Development of a core set of clinical skills for pharmacist prescribers working in general practice: A Delphi study

BackgroundWith increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed.ObjectiveTo develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine.MethodsBased on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1 = limited importance to 9 = critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3.ResultsFollowing Round 1, seven CSs met the criteria for inclusion: ‘Measuring heart rate (radial pulse)’, ‘Assessing respiratory rate’, ‘Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)’, ‘Measuring blood pressure (automated, i.e. electronic blood pressure monitor)’, ‘Measuring peripheral oxygen saturation (using pulse oximeter)’, ‘Measuring temperature’, ‘Measuring Peak Expiratory Flow Rate’. After two further rounds, a further four CSs were included consisting of ‘Undertaking a urinalysis’, ‘Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)’, ‘Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)’, and ‘Patient assessment via National Early Warning Score (NEWS)’. No consensus was reached on nine CSs.ConclusionThis study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine.     

Funding pharmacists in general practice: A feasibility study to inform the design of future economic evaluations

BackgroundFunding is a significant barrier to employing general practice pharmacists.Objective(s)To explore the feasibility of determining the cost-benefit of pharmacists in Australian general practice.MethodsTwo part-time pharmacists were employed by general practices in Canberra, Australia. Diaries of the pharmacists were analysed to determine time worked and participation in income-generating activities, including Government-funded programs: Asthma Cycle of Care, Home Medicine Reviews, and Health Care Assessments. Scenarios using different practice and business models were entered into value-cost models to determine the income generated by the pharmacists relative to their salary.ResultsOver 19 weeks, pharmacists A and B supported 47 and 23 Asthma Cycle of Care activities, generating income to the general practice of AU$4,700 and AU$2,300, respectively. The pharmacists spent 36.4 and 24.1 hours on activities usually conducted by general practitioners (GPs), allowing additional time for GP-patient consultations. Value-cost models determined AU$0.61 - AU$1.20 income generation by pharmacists per AU$1 salary.ConclusionsIt was feasible to determine the value-cost ratios of employing pharmacists in general practice using these methods. Future work should focus on developing a robust business model that includes health care system savings resulting from practice pharmacist interventions, determined from randomised controlled trials.     

临床药师工作中应把握的几个问题

结合国内外临床药学开展的实际情况,探讨临床药师常规工作中应把握的重点问题,为临床药师的实践工作提供参考。在临床实践前期,临床药师应做好知识和技能准备工作,重点弥补临床专业知识的欠缺;在实践中应注重用药细节,实时为医护患提供用药咨询,针对特殊患者提供药学监护,重点把握药品不良反应、药物相互作用等问题。同时,在参与临床工作时,应注重沟通、准确定位,提高医疗风险防范意识,保障临床合理用药。     

临床药师参与肿瘤内科工作实践探讨

本研究通过介绍肿瘤内科临床药师在临床实践中遇到的实际案例,如抗菌药物的合理应用、癌痛规范化治疗、治疗方案的制订、不良反应的药学监护及用药教育等,探讨临床药师开展药学服务的工作模式和切入点。     

中医全科对推动全科医学发展的思考

全科医学在我国经过近二十年的探索和实践,取得了长足发展,但全科医学的宗旨尚无法在社区卫生服务中得到完全的实现。因此,如何缓解卫生保健的供需矛盾,提升初级卫生保健能力,实现全科医学的宗旨,已成为当前社区卫生服务需要思考的问题。结合当前社区卫生服务中心的现状以及我国医学教育的特点,我们认为,加强中医全科建设,是提升初级卫生保健能力、满足群众基本医疗服务需求,实现全科医学宗旨的一种积极探索。     

临床药师在肝胆外科术后急性疼痛管理中的作用及工作实践

目的：探索临床药师中肝胆外科术后急性疼痛管理小组（APS）中的职责和工作模式。方法：临床药师与肝胆外科医生、护士成立APS团队，一起制定术后患者疼痛管理流程，明确各自工作职责，并与肝胆外科常规治疗组术后患者疼痛控制情况进行比较。结果：APS团队制定出详细的工作流程，临床药师明确其专业分工，并开展工作。APS治疗组术后患者疼痛控制情况较常规治疗组好。结论：临床药师参与肝胆外科APS团队不仅有效切入临床工作，而且能为术后患者提供良好的药学服务。     

临床思维对临床药师开展临床实践的指导作用

目的探讨临床药师以临床思维方式来指导临床实践工作的作用。方法临床药师在临床思维指导下以病史采集和用药教育、治疗方案分析、药学监护、不良反应分析等多方面为突破口开展了一系列临床实践工作。结果临床药师赢得了参与多例患者治疗的机会,并辅助临床医生使药物的选择更优化,使用更合理,提高了患者的用药依从性和安全用药意识。结论临床思维对临床药师更好地参与临床实践工作具有重要指导作用。     

The CombiConsultation for patients with diabetes,COPD and cardiovascular diseases: Evaluation of interventions and personal health-related goals

BackgroundThe CombiConsultation is a consultation with the community pharmacist for patients with diabetes, COPD and/or cardiovascular disease (CVD), aligned with the annual or quarterly consultation with the practice nurse (PN) or general practitioner (GP). The consultation is focused on the personal health-related goals of the patient.ObjectivesTo assess the number and types of personal health-related goals, drug-related problems (DRPs) and interventions identified by pharmacists during a CombiConsultation and to investigate which patients can benefit most from such consultation.MethodTwenty-one Dutch community pharmacies and associated GP practices were included in the CombiConsultation study. CombiConsultations were performed, involving patients with diabetes, COPD and/or (at risk of) CVD. The pharmacists set health-related goals together with the patients and identified DRPs. The number and types of personal health-related goals, DRPs and interventions were analysed. Associations between patient characteristics and the identification of at least one DRP were analysed by multivariate regression analysis.ResultsIn 834 patients (49% men, mean age: 70 years), 939 DRPs were identified, mostly (potential) side effects (33%), undertreatment (18%) and overtreatment (14%). In 71% of the patients, one or more DRPs were found, with a median of one DRP per patient. Pharmacists proposed 935 recommendations, of which 72% were implemented. DRPs were found more often in patients using a higher number of drugs for chronic conditions. A total of 425 personal health-related goals were set, of which 53% were (partially) attained.ConclusionThe CombiConsultation can be used as a compact health service contributing to safe and effective use of medication for patients with diabetes, COPD and/or (at risk of) CVD, also in patients under 65 or with less than 5 medications in use. The output of the CombiConsultation reflects its characteristics.     

药师下临床工作的实践和体会

目的:探讨药师下临床工作的主要内容和进行方式。方法:以笔者临床工作实践和经验为基础,对药师下临床的意义及本院临床药师工作特点进行阐述。结果和结论:药师必须适应医院药学工作的转型,做好临床工作。     

Pharmacist consultations in general practice clinics: The Pharmacists in Practice Study (PIPS)

BackgroundMedication-related problems (MRPs) are a concern in primary care settings. Pharmacists based in the community or community pharmacies are able to identify, resolve and prevent MRPs; however, the lack of a formal partnership with physicians and poor access to patients' medical records are limitations. In Australia, delivery of pharmacist services within general practice clinics is rare.ObjectivesTo evaluate the effectiveness of consultations by pharmacists based within primary care medical practices.MethodsA prospective, before-after intervention study was conducted at two primary health care (general practice) clinics in Melbourne, Australia. Participants were clinic patients who had risk-factors for MRPs (e.g. polypharmacy). Patients received a consultation with the pharmacist in a private consulting room at the clinic or in their home. The pharmacist reviewed the patient's medication regimen and adherence, with full access to their medical record, provided patient education, and produced a report for the general practitioner. The primary outcome was the number of MRPs identified by the pharmacist, and the number that remained unresolved 6 months after the pharmacist consultation. Secondary outcomes included medication adherence, health service use, and patient satisfaction.ResultsEighty-two patients were recruited and 62 (75.6%) completed the study. The median number of MRPs per patient identified by the practice pharmacist was 2 (interquartile range [IQR] 1, 4). Six months after review, this fell to 0 (IQR 0, 1), P < 0.001. The proportion of patients who were adherent to their medications improved significantly, according to both the Morisky (44.1% versus 62.7%, P = 0.023) and the Tool for Adherence Behaviour Screening (TABS) (35.6% versus 57.6%, P = 0.019) scales. There was no significant effect on health service use. Patients were highly satisfied with the pharmacist consultations.ConclusionsConsultations undertaken by pharmacists located within primary health care clinics were effective in identifying and resolving MRPs. The consultations were well received by patients and were associated with improvements in medication adherence.     

我院临床药师参与心内科药物治疗实践与体会

目的 探讨临床药师参与临床药物治疗对于提高临床合理用药整体水平的作用.方法 总结医院心血管专业临床药师参与临床药物治疗的经验,分析临床药师参与药物治疗后对合理用药部分指标的影响.结果 临床药师工作能明显改善部分合理周药指标.结论 临床药师在提高临床合理用药整体水平中作用明显,应该进一步加强临床药师队伍建设.     

基层医院开展临床药学服务的实践与体会

目的探讨基层医院开展临床药学服务的方法和体会。方法通过用药咨询、处方点评、临床合理用药指导和药物不良反应监测等模式有力推进该院临床药学工作的深入开展。结果通过近年来的实践与摸索,该院的临床药学服务模式已具雏形。结论临床药学服务的开展切实提高了医院的合理用药水平。     

Development of a method for clinical medication review by a pharmacist in general practice

Medication review of patients on long-term treatment in general practice in the UK has been reported to be inadequate. Proposals followed suggesting that pharmacists could use their expertise to lead such a medication review in conjunction with the general practitioner. This paper describes the concept of clinical medication review by a pharmacist based in general practice. We describe the development of a method for a structured and systematic process for undertaking such a review in clinics conducted by a pharmacist. The method was developed for a nationally funded study in the UK. We provide a definition of clinical medication review and suggests a structure for the process through data gathering, evaluation and implementation.     

从实践中探讨心内科临床药师的工作切入点与体会

我国临床药学现处于发展阶段,如何在工作中找准切入点,更好地提供专业化的药学服务是广大临床药师普遍关注的问题之一。笔者结合在心血管内科的工作实践,从临床实际需求出发,在注射剂的安全使用、药物辅料的不良反应、抗菌药物合理使用、药物相互作用以及用药指导等方面开展药学服务工作,探讨心血管内科临床药师的工作切入点,以供同行们参考。     

药师临护制度在临床抗肿瘤药物应用中的实践与研究

目的探讨药师临护制度在临床抗肿瘤药物应用中的效果,促进肿瘤科合理用药。方法将680例肿瘤科住院患者根据药师临护制度实施时间分为观察组和对照组各340例。观察组配备专门的临床药师,参与到临床治疗和护理的全过程;对照组未实施药师临护制度。对2组临床用药情况进行比较。结果 2组均未发生用药事故。观察组不合理用药、药物不良反应发生率均低于对照组,平均用药种类、平均用药费用均少于对照组,差异有统计学意义(P<0.01)。结论药师临护制度可有效提高肿瘤科临床用药效果,降低不合理用药和药物不良反应的发生率,对保障患者用药安全具有重要意义。     

Pharmacist services provided in general practice clinics: A systematic review and meta-analysis

BackgroundIntegration of pharmacists into primary care general practice clinics has the potential to improve interdisciplinary teamwork and patient care; however this practice is not widespread.ObjectiveThe aim of this study was to review the effectiveness of clinical pharmacist services delivered in primary care general practice clinics.MethodsA systematic review of English language randomized controlled trials cited in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and International Pharmaceutical Abstracts was conducted. Studies were included if pharmacists had a regular and ongoing relationship with the clinic; delivered an intervention aimed at optimizing prescribing for, and/or medication use by, clinic patients; and were physically present within the clinic for all or part of the intervention, or for communication with staff. The search generated 1484 articles. After removal of duplicates and screening of titles and abstracts against inclusion criteria, 131 articles remained. A total of 38 studies were included in the review and assessed for quality. Seventeen studies had common endpoints (blood pressure, glycosylated hemoglobin, cholesterol and/or Framingham risk score) and were included in meta-analyses.ResultsTwenty-nine of the 38 studies recruited patients with specific medical conditions, most commonly cardiovascular disease (15 studies) and/or diabetes (9 studies). The remaining 9 studies recruited patients at general risk of medication misadventure. Pharmacist interventions usually involved medication review (86.8%), with or without other activities delivered collaboratively with the general practitioner (family physician). Positive effects on primary outcomes related to medication use or clinical outcomes were reported in 19 studies, mixed effects in six studies, and no effect in 13 studies. The results of meta-analyses favored the pharmacist intervention, with significant improvements in blood pressure, glycosylated hemoglobin, cholesterol and Framingham risk score in intervention patients compared to control patients.ConclusionsPharmacists co-located in general practice clinics delivered a range of interventions, with favorable results in various areas of chronic disease management and quality use of medicines.     

Clinical pharmacists: Bridging the gap between patients and physicians

The clinical pharmacy has spread out drastically in terms of its professional services throughout the past few years. The clinical pharmacist become a crucial element of healthcare team and promotes patient care by interacting with physician and patient. The aim of this paper is to highlight the role of clinical pharmacists in various departments. It concludes that the features of interactions occurring between clinical pharmacists and physicians influence the teamwork between pharmacists and physicians and provide better patient care.