我国临床药师与医师协作概念的探讨

目的 弥补我国临床药师与医师协作概念的研究空白,为进一步提高我国临床药师与医师协作水平提供理论基础。方法 使用文献分析法梳理现有协作概念,结合我国临床药师与医师协作的实践现状及发展趋势,对概念基本要素进行解构,并阐释概念各要素的内涵。结果与结论 立足上述理论研究与实际情况分析,整合得到我国现有医疗卫生政策背景下临床药师与医师协作的概念,即临床药师与医师在临床药物治疗环节中坚持以患者为中心,以合理用药为核心,在沟通、尊重、信任、共享的基础上就药品管理与药物治疗问题共同决策,保障临床药学服务有效性、安全性、经济性,完善疾病综合治疗体系的协调与配合过程。     

国外医师与药师协作关系测量工具介绍及对我国的启示

目的：梳理国内外医师与药师协作关系测量工具,为我国医师与药师协作关系的建立及测量工具的开发提供建议。方法：总结已有的医师与药师协作理论及模型,选取4种协作关系测量工具,对医师与药师协作指数(PPCI)、医师与药师协作态度量表(SATP² C)、药师与全科医师跨学科协作频率测量工具(FICI-P,FICI-GP)、全科医师与药师协作态度指数(ATCI-P,ATCI-GP)进行分析。从内容、验证、应用(角度及特点)、模型基础和背景进行对比。结果与结论：初步构想出我国医师与临床药师协作态度模型及测量工具,主要为交互因素、环境因素、角色看法3个维度,回答使用李克特5分量表。我国应进一步扩大药师职责;医院应采取措施促进医师与临床药师协作;药师应在建立协作关系的过程中更加积极主动。     

医师-药师协作模式在门诊慢性病管理中的研究进展

慢性病已成为严重危害人类健康的公共卫生问题.近年来,医务工作者将医师-药师协作模式逐步引入到慢性病管理中,在疾病控制方面取得了一定的效果.本文结合国内外医师-药师协作管理高血压、糖尿病和高脂血症的相关研究,介绍了该模式的发展与内容,并阐述了3种不同形式的医师-药师协作门诊对疾病管理的效果、经济性和医师接受度的影响,同时...     

国际药师处方权模式及其对我国的启示

目的:借鉴药师处方权模式的国际经验,为药师处方权在我国的发展提供启示.方法:总结英国、美国、加拿大、新西兰、新加坡、澳大利亚六国药师处方权模式的关键差异,对比分析各类药师处方权模式的特点,归纳发展药师处方权必须具备的条件,并对药师处方权在我国的发展提出建议.结果:国际药师处方权可归纳为四类模式.结论:建议我国采取限制较...     

我国临床药师与医师协作产出相关研究分析

目的:总结当前我国临床药师和医师协作产出的研究现状,为全面了解相关研究的开展趋势以及临床药师和医师的协作价值提供参考.方法:收集文献,梳理我国临床药师与医师协作产出相关研究的基本特征、使用的产出衡量指标及指标结果,并从时间、医院等级和病种/情形等3个维度探讨临床药师与医师协作产出衡量指标的研究关注点及研究结果.结果 与...     

医师对药师的期望调研

在传统模式中,医师诊断开处方,药师调配、发药。虽然这种模式有了一些明显的变化,但仍延续至今。由于开处方一直是医师的职责,药师在药物治疗中所投入的努力最终还要取决于医师的意见。因此了解医师对药师的期望以及医师     

我国临床药师与医师协作关系模型的构建

目的:构建适用于我国医疗服务现状的临床药师与医师协作关系模型,为我国相关领域研究提供指导与借鉴。方法:以协作关系相关理论为指导,结合现有药师与医师协作相关理论与实践,通过文献归纳形成原始模型,结合专家访谈法进行修正、完善,最终完成整个模型的理论构建。结果:构建出由五个协作水平和三大类协作影响因素构成的我国临床药师与医师协作关系模型。其中五个协作水平为协作需求萌芽期、协作价值认同期、协作关系磨合期、协作模式强化期和协作关系形成期,三大类协作影响因素为临床药师与医师的个人特征、从业环境特征和交互特征。结论:构建的我国临床药师与医师协作关系模型可为促进二者协作关系、推动相关研究发展提供参考和依据。     

药师与医师加强交流之我见

医和药是不可分割的两个专业,在当前以病人为中心的医学工作模式下,为提高医疗质量,满足病人日益增长的医疗需求,药师与医师之间加强交流和沟通显得尤为重要。现结合多年的工作经验,简单阐述几点个人见解。     

临床药师参与乳腺癌多学科协作诊疗实践

目的 总结临床药师在乳腺癌多学科协作诊疗(MDT)工作中的实践经验,为药师参与乳腺癌MDT提供参考。方法 结合典型案例,分析合并症患者抗肿瘤方案的选择、药物相互作用的评估、不良反应的处理和抗骨转移方案的优化等,评估临床药师在乳腺癌MDT中的重点工作内容和效果。结果 临床药师在乳腺癌MDT中给予合理的用药建议,协助医师制定出最佳的治疗方案,保障患者合理用药。结论 临床药师融入MDT团队中,与各学科形成优势互补,有助于为患者提供个体化的综合治疗方案。     

浅谈医院药师与医师联合查房工作

随着时代的发展,我国医院药学部门的任务正逐渐发生根本性的变化:其学科性正由化学型转向生物型;其任务正由供应型转向服务型.<医疗机构药事管理暂行规定> [1]明确提出:医疗机构的药学部门要建立"以病人为中心"的药学管理模式,开展以合理用药为核心的临床药学工作,参与临床疾病的诊断、治疗,提供药品技术服务,以提高医疗质量.其目的是通过完美的药学服务达到理想的药物治疗效果,并保证以最高质量和最低成本达到最大的效益.因此,适应新形势的需要,开展药师和医师联合查房工作,充分发挥药师在药物治疗中的作用,就显得尤为重要.笔者在此讨论了医院药师与医师联合查房的工作方法和成效,提出了医院药师深入临床参与疾病诊断和用药决策的建议.     

临床药师与住院医师对最佳用药史采集完整性的比较

目的：比较临床药师与住院医师对最佳用药史采集的完整性。方法：纳入2015年5-11月期间入住某院神经内科的100名患者,分别由临床药师与住院医师对这100名患者进行用药史信息的采集,比较信息采集的完整性并评价其可能导致的潜在风险并分析原因。结果：临床药师在用药品种、药品剂型、用药依从性方面的信息采集的完整性优于住院医师,两组之间比较具有显著性差异（P<0.05）,但在用法用量、过敏史及不良反应史方面的信息采集完整性方面,两组比较没有统计学差异（P>0.05）,两组的最佳用药史采集均存在不完整性,都有可能导致患者潜在的不适或临床症状恶化的风险。结论：患者最佳用药史采集的完整可减少药物差异及潜在的用药风险,临床药师及住院医师在这方面均需加强,尽可能多地获取准确完整的用药信息。     

美国儿科药师成长历程及其对我国启示

儿童处于生长发育阶段,在用药上有其特殊性。然而目前我国儿童不合理用药现象仍较普遍。儿科药师在临床治疗中发挥着重要的作用,因此培养儿科药师,发挥其在儿科药物治疗领域的特殊作用尤为重要。然而,我国目前尚未确立儿科药师培养体系,儿科药师数量不足、资质还有待统一。美国儿科药师成长历程呈现进阶式,历经药学院教育、住院药师培训、在职培训、儿科药物治疗专家四个阶段,从药学院阶段到儿科药物治疗专家阶段对专业知识与实践经验的要求逐步提高。整个过程较为完整、系统,可供我国参考。     

Barriers interfering with establishment of Collaborative Drug Therapy Management (CDTM) agreements between clinical pharmacists and physicians

PurposeThe current level of awareness among health care providers towards working under collaborative agreements, and the barriers that interfere with establishing CDTM agreements between clinical pharmacists and physicians were studied.MethodsA structured survey was developed after reviewing the literature on CDTM. The questions were validated to assess the level of awareness regarding the role of clinical pharmacists in providing drug therapy management, and to determine the main barriers for not having collaborative agreements with different specialties. In addition to demographic data, physicians’ education background, reasons for not having clinical pharmacy services in their clinics, and their perceptions for signing a collaborative agreement were also collected. The sample for the study was obtained from different health specialties in Saudi Arabia. The validated survey was sent and received within approximately two months, Oct-Nov 2017.ResultsWe have received 55 responses from different sectors, a 79% response rate. Most physicians had worked before with a clinical pharmacist (76%) and of which 60% valued the services provided by the clinical pharmacist as extremely important and very important (29.1%; 30.9%) respectively. When physicians asked if they have heard about the Collaborative Drug Therapy Management agreement or the term CDTM, 67% of respondents haven’t heard that before. Most of the responses, regarding the physicians’ awareness of the actual CDTM agreement services, were correct. Only 18% selected incorrect CDTM services. The results showed higher percentages of physicians agreeing with the benefits of CDTM agreement as it can improve overall patient care, reduces risk of drug related adverse events or interactions and allows clinical pharmacists to be part of patient care; 85.5, 83.6 and 83.6 respectively. Physicians who rated the possibility to be involved or to encourage other health care professionals in signing collaborative agreements as high were 76.3 and 74.5 respectively. Based on their specialty, emergency medicine’s physicians were most likely to have a CDTM agreement and to encourage others too. On a scale from zero to hundred, the average of the responses rating lack of knowledge about such an agreement as potential barrier on preventing CDTM agreements was 69 ± 0.30. While the gender barrier had the lowest rating with a mean of 15.ConclusionThere is a huge lack of knowledge and understanding about the role of clinical pharmacists and in CDTM concept. This lack of knowledge affected on having collaborations between clinical pharmacists and physicians in different settings. Educating health care providers and stakeholders about the role of clinical pharmacists in providing drug therapy management and encouraging the concept of CDTM among healthcare providers are the main solutions to enhance clinical pharmacist’s role in patient care.     

Exploring elements of interprofessional collaboration between pharmacists and physicians in medication review

In medication review involving community pharmacists and physicians, there is an underlying assumption that if community pharmacists provide evidence based pharmacotherapeutic recommendations, physicians, in turn, will implement these recommendations. However, although in general medication review has been shown to improve the quality of medicine use, medication management plans arising from the medication review process are not always implemented. There is a need for better understanding of the factors that influence outcomes in medication review. The current paper will address some cultural and procedural factors that may assist in understanding outcomes in medication review using research into collaboration from areas outside the healthcare as a framework.     

Collaboration in chronic care: unpacking the relationship of pharmacists and general medical practitioners in primary care

Objectives The objective of this research was to gain deeper understanding of the expectations, experiences and perceptions of Australian general medication practitioners (GPs) and pharmacists around collaboration in chronic illness (asthma) management in the primary care setting. Methods A qualitative research methodology utilising a semi‐structured interview guide, based on theory and an empirical approach, was used to fulfill the objectives of this study. Face‐to‐face interviews with pharmacists (n = 18) and GPs (n = 7) were recorded, transcribed and coded for concepts and themes. Relationships between concepts and themes were examined and used to describe the nature of collaborative relationships in the primary care setting. Key findings A relationship between GPs and pharmacists currently exists although there is minimal collaboration and there are several areas of practice and patient care in which the two professional groups are mismatched. At the same time, this research uncovered key aspects of the GP–pharmacist relationship, which could be used to develop more collaborative relationships in the future. The findings from this study were evaluated in light of the Collaborative Working Relationships model and published literature. Conclusions A model for the development of GP–pharmacist relationship has been postulated which articulates the dynamic nature of professional relationship in primary care and highlights a pathway to more collaborative practice. Future research should focus on further developing this model.     

Collaborative working relationships between pharmacists and physicians: an exploratory study.

OBJECTIVES: To determine the degree of collaboration in a limited number of pharmacist-physician professional relationships and identify variables important in establishing collaboration between pharmacists and physicians. DESIGN: A multicase design, using a personal interview and a mailed survey. SETTING: Iowa. PARTICIPANTS: Pharmacists in 10 community pharmacies and physicians with whom they collaborated. INTERVENTION: Two researchers independently judged the stage of collaboration for each case and the level of effect each influence variable had on the development of pharmacist-physician collaboration. MAIN OUTCOME MEASURES: Using the Collaborative Working Relationship Model, nine indicators of collaboration were assessed. In addition, influence variables were studied, which included individual, context, and exchange characteristics believed to affect the development of collaborative working relationships between pharmacists and physicians. RESULTS: A Perrealt-Leigh reliability index of 0.89 was calculated as an estimate of interrater reliability of the judgments of nine indicators of collaboration. Four pharmacies were rated as having achieved early-stage collaboration, while six pharmacies were at late-stage collaboration. A high level of joint care activities, care communication, and increased accessibility to the physician and to patient information characterized late-stage collaboration. Six variables, labeled as discriminating, helped distinguish between early-stage collaboration and late-stage collaboration: the development of bidirectional communication, caring for mutual patients, the ability to identify a win-win opportunity, adding value to the medical practice, physician convenience, and movement toward balanced dependence between the pharmacist and physician. CONCLUSION: The development of collaboration between pharmacists and physicians is influenced by characteristics of exchanges occurring between them. Continued study of collaborative working relationships between physicians and pharmacists can assist health care practitioners in developing a team-based approach to patient care, improving the ability of pharmacists and physicians to work together to coordinate patient care.     

中国执业药师与美国药师注册管理的比较与思考

目的：本研究旨在提供一些建议,以促进我国执业药师注册制度的完善.方法：通过中美两国药师注册管理的比较,指出我国执业药师注册管理中可以借鉴的方面.结果与结论：本研究认为我国执业药师注册条件中应有实习要求,执业领域应放宽,并对注册资格保留以及兼职等问题提出建议.     

博观约取、德医双馨——记解放军第八十八医院

解放军第八十八医院诞生于1938年,1949年进驻徐州,1979年迁至山东省泰安市,是一所历史悠久、内涵厚重、特色突出、荣誉众多的现代化综合性医院,为全军首批三级甲等医院、部队服务先进医院、数字化医院试点单位。医院拥有1个国家重点专科（全军骨科中心）,3个全军重点专科（全军骨科中心、全军肝病诊治中心、全军优生优育中心）,1个全军血站（输血科）,