A retrospective study of drug‐related problems in Australian aged care homes: medication reviews involving pharmacists and general practitioners

Background Drug‐related problems (DRPs) in Australian aged care homes have been studied previously. However, little is known about the acceptance and implementation of pharmacists' recommendations by general practitioners (GPs) to resolve DRPs. Objectives The primary objective of this study was to investigate the number and nature of DRPs identified by accredited clinical pharmacists. The secondary objective was to study the GP acceptance and implementation of pharmacist recommendations to resolve DRPs. Methods This was a retrospective study of 500 randomly selected, de‐identified medication reviews performed by 10 accredited clinical pharmacists over 6 months across 62 aged care homes. The DRPs identified by pharmacists were subsequently classified by the drugs involved, types of problem (indication, effectiveness and safety) and medical diagnoses of the patient. GP written feedback on the medication review reports determined implementation of pharmacists' recommendations to resolve the DRPs. Results A total of 1433 DRPs were identified in 480 of the 500 residents. Potential DRPs were frequently classified as risk of adverse drug reactions, need for additional monitoring and inappropriate choice of a drug. Alimentary, cardiovascular, central nervous system and respiratory drugs were most frequently implicated, accounting for more than 75% of the DRPs. GPs' acceptance and implementation of pharmacists recommendations were 72.5% (95% CI; 70.2, 74.8) and 58.1% (95% CI; 55.5, 60.6), respectively. Conclusions Over 96% of the residents had potential DRPs identified by pharmacists. GP acceptance of pharmacists' recommendations was independent of the drug category, but not independent of the disease category.     

认知行为干预提高肾移植术后患者服药依从性效果的系统分析

目的探讨提高肾移植术后患者服药依从性的有效干预方法。方法计算机检索9个数据库,收集有关提高肾移植受者服药依从性的文献。两人独立进行文献的筛选,资料提取,质量评价。对目前关于提高肾移植术后患者服药依从性的认知行为干预方法进行分析并对其应用效果进行系统评价。结果最终纳入8篇文献,与常规护理相比,认知行为干预法可以有效提高肾移植术后患者的服药依从性。结论健康服务人员应结合医院和患者的实际情况,将认知行为干预法与常规护理相结合,用来提高肾移植术后患者的服药依从性。     

临床药师在呼吸科开展药学服务的实践与体会

目的介绍我院临床药师在呼吸科开展药学服务的工作模式,探讨专科临床药师如何更好地参与临床治疗、促进合理用药。方法通过列举部分药学服务实例,总结临床药师在呼吸科开展药学服务的方式与经验。结果临床药师通过参与药物治疗方案的制订或优化、解答医护人员的用药疑问、对患者进行用药教育、关注药品不良反应及药物相互作用等方式服务于临床,对合理用药起到积极的促进作用。结论临床药师要根据所在专科的特点,明确进行药学服务的切入点,并不断提高自己的专业水平,深入临床实践,更好地开展药学服务。     

病区口服用药管理流程优化再造的实践与效果

目的 通过对病区口服用药管理流程进行优化再造,降低病区口服用药不良事件的发生,保证用药安全.方法 选择口服药用量大的内科6个病区,将2007年1月至2008年12月发生的口服用药不良事件,进行根本原因分析,找出口服药发放过程中的环节质量问题,对病区口服药集体发放管理工作流程进行优化再造,再将流程再造前后6个病区发生的口服用药不良事件的例数和发生原因进行分析对比.结果 流程优化再造后口服用药不良事件的发生明显降低,P＜0.01,差异具有统计学意义.结论 口服用药流程的优化再造,是保证口服用药安全最有效措施.     

Participation in decision‐making about medication: A qualitative analysis of medication adherence

Rates of relapse in BD are high with medication nonadherence identified as an important contributor to relapse. Psychopharmacology remains a key component to the treatment of BD; therefore, increased understanding of medication use and ways to promote greater adherence is essential. The aim of the study was to identify how participants with BD experience taking prescribed medication. Participants had BD I or BD II, were users of specialist mental health services, aged 18–64 years, euthymic, mildly hypomanic or depressed, and on any combination of medication. Exclusion criteria were minimal. A semistructured interview was completed exploring patients’ views of BD and factors influencing adherence based on the Subjective Experience of Medication Interview. An inductive thematic analysis was used to identify themes. The study participants (n = 36) had predominantly bipolar I (78%) and were female (69%), and of New Zealand European ethnicity (67%) with 14% Maori. The mean age was 41 years (SD: 12.0). Findings from the thematic analysis generated three themes: Learning about the clinical meaning of having BD, Understanding how to use medication, and Understanding what works for me. The qualitative nature of our study limits the generalizability of our findings to a broader population of individuals with BD. The participants developed confidence in being in charge of their BD through a process of learning about BD and medication and understanding what this meant for them. The findings support greater emphasis on collaborative approaches that recognize the expertise of the individual with BD and the clinician.