试论医药分业体制的模式

经房从医院分出的模式不能解决目前存在假劣药品,药品回扣,药品价格和医疗制度改革两方面的问题,本文对医药分业的模式提出了不同的观点。     

药品回扣与医疗体制改革

本文论述了药品回扣的原因及解决的难度，提出医疗体制改革是关键，医疗体制改革的措施是医药分业，医院面向市场政府只补助一部分医院，建主对医生的监督制度。     

关于医药分业的断想

分析医药分业对医院药学的影响，指出了存在的有关问题．并就医药分业与医药抖技发展，整治药品购销回扣等内容展开了积极的讨论。     

分业:医、药两利的选择──山西忻州首家医药分业的昭示

时下，药品流通领域中的“回扣”风屡禁不止，由此引发的医药费用节节上涨，已使广大病患者不堪重负。人们越来越认识到，要防止和杜绝这一歪风，一个行之有效的办法，就是实行医药分业管理。然而，尽管业内人士在不断大声疾呼，应声而行者却甚是寥寥。究其原因，主要是医疗卫生单位及医生担心分业后自身利益受损。因此，面向医院建立补偿机制并在医疗单位大力倡导“以技养医”、供药部门提供优质服务已成为医药分业能否得以施行的关键所在。半年多来，山西省忻州市第一人民医院将所属中、西药房全部委托忻州药业（集团）有限公司经营管理．…     

早熟的“医药分业”

现在社会上不少人认为,医药分业的模式能解决医疗单位的假劣药品、药品回扣、药品价格和公费医疗负担方面的诸多问题.但从实际情况看,药房从医院分离或实行经营管理后,这些问题仍将存在. 从医院补偿机制来看,目前解决以药养医问题条件尚不成熟     

掩耳盗铃

为了保证经过招标的药品顺利进入医院药房,杜绝医生为了吃回扣而进行的编外采购和临床推销活动,某市的三甲医院推出了一项“新举措”:抽调纪委、党办、院办、医务科等科室工作人员,组成反药品回扣领导小组。小组工作人员每天穿便衣在医院各个科室巡逻,一日发现有给大夫回扣的医药促销代表,“便衣”们会依法将其扭送公安机关,而医院也对接受回扣的医生给予严肃处理,情节严重的将移交检     

浅议医药分业与药械科职能转变

长期以来,我国公立医院存在着医药合业的情况。为了抑制公立医院医药合业带来的不良影响,我国积极探讨在公立医院实行医药分业改革。医药分业使得医生开大处方的动力下降,保证了药品的合理和规范使用。在医药分业的情况下,原有药械科职能的转变成为亟待解决的问题。随着医药分业改革的逐步进行,药械科不能削弱,而是要加强医药结合,配合临床工作,发挥对临床医师用药的监督、科学研究和教学职能。为此,药械科与临床活动实行分开核算和分开管理,做好药械科的药学监护管理、加强药械科的继续教育,重视人才培养,实现医院药械科管理现代化、信息化。     

浅淡利用处方权收受医药回扣的法律认定及整治——依达拉奉案例的反思

医药回扣是导致国内药品价格虚高的一个重要环节.医生利用处方权收受药品回扣数额较大己被定性为非国家工作人员受贿罪.然而,对于有行政职务的医生的受贿行为,以及科室集体受贿的定罪,仍存在争议.本文结合案例讨论医药购销领域商业贿赂的定罪及法律缺陷,以期进一步完善立法,增加法律威慑力,规范医疗系统的商业行为.     

“医药分业”的利弊,动力阻力和前提条件研究

医药分业的定义 “医药分业”的定义,是打破现有医药管理体制,药品的生产、供销、使用的质量监控由专设的相应机构负责。医院药房与医院分离,交由医药管理部门统一经营管理,形成由药师配方的以盈利为目的的经营性药店。医院仅承担药品的处方职能。病人持方自主选择药店配药。通过行业管理,以期达到医生行医、药师卖药,各司其职、各尽其责目的。     

回扣当用猛药治

药品回扣风,不仅成了人们饭后茶余的话题,也是社会上人们关注的焦点和热点问题。药品回扣,多为药品推销员或药厂医药代表与处方医生私下达成协议,按使用某药品的处方额给医生一定的回扣。因为有回扣,造成许多医生“谁给的好处多,就用谁的药”,大处方也就由此而来。于是,对患者来说,本是小病,用上几元或十几元的药品就能治好的,结果可能要花去上百元的药品费用。当然,大处方的根源不止于此,还有“以药养医”的机制等深层次问题。药品回扣毒化了社会风气,损害了党和政府的形象。也是与俄党一贯倡导的“为人民服务”宗旨和提倡文…     

A survey of current operations and future plans for ambulatory pharmacy services

Survey results indicate that the number of hospital-based ambulatory pharmacies in the survey area is increasing substantially. By the end of 1989, there would have been a 71 percent increase in the number of hospitals providing ambulatory pharmacy services in this region. This assumes that those hospitals in the planning stages of developing ambulatory pharmacy services completed their plans. While the number of hospital-based ambulatory pharmacies is on the rise, there has been a concurrent increase in the number of services provided by the pharmacies already in operation. There has been a 38 percent increase in the number of services provided by these pharmacies since the inception of DRGs. The services that have been added are primarily specialized services including home TPN compounding, intravenous antibiotic compounding, intravenous chemotherapy compounding, medical supplies, and durable medical equipment. It is likely that these services will continue to increase in the coming years as home therapies continue to become more advanced. The study also indicates that most hospital-based ambulatory pharmacies in this region are operated as nonprofit entities. A trend toward for-profit pharmacy operations was anticipated, and this is still anticipated as more ambulatory pharmacy operations become separate entities from inpatient services. Future studies of this type should monitor this possible trend. Most hospital-based ambulatory pharmacies are owned by the hospital or a hospital affiliate. More than half of respondents reported their ambulatory pharmacies are located within the inpatient pharmacy of the hospital. As the trend toward separate ambulatory pharmacy operations increases, it would not be unusual for the pharmacies to be operated by for-profit affiliates of the hospital or outside contractors. Barker predicts that hospital-based ambulatory pharmacies could become units of major drug store chains in the future. This is another area that is worthy of future studies of hospital-based ambulatory pharmacy operations. Overall, the results of this study indicate that hospitals in this region have not remained static since the inception of DRGs. There seems to be a dynamic period of change evolving in the delivery of health care services in this region. The demographic section of this study reveals that the majority (more than 70 percent) of the hospitals surveyed are operating fewer numbers of beds for inpatient services since ther inception of DRGs. The length of time that patients remain in the hospital for inpatient services is decreasing, resulting in decreased demand for inpatient beds.(ABSTRACT TRUNCATED AT 400 WORDS)     

株洲市试行医药分业的有关情况

本文通过对株洲市实行医药分业试点工作的回顾和对医药分业后的医疗单位药品经营和管理情况的跟踪调查,分析了实行医药分业管理给医疗机构带来的影响,提出了在试点工作中遇到的几个问题,以及解决这些问题的几点建议.     

优质廉价药短缺的对策研究

明确界定优质廉价药的内涵,从药品生产成本、新药注册制度、招标采购制度、以药养医机制、零售药店等方面分析我国优质廉价药短缺的原因,系统地提出促进优质廉价药生产和使用的具体对策,为促进优质廉价药生产和使用的对策研究提供参考.目前我国的医疗卫生相关体制、制度尚未完善,促进优质廉价药品在基层医疗机构和零售药店中的使用具有较大的实际意义.     

Hospital outpatient pharmacies and durable medical equipment

Factors to consider when planning and implementing a durable medical equipment (DME) business are discussed. Although hospital pharmacists have begun to provide home health-care and other outpatient-care services, few hospital pharmacies have implemented DME businesses in conjunction with those services. By providing DME to patients, hospital pharmacies can realize substantial net income while improving continuity of patient care. Before establishing a DME business, pharmacists should consider where the showroom will be located, who will deliver and set up the equipment and train patients to use the equipment, and how the business will be promoted within the hospital; they must also become familiar with methods of reimbursement for DME. It is also important for pharmacists to decide whether the hospital should enter into a joint-venture relationship with an established community-based DME dealer or act as sole owner of the DME business. As hospitals search for ways to generate income from sources other than inpatient care and to encourage patients to use hospital services, hospital pharmacists should not overlook the possibility of establishing a DME business in conjunction with other outpatient-care programs.     

Clinical and conventional pharmacy services in Polish hospitals: a national survey

Background Pharmacist-led care services within the hospital pharmacy setting have a significant impact on efficient drug management processes. The work of pharmacists is directly associated with the provision of drugs and medical supplies along with additional clinical, administrative, organizational and educational duties. Depending on the country, these practice roles may differ to a significant extent. Objective The aim of this research was to explore the role of the hospital pharmacist and the provision of both clinical and traditional pharmaceutical services for patients and medical staff in Polish general hospitals. Setting Hospital pharmacies from all general hospitals in Poland. Method A cross-sectional study was conducted, utilizing an anonymous questionnaire as the research instrument. Heads of hospital pharmacies were requested to participate in this study and complete the questionnaire. The survey was initially piloted to improve the research method. Main outcome measure The types of pharmaceutical services performed in Polish general hospitals. Results 166 hospital pharmacies took part in this survey. The overall response rate was 60.8 %. The total number of full-time equivalent (FTE) professionals employed within the surveyed hospital pharmacies was approximately 833. The procurement and distribution of drugs were identified as pharmaceutical services performed by most of the participants. The significant majority of pharmacists were also involved in compounding, adverse drug reaction monitoring and rational drug management services. Eleven (7 %) of the responding pharmacists had direct contact with patients and 7 (4 %) pharmacists took part in ward rounds. More precise legal regulations regarding hospital pharmacy practice were measures indicated by most pharmacists as necessary changes required in the hospital pharmacy system. Conclusion Polish hospital pharmacists provide various pharmaceutical services. Their work is closely related with direct provision of drugs. There is an observed inadequate level of clinical services provided in comparison to clinical settings in other countries.     

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

Sodium bicarbonate is central to the treatment of many poisonings. When it was placed on the FDA drug shortage list in 2012, alternative treatment strategies to specific poisonings were considered. Many hospital pharmacies, poison centers, and medical toxicologists proposed sodium acetate as an adequate alternative, despite a paucity of data to support its use in medical toxicology. The intention of this review is to educate the clinician on the use of sodium acetate and to advise them on the potential adverse events when given in excess. We conducted a literature search focused on the pharmacology of sodium acetate, its use as a buffer in pathologic acidemia and dialysis baths, and potential adverse events associated with excess sodium acetate infusion. It appears safe to replace sodium bicarbonate infusion with sodium acetate on an equimolar basis. The metabolism of acetate, however, is more complex than bicarbonate. Future prospective studies will be needed to confirm the efficacy of sodium acetate in the treatment of the poisoned patient.     

改进县级医院门诊西药房的药学服务工作质量的思考

门诊西药房属于药剂科的一部分,是医院中重要的对外窗口。门诊西药房的药学服务水平会直接影响医院的形象。县级医院受软硬件所限,门诊西药房在管理和人员方面均存在缺口。为有效提高我院门诊西药房的药学服务工作质量,本文通过找出门诊西药房中存在的问题并进行分析,制定切实可行的改进措施。     

Thoughts on a program for pharmaceutical practice

The educational curriculum for pharmaceutical students in Japan will be dramatically changed in April, 2006. There has been active discussion about how to manage the additional two years in the new program to educate students most effectively. In particular, the program of clinical practice in pharmacies, which will be undertaken for 10 weeks, has been received enthusiastically, because it was not considered sufficient in the previous educational program and it will be one of the most important issues in the new curriculum. I am neither a pharmacist nor a professional in pharmaceutical education, but I believe firmly that an effective program of clinical practice in community pharmacies will be indispensable in making the new curriculum successful. I also believe that community pharmacists educated in the new course will change medical systems in this country from the viewpoint of a general thoracic surgeon and chief executive officer of Pharmedico, Co., Ltd. which manages eight pharmacies in Osaka, Japan. In this article, I give my opinions on the advisable vector of clinical practice for pharmaceutical students and the direction of clinical training in the new educational program.     

谈我国网上药店的发展及建议

通过分析我国网上药店发展的现状及存在问题,从加大宣传力度、充分发挥网上药店优势,提升网上药店的服务水平、加强监督管理、与实体药店结合、完善社会医疗保险制度五个方面提出了我国网上药店发展的建议。     

System for Exchanging Information Among Pharmacists in Different Practice Environments

ObjectivesA system for exchanging patient information among hospital, long-term-care (LTC), and ambulatory care pharmacies is described, and the influence of that system on pharmacist interventions is reported.MethodsStudy sites consisted of three ambulatory care pharmacies, one LTC pharmacy, and one hospital in a small Midwestern city. Meetings were held by clinicians, the investigators, and hospital administrators to plan the information-exchange system. From January through June 1996, patients admitted to the hospital were checked to see if they came from a participating (source) pharmacy; if so, they were randomly assigned to experimental and control groups. The hospital requested preadmission information from the source pharmacy for experimental group patients and did not do so for control patients. After the information arrived, the hospital pharmacists could use it to identify and document drug therapy problems. When an experimental group patient was discharged, the hospital sent information to the appropriate source pharmacy. A total of 156 patients were enrolled in the study.ResultsComplete information transfer occurred for 75% of experimental group patients. Significantly more experimental group patients than control patients had at least one in-hospital pharmacist intervention recorded. Similarly, in the ambulatory care pharmacies (but not the LTC pharmacy) significantly more interventions per patient were documented for the experimental group.ConclusionHospital and ambulatory care pharmacists documented more interventions for patients about whom information had been supplied than for patients for whom that information had not been supplied. No difference in intervention rates was observed for LTC pharmacists, who were already being supplied information by the LTC facilities about patients discharged from the hospital.