聚类分析方法在社区卫生服务药品配置研究中的应用--社区卫生服务药品配置研究(1)

目的 :了解社区卫生服务药品配置的现况 ,为完善社区卫生服务药品配置提供参考。方法 :通过典型抽样调查 3 2所社区卫生服务机构 ,采用聚类分析方法对社区卫生服务药品配置进行了分析。结果 :社区卫生服务机构现有药品配置可以分为四类 ,第一类社区卫生服务机构配备了 2 0类超过 3 5 0种的药品 ;第二类社区卫生服务机构配备了 2 0类 2 0 0种到 3 5 0种药品 ;第三类社区卫生服务机构配备的药品在 1 3类与 1 9类之间 ,种数基本在 1 0 0种到 2 0 0种之间 ;第四类社区卫生服务机构配备的药品在 1 0类左右 ,种数大多少于1 0 0种 ,并且不能保证基本医疗服务的需要。     

基于系统论的社区卫生服务机构药品零差率政策运行分析

引入系统论思想,确定影响药品零差率政策实施的因素,并提出通过确立药品采购的层次性、保持药品供应的动态性、提高社区自身的功能性、降低内部的关联性、完善政府的调控性、推动建立积极的外部环境等措施来推动药品零差率政策的运行。     

北京市社区卫生服务中心妇幼保健人员配置状况调查

目的:了解北京市社区卫生服务中心的妇幼保健人员情况,为社区妇幼卫生规划提供参考。方法:依据2010年各区县妇幼保健机构填报的"北京市妇幼保健统计报表"及各区县卫生局填报的"北京市妇幼卫生基本情况调查表",综合分析北京市各区县社区卫生服务中心的妇幼保健人员情况及其工作量,并以洛伦兹曲线和基尼系数分析北京市各区县社区妇幼保健人员分布的公平性。结果:2010年北京市社区卫生服务中心共有妇幼保健人员1 985人(包括专兼职人员),平均每5 000人口配备0.51名妇幼保健人员。72.59%的社区妇幼保健人员具有大专以上学历,40.45%的妇幼保健人员具有中高级职称。社区妇幼保健人员分布的情况,按照常住人口数量计算得到的基尼系数为0.22,按照国土面积计算得到的基尼系数为0.75。结论:北京市社区卫生服务中心的妇幼保健人员数量不足;各区县社区妇幼保健人员学历较高,但职称结构不尽合理;社区妇幼保健人员均衡性的人口配置优于地理配置。     

上海市社区卫生全科团队配置及服务开展现况分析

[目的]分析上海市社区全科服务团队配置及服务开展现况,为开展社区全科团队服务模式研究提供基础信息。[方法]发放调查问卷对全市所有社区卫生服务中心全科服务团队开展现况调查,进行计数、构成比和中位数等统计分析,比较市区、近郊区、远郊区社区全科服务团队设置、团队人员配备情况,对团队服务项目进行排序。[结果]全市96.62%的社区组建全科服务团队,团队地域（人口）配置达标率、每万人口专业人员配置达标率分别为59.83%、27.34%。每个团队平均服务人口0.96万人、服务里委（村）数3个、服务半径1.5 km、配备专业人员7人。地区配置平均水平存在差异,市区、近郊区、远郊区地域（人口）配置达标率分别为80.35%、55.81%、47.79%;每万人口专业人员标准配置达标率分别为6.07%、38.15%、34.95%;团队服务人口市区最多为1.65万,远郊区最少为0.53万;服务居委（村）市区最多为5个、远郊区最少为2个;服务半径市区最小为0.68 km,远郊区最大为2 km;团队人员配备也不一致,市区团队配备全科医生、护士、公卫医生各2人,近郊区全科医生和护士各2人、公卫医生1人,远郊区配备全科医生、护士、公卫医生各1人、乡村医生3人。示范点社区卫生全科团队平均开展服务项目23个,前20个项目中60%为慢病防治相关项目。[结论]社区基本完成全科团队组建,市区、近郊区、远郊区县团队配置存在差异,团队专业人员配备有待提高。全科团队开展以慢病防治为主的社区公共卫生服务。     

上海市社区卫生人力资源配置对医疗服务的影响

该文通过对上海社区卫生服务中心卫生人力资源现状的调研,认为区域卫生人力资源及其配置对社区医疗服务的质量和发展有着重大的影响,并就此提出建议和看法。     

上海市虹口区社区卫生服务中心公共卫生人力资源配置分析

随着国家公共卫生服务项目和家庭医生制度服务的深入推进,近几年上海市虹口区各社区卫生服务中心不断充实公共卫生人力资源,通过梳理2014—2017年虹口区各社区卫生服务中心人力资源配置的变化情况,发现公共卫生人员数大量增加,所占比例提升约1倍。公共卫生人力资源配置的特点表现为:一是平均年龄更加年轻;二是兼职人员大量增加;三是公共卫生高级人才缺乏;四是基于服务人口数的公共卫生人力资源配置公平性的差异有所扩大。调查发现,各社区公共卫生人员中存在工作压力较大、薪酬满意度低、培训需求大和人员配置不够完善等问题,并提出了相应的对策建议。     

社区卫生服务药品管理政策实施现状分析

目的:通过对政策制定、执行及实施状况分析,研究总结了试点地区社区卫生服务药品政策具体措施及政策执行中存在的问题,并提出了相关政策建议。方法:利用文献检索及现场调查方法收集定性和定量数据;对定性数据利用GiorgiA(1995)的四步法进行主题性分析,对定量数据利用excel2003及spss13.0进行统计分析。结果:当前药品政策措施主要包括社区卫生服务基本药品目录的制定,药品采购、配送,价格零差率或低差率销售。药品政策的实施降低了处方费用,提高了药品质量,但居民满意度整体不高。结论:社区卫生服务药品销售不宜仅限于基本药品目录;药品政策的有效实施需要完善补偿政策;药品管理政策的开展与财政收支管理、医疗保险等制度密切相关。     

广西省城市社区卫生人力资源配置公平性分析

目的 分析广西省城市社区卫生人力资源配置现状,并评价其分布的人口公平性和地理公平性.方法 采用Lorenz曲线和Gini系数对人力资源配置公平性进行评价.结果 社区医生、护士和专职防保人员按人口分布的Gini系数分别为0.298 1,0.290 5和0.396 3;按地理分布的Gini系数分别为0.616 8,0.612 6和0.690 9.结论 广西省城市社区卫生人力资源配置的人口公平性优于地理公平性;专职防保人员配置比社区医生和护士配置的公平性低.     

药品零差率对社区卫生服务中心药品费用的影响

采用处方抽样的方法比较药品零差率政策实施前后,某社区卫生服务中心药品费用的变化.结果显示:零差率政策实施后的2009-2010年,零差率药品销售金额、占全部药品总销售金额的比重均较之前下降,抽样处方中的零差率药品均次处方金额也较之前下降;但零差率药品金额占药品总金额的份额太小,对总体的影响不大.可见,零差率政策并未真正切断药商和医生之间的利益链.应切实将基本药物价格稳定在合理范围内,并充分利用市场经济的手段,促使医疗机构处方自由外配.     

基层社区卫生服务机构疾病预防控制能力与人员配置研究

目的了解苏州城区基层社区卫生服务机构疾病预防控制人力现状,分析存在的问题,提出加强基层社区卫生服务机构疾病预防控制能力建设的建议和措施。方法分层抽样选择辖区内9家社区卫生服务机构,用卫生统计学方法分析各机构疾病预防控制工作和相关的人力状况,找出影响因素。结果基层社区卫生服务机构疾病预防控制人员配置不足,区属社区和医院社区组成的公立社区卫生服务机构疾病预防控制能力和人员配置要优于民营社区。结论应将基层社区机构疾病预防控制能力建设纳入疾控体系建设区域规划,进一步加强基层疾病预防控制人员队伍建设,提高人员素质,促进基层社区卫生服务机构疾病预防控制能力建设。     

军队药学勤务再定义

目前，对军队药学勤务尚无明确定义，一般来说是指军队药学业务工作，其首要任务是策划、贮存、供应军队为完成战伤救治、疾病防治、防疫保健等任务所需要的药品、医疗器械和卫生材料。军队药材供应管理学就是我军研究药材供应的学科。本文通过对美军平战时药学勤务改革的分析，提出我军药学勤务定义是为完成军队战伤救治、疾病防治、防疫保健等任务所提供的药学服务，并明确了药学勤务今后的发展方向。     

Enhancing Outcomes Research

The emphasis on healthcare in the US is shifting to the ambulatory environment. To date, few studies have evaluated the effects that community pharmacists have on patient care. In an attempt to address this issue, 4 academicians from a college of pharmacy developed a research network of community pharmacists, the Community Pharmacist Research Network (CPR-Net), to study pharmaceutical care outcomes in community pharmacies.CPR-Net practitioners are located throughout the state of Georgia, USA, and offer a variety of dispensing and clinical services. Research interests of these practitioners include pharmaceutical care, health-related quality of life (HR-QOL), pharmacoeconomics and product evaluation. Regarding specific disease states, CPR-Net members are most interested in studying diabetes mellitus, hypertension and asthma.The first project conducted was an assessment of the HR-QOL and adverse effects experienced by patients receiving antidepressant therapy. The pilot project demonstrated that pharmacists could have patients complete the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire in the Community pharmacy setting and that community pharmacists could prospectively collect clinical outcomes data.Benefits of this partnership between the Clinical Outcomes Research Group (CORG) and CPR-Net include the opportunity to study pharmaceutical care in real world conditions. Conducting quality research in community pharmacies can be difficult and requires a close relationship between investigators and practitioners. Since most pharmacists practice in a community setting, we need applied research to study the pharmacist’s unique contribution to healthcare.     

The German experience in reference pricing

Price regulation schemes function both as a means for public authorities to contain costs, and as an economic tool to support the national pharmaceutical industry. This twofold contradictory aim of public intervention in pharmaceutical demand and supply makes such pricing schemes difficult to apply. This article concerns the reference price scheme which concerns setting a price cap for each active ingredient, or group of active ingredients considered equivalent according to some feature (e.g. therapeutic effects and chemical structure). In 1989, the reference price scheme for reimbursable drugs was introduced in Germany to reduce pharmaceutical expenditure, which had been steadily increasing in the past. The study investigates the economic effects of introducing reference prices in Germany in order to assess whether this system has been effective in containing public pharmaceutical expenditure. We conclude that the reference price scheme is an effective tool for price control, but cost containment requires further measures.     

Assessment of pharmaceutical care for pregnant women treated in the public health system in Praia Grande, São Paulo State, Brazil

The use of medication in primary health care has increased steadily in recent decades, thus highlighting the relevance of assessing the pharmaceutical care provided to patients in the primary care setting. This article aimed to evaluate the pharmaceutical care provided by the public system in Greater Metropolitan Santos, S?o Paulo State, Brazil, focusing specifically on women during gestation. Methods included secondary data analysis, document analysis, interviews with key players, and visits to health services and to the pharmaceutical supply center. Deficiencies were identified in most stages of pharmaceutical care: selection, planning, purchase, storage, distribution, and dispensing. The results suggest that in order to improve primary health care, with better access, equality, and comprehensiveness, the evaluation of pharmaceutical care should be incorporated as a routine procedure.     

免费用药政策对促进中国药品公平可及的启示

促进药品公平可及是保障卫生公平性的重要内容。国际上通过免费用药政策保障药品公平可及是通行惯例,大部分国家免费用药政策覆盖人群包括无支付能力的患者、5岁以下儿童、孕妇和老年人,免费药品包括基本药物、慢性病用药、传染性疾病和疫苗等,免费用药筹资来源包括医疗保险、政府财政直接投入和国际援助,免费用药发放多依赖公立医疗机构。我国免费用药政策主要针对部分传染性疾病和疫苗,疾病覆盖面较窄。本文认为,我国经济发展已达到中等收入国家水平,应当扩大针对糖尿病、高血压等慢性病免费用药范围,并通过对基本药物免费进一步促进中国药品公平可及。     

Census based mortality study of pharmaceutical industry workers

This study was designed to investigate whether the mortality of British pharmaceutical industry workers showed any evidence of occupationally related patterns associated with particular sections of the industry with special emphasis on cancers and respiratory diseases. The data were extracted from census schedules by the Office of Population Censuses and Surveys using occupational categories recorded by pharmaceutical workers at the 1961 and 1971 censuses of England and Wales. Subsequent mortality was ascertained through the National Health Service Central Registry. Both cohorts, followed up to the end of 1981, showed a "healthy worker effect," with overall SMRs ranging from 0.77 to 1.04, though comparison with the employed populations of the longitudinal study reduced this effect by 25%. Evidence of inconsistent excess mortality was noted in small numbers for suicide (SMR 0.91 to 2.79) and cancer of the large intestine (SMR 1.09 to 2.38). There was no clear association between the type of industry and the causes of death investigated. Although the census based study has several methodological shortcomings, there was no evidence, on the basis of this study, to suggest any excess mortality risk from employment in the pharmaceutical industry.     

Census based mortality study of pharmaceutical industry workers.

This study was designed to investigate whether the mortality of British pharmaceutical industry workers showed any evidence of occupationally related patterns associated with particular sections of the industry with special emphasis on cancers and respiratory diseases. The data were extracted from census schedules by the Office of Population Censuses and Surveys using occupational categories recorded by pharmaceutical workers at the 1961 and 1971 censuses of England and Wales. Subsequent mortality was ascertained through the National Health Service Central Registry. Both cohorts, followed up to the end of 1981, showed a "healthy worker effect," with overall SMRs ranging from 0.77 to 1.04, though comparison with the employed populations of the longitudinal study reduced this effect by 25%. Evidence of inconsistent excess mortality was noted in small numbers for suicide (SMR 0.91 to 2.79) and cancer of the large intestine (SMR 1.09 to 2.38). There was no clear association between the type of industry and the causes of death investigated. Although the census based study has several methodological shortcomings, there was no evidence, on the basis of this study, to suggest any excess mortality risk from employment in the pharmaceutical industry.     

An Innovative Pharmaceutical Care Practical Course

The innovative practical course was developed to improve the students’ ability to acquire pharmaceutical care skills. The primary components of the course were in-school training using small group discussions and hospital experience including identification, analysis, prevention and resolution of drug-therapy problems, patient counseling on their medications and diseases, and interaction with medical team. Specific objectives of the research were to (1) compare students’ performance before and after the course, (2) measure students’ perceptions of their pharmaceutical care skills before and after the course, (3) determine students’ perception of the value of the course. Statistical comparison of pre-test and post-test grades indicated both a retention and acquiring pharmaceutical care skills. A pre-course and post-course survey instrument was designed to measure students’ perception of their pharmaceutical care skills. Perception of most of the items of the survey was significantly improved at the end of the course. Overall, the majority of students were highly satisfied with the course. In conclusion, the present study demonstrates that the innovative pharmaceutical care practical course was successfully introduced.     

Using pharmacy data to identify those with chronic conditions in Emilia Romagna, Italy

BACKGROUND AND OBJECTIVES: Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patterns of morbidity in Emilia Romagna, a large Italian region; and to compare estimated prevalence rates using pharmacy data with those available from a 2000 Emilia Romagna disease surveillance study. METHODS: Using the Chronic Disease Score, a list of chronic conditions related to the consumption of drugs under the Italian pharmaceutical dispensing system was created. Clinical review identified medication classes within the Italian National Therapeutic Formulary that were linked to the management of each chronic condition. Algorithms were then tested on pharmaceutical claims data from Emilia Romagna for 2001 to verify the applicability of the classification scheme. RESULTS: Thirty-one chronic condition drug groups (CCDGs) were identified. Applying the model to the pharmacy data, approximately 1.5 million individuals (37.1%) of the population were identified as having one or more of the 31 CCDGs. The 31 CCDGs accounted for 77% (E556 million) of 2001 pharmaceutical expenditures. Cardiovascular diseases, rheumatological conditions, chronic respiratory illness, gastrointestinal diseases and psychiatric diseases were the most frequent chronic conditions. External validation comparing rates of the diseases found through using pharmacy data with those of a 2000 Emilia Romagna disease surveillance study showed similar prevalence of illness. CONCLUSIONS: Using Italian automated pharmacy data, a measure of population-based chronic disease status was developed. Applying the model to pharmaceutical claims from Emilia Romagna 2001, a large proportion of the population was identified as having chronic conditions. Pharmacy data may be a valuable alternative to survey data to assess the extent to which large populations are affected by chronic conditions.