药物经济学评价方法在临床药学中的应用

概述了药物经济学常用的 4种评价方法并且进行了对比 ,通过引用实例阐述了药物经济学在临床药学中的应用     

A Required Course in the Development, Implementation, and Evaluation of Clinical Pharmacy Services

Objective

To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model.

Design

Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation.

Assessment

One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7.

Conclusion

The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care.     

A clinical knowledge measurement tool to assess the ability of community pharmacists to detect drug-related problems

Introduction Drug‐related problems (DRPs) are associated with significant morbidity and mortality, with most DRPs thought to be preventable. Community pharmacists can detect and either prevent or resolve many of these DRPs. A survey‐based clinical knowledge measurement tool was designed and validated to estimate a community pharmacist's clinical knowledge and ability to detect and appropriately resolve DRPs. Methods Nine clinical cases with seven multiple‐choice statements (63 statements in total) were constructed, based on scenarios that were found to occur frequently in Australian community pharmacies. The statements aimed to assess a pharmacist's ability to identify, gather relevant information about and make appropriate recommendations to resolve, a DRP. The survey was pilot tested with 18 academics at three Australian pharmacy schools, resulting in the removal of 23 statements. The survey was then administered to undergraduate pharmacy students (28 fourth‐year, 41 third‐year and 42 first‐year students) and to 433 Australian community pharmacists who were participating in an intervention documentation trial. The pharmacists' resultant survey scores were correlated against their actual rate of documenting clinical interventions. Results The tool had relatively good internal consistency. Significant differences were seen between the three groups of students (P < 0.01). Community pharmacists with additional clinical qualifications had a significantly higher score than other participating pharmacists (P < 0.01). A moderate, but significant, correlation was seen between the pharmacists' survey score and their clinical intervention rate in practice during the trial (P < 0.01). Conclusion The clinical knowledge measurement tool appeared to estimate a pharmacist's ability to detect and resolve DRPs within the community pharmacy environment.     

临床药师查房记录的初步回顾性分析

目的总结临床药师查房工作,积累药学监护经验,提高药学服务质量。方法翻阅2009年临床药师查房记录,对典型病例进行整理、分类并分析。结果临床中药物不良反应、药物性肝炎以及各种不合理用药比较常见,用药安全管理需要加强。结论临床药师进入临床一线,加强医、药、护、患间的交流与合作,有利于用药安全和临床药师的成长。     

临床药师参与抗菌药物会诊工作分析

目的通过调查临床药师参与抗菌药物会诊工作的现状,评价临床药师会诊实践的效果。方法对2012年9月至11月临床药师参与抗菌药物会诊的病历资料进行回顾性统计和分析。结果临床药师参与抗菌药物会诊100例次,申请会诊科室18个,外科申请会诊次数最多,有80例次,占80.00%,普通会诊83例次,急会诊16例次,院内大会诊l例次;会诊建议采纳率为94.00%,治疗有效率为73.63%。结论临床药师参与会诊,协助医师制订个体化抗菌药物治疗方案,对于促进临床抗菌药物的合理使用有重要意义。     

用药物经济学优化治疗方案,指导临床合理用药

提出药物经济学应纳入医院临床药学的管理范畴，应用为临床药师的工作职能，临床合理用药应从药物治疗的安全，有效，经济三项抓起，将药物经济学原理和方法应用于对临床药物治疗过程及结果的评价，应从药物经济学角度选择合适的治疗方案，指导临床合理用药。     

临床药师参与心血管内科药物治疗案例分析

目的:探讨我院心内科临床用药常见问题,促进合理用药。方法:结合心血管临床工作实际案例,进行用药审核和点评工作,从药品不良反应监测、药物相互作用、给药途径、特殊人群用药、治疗方案优化等角度进行分析。结果:临床药师通过参与临床用药治疗和药学监护,发现、解决了实际存在的用药问题。结论:临床药师介人临床实践已初步取得积极效果,药师利用药学专业知识,提高了临床合理用药水平,保障了用药安全。     

试论我国临床药学的现状与对策

本文小结了我国开展临床药学工作以来所取得的主要成绩,阐述了目前尚存在的问题,并对其产生的原因作了简要的分析。在此基础上,笔者提出了今后发展的对策,尤其对建立规章制度、培养人才、药师下病房三个主要问题进行了较为详细的论述。     

临床药学研究与实践应充分重视药物调剂工作简

目的 促进药物调剂业务在临床药学研究领域的地位提升与发展.方法 结合临床药学实践,以药物调剂对临床合理用药的作用为目标进行探究.在研究中以当代药物和疾病的系统知识和理论为基础,并结合药物调剂过程中参与临床诊治的合理用药实际案例的方法,指导患者合理使用药物提高临床用药的医疗质量,患者及家属对药师的合理用药指导服务给予了充分肯定,体现了药师在合理用药中的重要作用.结果与结论 医院的临床药物调剂工作是一个在合理用药中发挥药师作用,医院药学部门直接参与合理用药有效的、最基础的重要平台.在临床药学研究与实践中重视药物调剂工作,对于提高医疗机构合理用药水平具有积极的现实意义.     

临床药师干预对某院中成药注射剂使用的影响

目的 了解临床药师干预前后本院门诊中成药注射剂的应用情况,提高中成药注射剂的应用水平,保证临床用药安全.方法 随机抽取临床药师干预前后的门诊处方进行比较分析,考察临床药师进行干预后的工作成效.结果 干预后中成药注射剂不适宜处方从33.3％下降到5.2％.结论 临床药师干预对中成药注射剂的规范使用有显著的促进作用...     

信息化服务在临床药学工作中的重要性

目的从药品不良反应、药物咨询服务、药学教育3个侧面反映信息服务在现代临床药学工作实践中的重要性,揭示信息系统与医院药学、临床药学密不可分的关系。方法分析了信息服务对药品不良反应监测、药学教育以及药物咨询等药学服务工作的推动、促进作用。结果信息化系统的持续改进是全面提升临床药学和药学服务质量的保证。结论信息服务是药学服务的精髓,只有进一步完善信息化服务系统,才能为广大患者和医务工作者提供更加完善的药学服务。     

Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Drug-related problems and associated variables

BackgroundA medication use review (MUR) aims to optimize medication use, patient knowledge and can improve health outcomes. This pharmaceutical care service is not yet available in Belgium.ObjectivesTo describe drug-related problems (DRPs) detected during a MUR, subsequent interventions proposed by pharmacists and evolution of DRPs until follow-up and to identify patient-related variables associated with the number of reported DRPs.MethodsBelgian community pharmacists provided a MUR to older polymedicated ambulatory patients and registered DRPs, interventions and resolution at follow-up using the PharmDISC classification. The relationship between 14 patient-related variables and the number of reported DRPs was investigated with univariate analysis. A prediction model was developed with significant variables using negative binomial regression analysis.ResultsAcross 56 pharmacies, 453 patients received a MUR and 1196 DRPs were registered (median 3DRPs/patient, range 0–10). Only for 11.7% of patients no problems were identified. The top-3 causes were interaction (15.2%), inappropriate timing or frequency (13.5%) and adverse effect (11.9%). The top-3 recommended interventions by pharmacists were transmission of information (25.1%), in-depth patient counselling (15.0%) and therapy stop (8.2%). After six weeks, 42.6% of DRPs were resolved; data was missing for 33.3%. A higher number of chronic drugs, female gender and living alone were associated with more DRPs. The prediction model found that per additional chronic drug, the number of problems increases by 4.3% (95% CI: 2.0–6.6%). Male gender decreases DRPs by 22.1% (95% CI: 10.4–32.0%). Living alone provided no additional predictive value in the prediction model. Confounding process- and pharmacist-related variables also influenced the number of reported DRPs.ConclusionA MUR appears an effective strategy to detect and resolve DRPs. The number of chronic medications and female gender predict a higher number of DRPs. These findings are a starting point for evidence-based eligibility criteria for a MUR service in Belgium.     

肿瘤科开展临床药学工作的实践及展望

结合临床实践以及临床工作的体会,探讨药师深入肿瘤科临床促进合理用药的方法。肿瘤专科临床药师须不断加强理论学习与实践,利用自身的药学知识,配合医护人员对病人进行药学监护,降低用药风险,从而提高用药的安全性和有效性。     

临床药学服务经济评价方法探析

目的 为我国临床药学服务经济学评价研究提供参考.方法 介绍美国临床药学服务经济评价研究的评价方法、评价内容以及评价结果等方面的信息.结果与结论 开展临床药学服务有着巨大的价值,可以节约医疗成本.进行临床药学服务评价的方法还需要不断发展与完善,以提供更多更好的证明临床药学服务价值的证据.     

医院药物临床试验中心药房的标准化建设和规范化管理

目的 建立药物临床试验药房的建设和管理的标准。方法 参照已有规范及检查标准,并结合龙华医院药物信息化管理系统的相关实践,总结归纳医院药物临床试验中心药房的标准化建设和规范化管理的经验。结果 从药物临床试验中心药房的管理模式、管理流程、硬件设施、文件资料的管理和信息化系统的应用等多方面综合阐述更为规范化、科学化、系统化的医院药物临床试验中心药房的标准化建设和规范化管理的实践策略及思考。结论 试验用药物的规范化管理是整个临床试验的重要组成部分。为了稳步提高国内药物临床试验研究质量,需要针对试验用药物管理存在的问题,不断完善制度建设和软硬件条件的配备,切实保障受试者用药安全。     

Impact of Pharmacy Student Interventions in an Urban Family Medicine Clinic

Objectives. To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions.Methods. A prospective, unblinded study was conducted to determine the number and cost avoidance value of clinical interventions made by pharmacy students completing advanced pharmacy practice experiences (APPEs) in an urban family medicine clinic.Results. Eighteen students completed this experience in the 8 months studied. Of the 718 interventions performed, 77% were accepted by physicians, including 58% of the 200 interventions that required immediate action. Projected avoidance was estimated at $61,855.Conclusion. The clinical interventions by pharmacy students were generally well received by healthcare providers and resulted in significant cost savings. Pharmacy students can play an important role in a family medicine clinic.     

以治疗药物监测为基础的临床药学实践

目的：介绍以治疗药物监测为基础的临床药学实践方法及体会。方法：从血药浓度的准确测定、知识准备、结果解释的方法和案例分析来加以介绍。结果：药师开展结果解释,可以发现许多影响血药浓度的不良因素,得到医生和病人的认同。结论：系统地开展血药浓度结果解释工作是药师从事临床药学实践的重要内容之一。