for every article.ResultsThree thousand nine hundred and twenty articles were reviewed, and 13 studies met eligibility criteria (n = 7 for depression; n = 6 for pain). Most studies demonstrated improvement in measures of depression or pain. However, compared to usual care or other control conditions, most of the depression and pain-specific interventions did not provide additional symptomatic benefit. The community pharmacy-based interventions were superior for other outcomes including medication adherence, reducing stigma, improvement in self-efficacy, and improvement in general management of disease.ConclusionCommunity pharmacies may be uniquely positioned to deliver interventions that improve outcomes associated with successful depression and pain treatment outcomes. However, the benefits of published community pharmacy-based treatments for actually improving depression and pain severity has not yet been established. Innovative interventions and additional research may be needed to achieve clinical success for pharmacy interventions for depression and pain.     

护理干预对社区慢性病患者生活质量改善效果分析

目的：探讨护理干预对社区慢性病患者生活质量的改善效果。方法300例慢性病患者随机分为试验组和对照组,各150例。两组患者均给予原发病的常规治疗,此外,对照组配合常规的护理,试验组则给予社区综合性护理干预。实施护理干预后,比较两组患者的心理状态、治疗依从性及生活质量的改善程度。结果试验组患者心理状态评分显著低于对照组（P〈0.05）,治疗的依从性及生活质量明显优于对照组,差异有统计学意义（P〈0.05）。结论对社区慢性病患者实施综合性护理干预,能有效改善患者心理状态,提高其治疗依从性,同时对患者的生活质量有较显著的改善。