我院信息化药学服务平台的创建与应用

目的:创建一种医院药学服务的信息化工作平台,提高药学服务水平。方法:根据药学服务的最新理念,利用医院信息系统的局域网资源,以网络技术为支持将临床药学、药事管理和药学信息等分散数据融合形成信息化药学服务平台。结果:建立了多个药学数据库;实现信息查询、信息收集、信息发布、药历生成、流媒体教学和医-药(住院)、医-患(门诊)在线互访等服务功能;建成了药学服务局域网站,并扩展至互联网。结论:依托信息化平台开展药学服务是一种较好的医院药学工作模式。     

传染病医院开展临床药学工作的实践与体会

目的:建立健全传染病医院临床药学服务体系。方法:介绍我院临床药学工作模式。结果与结论:我院通过对门诊患者和住院患者分别进行药学服务,包括构建信息化系统、设立门诊咨询室、建立门诊患者药历,以及药师深入临床查漏补缺、收集药物资料为医师和患者举办药物知识讲座、深入开展药品不良反应监测、制定个体化用药方案等,使我院合理用药水平得到了进一步提升。     

医院开展社区药学服务需求的调查研究

目的:为医院深入、真实了解社区药学服务工作的需求提供参考。方法:通过设计调查问卷对不同社区开展社区药学服务的需求现状调研,并分析调研结果。结果:调查发现社区居民得到的药学服务非常少,亟需了解药品价格、真假等方面内容,其中多数还不知道社区药学服务的重要性和迫切性。结论:可充分利用医院药学部门的专业技术优势,从定点、定期深入社区开展药学服务,对门诊或住院患者延伸社区药学服务,利用现代化通讯工具拓展社区药学服务等角度,进行不同方式、内容和对象的社区药学服务,以建立一个满足需求的社区药学服务模式。     

Patients' perspectives on medicines and pharmacy: views of patients with Type 2 diabetes

□ The study was conducted to inform the design of pharmaceutical care support to patients with Type 2 diabetes – a recognised health care priority and a target for new pharmacy initiatives □ Interviews in an outpatient clinic revealed an apparent lack of patient‐pharmacist communication and low patient expectations □ Some patients felt a lack of feedback about the results of clinic checks and what they meant for disease control □ Patient information leaflets were not consistently seen as meeting patients' needs for information and advice □ Patients' experiences can be used to develop the role of community pharmacy services within the health care team effort     

Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting.

The effects of psychiatric pharmacy services on clinical outcomes of acute care psychiatric inpatients were studied. Patients recruited at a state psychiatric facility during phase 1 (October 1996-March 1997) served as the control group and received only traditional centralized pharmaceutical services and physician-requested psychiatric pharmacotherapy consultations. Patients recruited during phase 2 (May-December 1997) received intensive psychiatric pharmacy services and served as the experimental group. Pharmaceutical services during phase 2 included attending treatment team meetings, performing baseline assessments and weekly reviews, providing pharmacotherapy recommendations, obtaining medication histories, reviewing drug administration records daily, monitoring for adverse drug reactions, conducting medication education classes, and counseling patients before discharge. Outcome variables included clinical response determined with objective rating scales, cost of care, length of stay, adverse events, rate of acceptance of recommendations, patient compliance with the first clinic visit scheduled after discharge, quality of life, and patient satisfaction. Data were analyzed for 48 patients in the control group and 45 patients in the experimental group. There were no significant differences between the two groups with respect to age, sex, duration of illness, number of hospitalizations, and number of months since the last hospitalization. Patients in the experimental group showed significant improvements in clinical response and drug-induced extrapyramidal symptoms compared with the controls and were highly satisfied with the pharmaceutical services they received. Medication costs did not differ significantly, and length of stay was about 29 days for each group. The provision of clinical pharmacy services provided to inpatients in an acute care psychiatric facility was associated with improvements in rating-scale scores for clinical response and for drug-induced extrapyramidal symptoms.     

Pharmaceutical services in U.S. hospitals in 1989.

The results of a spring 1989 national survey of hospital-based pharmacy services are reported. The study group (n = 2112) comprised half of U.S. acute-care general surgical or medical hospitals with 50 or more licensed beds. Pharmacy directors were asked about their hospital's provision of 14 clinical pharmacy services. The survey had a response rate of 56% (1174 usable responses). Provision levels varied significantly with the pharmacy drug delivery system for 14 services, pharmacy director's education for 12 services, hospital teaching affiliation for 12 services, hospital ownership for 9 services, hospital size for 9 services, and geographic region for 5 services. The following percentages of respondents offered specific services: drug-use evaluation, 90%; inservice education, 66%; adverse drug reaction (ADR) management, 46%; drug therapy monitoring, 41%; pharmacokinetic consultations, 40%; parenteral-enteral nutrition team participation, 28%; patient medication counseling, 26%; drug therapy protocol management, 25%; cardiopulmonary resuscitation (CPR) team participation, 25%; clinical research, 22%; drug information, 16%; participation in medical rounds, 13%; poison information, 9%; and medication histories, 2%. Pharmacist staffing requirements for clinical services usually centralized within the department were highest for drug information and poison information. Within hospitals offering the services, four of nine patient-specific services were potentially available to more than half the patients: ADR management, CPR team participation, drug therapy monitoring, and nutrition team participation. Drug therapy protocol management required the most pharmacist staff time. Only one service, pharmacokinetic consultations, was justified by more than half of the providers of that service. Respondents expected all the services to undergo net growth during 1989-90. The 1989 National Clinical Pharmacy Services Survey showed that provision of clinical pharmacy services varied with the pharmacy drug delivery system, pharmacy director's education, hospital teaching affiliation, hospital ownership, hospital size, and geographic region.     

供应-调剂-配送供应链系统用于医院药品管理效果评价

目的评价供应-调剂-配送(SPD)供应链系统用于医院药品管理的效果,为医院开展相关工作提供参考。方法医院建立SPD供应链管理模式,统一规范管理医院药品物流和信息流,利用信息条码技术,将药品的供应、库存、调剂、配送等工作进行集中于SPD供应链系统中一体化运行。回顾性调查SPD供应链系统运行前(2018年1月至5月)及运行后(2019年1月至5月)月均药房盘点所用时间、月均账物相符率、门诊患者取药平均等候时间、住院患者口服用药医嘱单平均调剂时间,同时全样本抽取同期药品管理、药品调剂、临床给药、信息管理环节的全部用药错误记录,对比分析SPD供应链系统运行前、后上述指标的变化,评价SPD供应链系统对药品管理及防范用药错误方面的改进效果。结果与运行前比较,该院SPD供应链系统运行后月均药房盘点所用时间、门诊患者取药平均等候时间、住院患者口服用药医嘱单平均调剂时间均显著缩短(P<0.05),月均账物相符率显著升高(P<0.05),药品管理、药品调配及临床给药环节错误例数显著减少(P<0.05)。结论SPD供应链系统的应用,可有效提升医院药品管理效率,减少用药差错,保障患者用药安全。     

Evidence-based core clinical pharmacy services in United States hospitals in 2020: services and staffing

We developed a model for the provision of clinical pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing clinical pharmacy services. To provide 14 specific clinical pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core clinical pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core clinical pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core clinical pharmacy services could be provided with only modest increases in clinical pharmacist staffing.     

新时代下广州市城区社区卫生服务中心药学服务建设现状调查研究

目的调查广州市城区社区卫生服务中心药学工作现状,为提升基层医院药学服务能力提供参考。方法采用问卷调研方式对广州市城区社区卫生服务中心的基本服务情况、药学部门建设、设施设备、药事管理和药学服务开展进行调查,评价广州市城区社区卫生服务中心药学服务能力。结果98.4%的社区卫生服务中心配有专职的药学技术人员,其学历主要为大专(32.1%)和本科(54.3%);多数设置有门诊药房(97.7%),但配置有门诊自动发药机的只占4.5%、配备口服片剂自动包药机的只有1.5%;将合理用药纳入绩效考核(86.5%);多数社区卫生服务中心有设立用药咨询窗口(79.7%),开展患者用药教育工作(88.0%);开展家庭药师纳入家庭医生签约服务团队工作(73.7%)。结论广州市城区社区卫生服务中心药学服务建设已取得一定成绩,但药学人员队伍与自动化、信息化建设仍有待加强,药学服务水平有待进一步提升。     

Pharmacist involvement in a chemical-dependency rehabilitation program

Pharmacist involvement in a small hospital for the treatment and rehabilitation of patients with chemical dependency is described. The pharmacist's primary responsibilities include provision of pharmaceutical services to meet the medical needs of patients during detoxification; development of detoxification protocols for management of withdrawal from drugs of abuse; education of patients and their families, other clinical staff members, and pharmacy students about the pathophysiology of addiction, treatment options, and the foundations of recovery; medication and addiction counseling; and multidisciplinary team support of recovery. To successfully fulfill this complex role, the pharmacist must have specialized education on alcoholism and addiction, develop good communications skills, and learn the dynamics of recovery support groups. The pharmacist employed at this hospital spends about 70% of her time with pharmaceutical services and 30% with counseling services. A pharmacist working in a chemical-dependency rehabilitation program has a unique opportunity to affect positively the physical and emotional health of the recovering individual by taking on responsibilities beyond those traditionally associated with pharmacy practice.     

Hospital pharmacists’ pharmaceutical care for hospitalized patients with COVID-19: Recommendations and guidance from clinical experience

ObjectiveTo discuss hospital pharmacists’ role in providing pharmaceutical care for hospitalized patients with COVID-19 to promote patient care and management during the pandemic.MethodBased on the method of evidence-based pharmacy, clinical evidence of therapeutical drugs for COVID-19 were retrieved and summarized. Based on clinical experience Chinese hospital pharmacists gained from providing pharmaceutical care services during COVID-19 pandemic, taking COVID-19 hospitalized patients’ needs into consideration, the methods and strategies hospital pharmacists shall use to provide pharmaceutical care were analyzed and summarized.ResultsHospital pharmacists shall support pharmaceutical care services by participating in making evidence-based decisions for medication, monitoring and evaluation of medication safety and efficacy, providing strengthened care for special population and patients with combined underlying diseases, monitoring and management of convalescent plasma therapy, providing emotional counselling and psychological support, and providing scientific information about COVID-19 vaccines.ConclusionThe need of pharmaceutical care services in COVID-19 hospitalized patients during this pandemic was quite distinguished from the past. Hospital pharmacists shall join the collaborative multidisciplinary team to improve COVID-19 patients’ outcome and reduce mortality, and to facilitate the pandemic control.     

Workload pressure among recently qualified pharmacists: An exploratory study of intentions to leave the profession

Objectives To explore the reasons why recently qualified pharmacists had chosen to follow non‐standard career paths, or were thinking of doing so. Methods Participants in a nationwide longitudinal cohort study examining pharmacy careers who were either working in non‐standard roles (i.e. not primarily employed in community, primary care or hospital pharmacy), or who had expressed a likelihood of leaving the profession in the near future, were invited to participate in a follow‐up qualitative study. After pilot work to inform the design of a semi‐structured interview schedule 12 telephone interviews were conducted with pharmacists who had qualified within the last 5 years. Key findings Regardless of the sector in which these early career pharmacists had gained work experience, there was a common occurrence of workload pressures influencing career decisions. Pressures in community pharmacy were often related to the need to meet certain targets in a business environment. Community pharmacists also bemoaned a lack of resources, such as support staff, which often meant that their day‐to‐day routines became monotonous and unfulfilling. A feeling of being undervalued and underutilised was the main concern voiced by all pharmacists and represented the views of those with experience of working in both the community and hospital sectors. This situation arose because participants felt that they had been highly trained to deliver new pharmaceutical services yet the opportunities to use their skills did not materialise, partly due to the nature of their workloads. Conclusions Early career pharmacists can become disillusioned because the pressure to perform routine tasks often results in a lack of time to provide new pharmaceutical services. Increased job satisfaction levels are seen when more opportunities for clinical input are afforded to pharmacists. This could be achieved through the use of clear guidelines on staffing levels and, more importantly, the provision of adequate support staff.     

疼痛药学门诊工作模式与成效

目的：探讨临床药师针对门诊疼痛患者进行药学服务的工作模式及成效。方法：简述2种不同的疼痛患者门诊药学服务模式,并对药师独立的疼痛药学门诊患者的用药教育效果进行分析。选择2017年1月至6月在某院疼痛药学门诊就诊的患者198名填写问卷,临床药师对其进行药学照护和用药教育,对比患者教育前后的问卷得分情况。结果：患者用药教育前得分是3.18±1.98,用药教育后得分是12.56±2.24,结果有统计学差异（P<0.001）。结论：通过开设不同模式的药学门诊,临床药师在门诊疼痛患者的诊疗中发挥了积极的作用,为其他专科药学门诊的开展提供了新思路。     

临床药师对乙型肝炎患者抗病毒治疗药学宣教的效果分析

目的:了解具有抗病毒治疗指征的慢性乙型肝炎病毒(HBV)感染肝病患者未接受抗病毒治疗的原因,并对抗病毒治疗药学宣教的效果进行评价。方法:随机选取住院和门诊具有抗病毒治疗指征的慢性HBV感染相关肝病患者,对未接受抗病毒治疗的患者进行原因分析。对住院患者开展抗病毒治疗的药学监护实践,并统计分析药学服务后的效果。结果:抗病毒治疗总体实施率为88.7%,门诊与住院患者差异无统计学意义;导致患者不接受抗病毒治疗的主要原因依次为经济因素(占28.6%)、担心耐药(占27.8%)、生育问题(占22.2%);临床药师对262名住院患者实施药学服务前后,各项统计指标差异均有统计学意义。结论:慢性乙型肝炎患者的抗病毒治疗实施率较高,经济因素、担心耐药、生育问题是目前制约患者实施抗病毒治疗的主要因素;临床药师在保证患者合理用药、确保药物疗效和提高服药依从性方面,发挥了重要作用。     

中医院住院糖尿病患者药学监护模式的构建与实施

目的：探讨住院糖尿病患者药学监护模式。方法：通过临床药师对糖尿病患者的药学监护为例,依据三甲中医医院糖尿病专科实际情况,制订了住院糖尿病患者的药学服务路径及服务内容,按照服务路径监护并实施。结果：依据药学服务路径进行监护,糖尿病患者得到更好的药学服务,不合理用药、药品不良事件得到及时发现并干预,患者综合治疗效果得到提高。结论：建立医院糖尿病专科的临床药学服务工作模式,为临床药师全面参与临床药物治疗工作提供参考,有利于对糖尿病患者进行有效的用药管理,保障患者用药安全有效。     

The provision of pharmaceutical care in a Veterans' Affairs Medical Center outpatient HIV clinic

Recognizing the unique needs and demands of HIV-infected patients, it was decided to implement pharmaceutical care in a VAMC outpatient HIV clinic. Services provided to the patients by the pharmacist include drug information, medication counseling with the help of educational handouts, and drug-related problem identification and resolution. The pharmacist also serves as a liaison between the patient and the VAMC outpatient pharmacy if conflicts arise. Services provided to the other members of the HIV clinic team include the provision of drug information and participation in clinical research. In addition, the HIV clinic provides a training site for pharmacy practice residents and Doctor of Pharmacy students on their ambulatory care rotation.     

智能化患者服药提醒App的调研与开发

目的：通过移动互联网帮助患者进行个性化精准用药,保障药物安全、有效、合理使用,减少药物不良反应及药源性疾病的发生。方法：收集某院药学门诊信息,根据药房840余种药品制作用药数据库,搭建云服务器,连接医院HIS系统,开发具有自主知识产权的智能化患者用药教育APP"服药管家"。以问卷调查方式调研湖南省不同医院患者对APP的接受程度。结果：共收集1 146条患者药学咨询信息,咨询信息排名前三位的是：用法用量38%（435次）、适应证23.4%（102次）、不良反应18.2%（208次）。共发放问卷414份,有效回收388份。全部受调查的人群当中有77.6%的人群有智能手机,43.9%的人群愿意接受包括智能手机APP在内的有偿药学服务。结论：湖南省范围内,住院门诊患者对药学咨询服务需求迫切。以互联网为媒介的有偿药学咨询服务具有一定的市场潜力。智能化患者服药提醒APP"服药管家"功能设计合理,将精准化提升患者用药。在患者人群中有一定认可度,具有扩大推广的价值。     

中国临床药师工作模式的系统性评价

目的:评价中国临床药师干预效果的研究,考察临床药师的干预模式,评价临床药师的干预结果。方法:检索PUBMED、COCHRANE、CNKI、万方、维普数据库,纳入中国临床药师干预的随机对照试验,两名评价员按照固定的纳入排除标准,独立对文献资料进行提取。结果:共纳入临床药师参与的随机对照试验25篇,干预领域从高到低依次为内分泌科、呼吸科、心血管科、抗感染科、肿瘤科。干预方式为医院药学信息服务、药物认知或生活方式干预、患者教育与用药咨询、出院用药与随访、建立医疗团队等项目。药师干预的一级、二级、三级、四级有效率分别为50%、75%、76%、86%。结论:临床药师的干预可以提高依从性、认知度,降低患者不良反应发生率的药费。临床药师工作模式已经初见成效,但我国药学服务的模式与评价模式仍有待改善。