《国家基本药物目录》儿童用药分析及思考

目的分析《国家基本药物目录》中儿童用药的分布情况,为单独制定我国儿童基本药物目录提供建议。方法统计《国家基本药物目录》中口服化学药物涉及儿童用药的说明,查阅《中国药典临床用药须知》（2010版）单个药品说明书中与儿童用药有关的内容,列表分析;在国家食品药品监督管理总局CFDA网站数据查询窗口,以2012年版《国家基本药物目录》中纳入的儿童用药为检索词检索相关信息,对药品的剂型、规格、生产企业等信息列表统计。结果化学药物部分有288种口服药物,其中儿童专用药物1种,儿童可用药物207种（71.88%）,含新生儿用药说明药物19种（6.60%）。中成药部分9种儿童用药,剂型以颗粒剂为主,共20种规格,其中9种为独家品种。结论现版目录仍不能满足儿童用药需求,建议增加对儿童药物研发等环节的经济补偿;制定符合我国儿童疾病需求的儿童基本药物目录,完善儿童用药信息。     

Patient sources of drug information and attitudes to their provision: a corticosteroid model

Aim: To determine patients' preferred sources of drug information and their attitudes to how this is provided.Design: A quantitative evaluation via personal interviews using a formal questionnaire.Subject and settings: A group of 101 inpatients in a chest ward at the Royal Devon & Exeter Healthcare NHS Trust.Outcome measures: Preferred sources for medication advice; personal involvement in own treatment; adequacy of consultation period; medication compliance; post discharge sources of drug information; recalled benefits and side effects of corticosteroids.Results: Preferred source of drug information was: doctor (35%), pharmacist (11%) and nurse 4%. Sixty percent of patients wanted to be involved in the choice of their medication, thirtynine percent leaving it totally to the doctor and one patient who wanted the final word in what was prescribed. Sufficient discussion time with GPs was reported by 66% of patients (12%, insufficient) and 53% with hospital doctors (19%, insufficient). Noncompliance with medication was reported by 66% and compliance by 24%. Medication advice sources used when at home were; community pharmacists (22%), GPs/books & magazines/specialist societies (all 18%), nurses (10%) and others less than 8%. Benefits of corticosteroids recalled by patients were: 'improving breathing' (14), 'general improvement' (9) and 'improved mobility'/'greater appetite' (both 5) 'with little change' reported by 13. Knowledge of side effects was much more comprehensive with; oedema/weight gain (50), skin/hair problems (33), osteoporosis (33), bruising (12) and mood changes (10) most commonly featured in responses. Almost all patients confirmed they liked to be given printed information about their medication.Conclusion: Patients sought their medication advice from a variety of sources and armed with this almost two thirds of patients wished to exercise their rights to be involved with their treatment planning. Sufficient discussion time appeared to be available to about half of the interviewees though only a few understood the intended benefits of prescribed corticosteroids used as an example in this work. A much better knowledge of drug side effects might have partly explained the high level of declared noncompliance. Although pharmacists featured as the preferred source of drug information for some patients, a much more detailed investigation is needed of patients' attitudes to the profession and to individuals' consultation and communication skills.     

Prevalence of polypharmacy in a Scottish primary care population

Purpose

Polypharmacy—the use of multiple medications by a single patient—is an important issue associated with various adverse clinical outcomes and rising costs. It is also a topic rarely addressed by clinical guidelines. We used routine Scottish health records to address the lack of data on the prevalence of polypharmacy in the broader, adult primary care population, particularly in relation to long-term conditions.

Methods

We conducted a cross-sectional analysis of adult electronic primary healthcare records and used linear regression models to examine the association between the number of medicines prescribed regularly and both multimorbidity and specific clinical conditions, adjusting for age, gender and socioeconomic deprivation.

Results

Overall, 16.9 % of the adults assessed were receiving four to nine medications, and 4.6 % were receiving ten or more medications, increasing with age (28.6 and 7.4 %, respectively, in those aged 60–69 years; 51.8 and 18.6 %, respectively, in those aged ≥80 years), but relatively unaffected by gender or deprivation. Of those patients with two clinical conditions, 20.8 % were receiving four to nine medications, and 1.1 % were receiving ten or more medications; in those patients with six or more comorbidities, these values were 47.7 and 41.7 %, respectively. The number of medications varied considerably between clinical conditions, with cardiovascular conditions associated with the greatest number of additional medications. The accumulation of additional medicines was less with concordant conditions.

Conclusions

Polypharmacy is common in UK primary care. The main factor associated with this is multimorbidity, although considerable variation exists between different conditions. The impact of clinical conditions on the number of medicines is generally less in the presence of co-existing concordant conditions.     

Utility and value of a medicines information service provided by pharmacists: a survey of health professionals

Objectives Many health professionals lack the time and skills to search for and appraise information on medicines. A solution might be to use others skilled in evidence appraisal, who make recommendations or provide information tailored to patients' needs. The objectives of this study were to assess how advice provided to health professionals by the northwest of England regional medicines information centre is used, whether it is useful for patient care and to measure satisfaction with the service. Methods A questionnaire was designed and sent to health professionals who contacted the centre between September 2008 and March 2009. Enquirers contacting the centre more than once were sent a questionnaire only in response to their first enquiry during the study period. Non‐responders were sent a reminder. Key findings Questionnaires were sent to 672 enquirers; 68% were returned. Nearly all respondents used the advice provided. Of the 430 respondents who provided data on how they used the information, 81% used it to manage a current patient and 29% to plan the care of future patients; nearly all considered it useful. Where data were given (n = 366), half used it to check if current or proposed management was appropriate, 45% to make changes to therapy and 35% to advise another health professional. In addition to patient care, one‐quarter (n = 105/430) of respondents used the information for continuing professional development and 16% (n = 69/430) for training or teaching. Conclusions Health professionals value the enquiry‐answering service and use the advice provided for patient care, continuing professional development and educating patients and other health professionals. The service is responsive, supporting the care of patients needing immediate and future management.     

Phone calls to a hospital medicines information helpline: analysis of queries from members of the public and assessment of potential for harm from their medicines

Objective To find out what questions the public ask of pharmacists on a hospital medicines information helpline, and to assess the potential for improving individuals' management of medicines through telephone helpline support. Methods We analysed consecutive phone calls made by members of the public over 6 months to a hospital pharmacy medicines information helpline. Calls were coded for type of medicine, reason for phoning and any error revealed in the call. We also looked at which medicines were associated with harm and/or potential for harm had the caller not enquired about appropriate action to take. Key findings Five hundred of the 923 consecutive calls to the helpline were from members of the public (including discharged hospital patients). Antimicrobial agents, analgesics and cardiovascular medicines accounted for approximately half of all calls. The reason for phoning was most often to ask about interactions (22%), directions for use (21%) or advice on adverse effects (15%). In a third of calls it is possible an error had occurred (including patient error and directions missing from a dispensed item). Forty‐eight per cent of calls were concerned with harm or judged to have potential for harm had professional information not been available. Four of these cases (0.8%), one of which was patient error and three of which were adverse effects reported by the caller, were categorised as Harm Index category F, defined as requiring intervention and referral. Conclusions Our medicines information helpline appears to be a valuable resource for discharged patients and public and the advice given may be expected to improve safety with medicines and reduce harm. Our results reveal gaps in patient education about their medicines, some of which could be addressed by dispensing staff or the pharmacist at discharge. The data provide a baseline for measuring improvements in medicines management and will be useful in identifying patients who may benefit from follow‐up call support from pharmacists.     

The advisory role of the community pharmacist in self-medication

A survey was carried out to determine the role of the community pharmacist in self-medication by the public. This included provision of advice on the use of medicines and on general health matters. Medicine sales during one trading day were recorded in 57 pharmacies in the Wellington area. 58.6 percent of customer requests for medicine or advice resulted in the sale of a medicine without additional advice. The remaining 41.4 percent of contacts were accompanied by advice from a pharmacist whether a medicine sale was made or not. Of the total advised contacts, 7.8 percent resulted in referral to seek medical advice and 9.8 percent were for general health advice with no sale of a medicine. The results of the survey suggest an important role for the community pharmacist as an adviser in self-medication and in the screening of minor illness.     

Medication use during neonatal and pediatric critical care transport

The Pediatric Critical Care Unit (PCCU) at the Children's Hospital of Western Ontario provides a transport service and team (critical care physician, critical care nurse, respiratory therapist) which transports critically ill newborns, infants, and children. The purpose of this study was to identify the medications used during transport and to determine age-related differences. Results of a prospective study of all drugs administered by the transport team to 174 patients during their stabilization and transport from November 1, 1987 through October 31, 1988 are presented. One hundred and twenty-one (69.5%) patients received at least one medication. The most frequently administered medications were antibiotics (38.5% of patients), followed by morphine (27.0%), anticonvulsants (23.6%), neuromuscular blockers (14.4%), respiratory drugs (11.5%), inotropes (10.9%), and sedatives (7.5%). Miscellaneous medications were administered to 48.8% of patients. The use of different classes of drugs varied with age; anticonvulsants were most frequently administered to children, sedatives and respiratory medications to infants, and antibiotics and miscellaneous medications to newborns. The wide range of medications used may reflect the diversity of diseases causing critical illness which reinforces that transport teams must have access to and knowledge of a variety of medications. The formulary of medications taken by the critical care transport team is included.     

Diarrhoea management by pharmacy staff in retail pharmacies in Hanoi,Vietnam

A survey was conducted in a sample of 29 pharmacies in the Badinh district of Hanoi, Vietnam, to determine the knowledge and behaviour of pharmacy staff in dealing with cases of acute diarrhoea in children. The survey found that antibiotics and antidiarrhoeal drugs were suggested in the majority of cases (45 per cent and 69 per cent, respectively) while oral rehydration salts (ORS) were suggested in only one case. In about 80 per cent of the observed cases in which antibiotics were supplied, one to four tablets were given, enough for only one to two days. The advice given by pharmacy staff to purchasers was poor. Only about half the pharmacy staff asked for information about the stool, age of the child and frequency of diarrhoea, while questions about medicines that had already been taken, feeding and health status were rarely asked. In about 10 per cent of the cases, no questions at all were asked. The mean cost of the treatment was $ 0.53 (95 per cent CI = 0.37–0.68). Constraints of knowledge, time and finance could be the reasons for this inappropriate management of childhood diarrhoea.     

Domiciliary medication reviews by fourth year pharmacy students in Western Australia

Objective The principal aim of this study was to assess the potential value of final‐year undergraduate pharmacy students in domiciliary medication review (DMR). Method Students attended workshops on communication skills, complementary medicines and medication review. Each student contacted 5–10 patients by telephone and asked them to identify from memory all current medications. The student later conducted a DMR in the patient's home and prepared a report for the pharmacist preceptor and the patient's medical practitioner (GP) to review. Results The students recruited 189 patients, 80% of whom were over 60 years of age. The mean number of medications recalled by patients (5.8±2.9) was significantly lower than the number of medications that patients were actually taking (8.5 ± 3.5; P <0.001). Overall, 39% of patients gave incorrect/unknown indications for at least one medication and 17% had expired medicines. Students identified an average of 2.1 ± 1.7 actual or potential medication problems per patient. The mean number of problems endorsed by the pharmacist and GP were 1.1 and 0.9, and an additional 0.4 and 0.2 problems were identified, respectively. Nineteen patients (10%) required changes in therapy. Pharmacists and GPs thought it was appropriate for students to conduct DMRs under supervision and to include DMR as part of the students' training. Conclusion Final‐year pharmacy students were capable of collecting and collating medication information for DMRs in the community setting. The programme was acceptable to patients, GPs and pharmacist preceptors. Experience in DMRs should be included in the education of pharmacy students and pre‐registration trainees.     

我院儿童药品及说明书中有关儿童用药信息的调查研究

目的:调查我院儿童用药现状及存在的问题.方法:对我院库存药品说明书进行调查,调查儿童用药信息是否完整.结果:我院库存药品共728种,仅381种(52.3％)有儿童用药资料,117个品种(16.1％)为儿童专用剂型.非儿童专用药品中,264个品种说明书中有明确的儿童应用年龄范围、用法用量等资料,其中剂型上以注射剂最多,有163种,占61.7％;药品类别上以抗感染类药物品种最多,有65种,占24.6％.结论:儿童专用药品严重缺乏,药品说明书中儿童用药信息不充分.