临床药师对高血压病患者用药依从性的干预

目的探讨对高血压患者制订个体化的给药方案和用药指导,并通过科学合理的干预措施,提高高血压病患者用药依从性的影响。方法 118例高血压病患者随机分为干预组和对照组各59例,干预组实施个体化给药、用药指导和科学合理的干预措施等,对照组不予以干预,分别在干预前和干预1年后对2组患者进行用药依从性和血压达标率等调查。结果干预组用药依从性由干预前18.6%提高到干预后的62.7%,血压达标率由13.6%提高到57.6%,干预组与对照组在干预后药物依从性和血压达标率方面比较差异有统计学意义（P〈0.05）。结论根据个体差异、时辰药理学、药剂学等,临床药师参与医师对高血压患者用药,制订个体化的给药方案和用药指导,并通过科学合理的干预措施提高患者用药依从性,血压达标率与用药依从性呈正相关。     

药师参与门诊老年高血压患者慢病管理的效果评价

目的：评价药学服务对门诊老年高血压患者开展药学干预的效果。方法：选取本院门诊就诊的高血压患者200例,随机分成两组：对照组行常规用药指导;干预组行高血压病的相关医学知识、合理用药知识教育,定期随访、用药指导等干预措施,历时12个月。以患者血压控制率、对高血压知识的认知程度和用药依从性作为评价指标。结果：干预组血压达标率从31.13％提高到74.71％,高血压认知问卷分数从干预前的61.07分提高到77.07分,不及格率从39.08%下降到2.30%;用药依从性从31.00%提高到86.20%,与干预前比较均有显著差异（P<0.05）,与对照组比较差异有统计学意义（P<0.05）。结论：药师主导的药学服务有助于增强患者对疾病和合理用药的认知,提高血压达标率和用药依从性。     

临床药师参与治疗管理对门诊2型糖尿病合并高血压患者 血压控制的影响*

目的:探究临床药师参与治疗管理及对门诊Ⅱ型糖尿病合并高血压患者血压控制的作用。方法:纳入2017年6月至2018年6月500例心内科门诊Ⅱ型糖尿病合并高血压患者,随机分为对照组和药师干预组,各25例。对照组完成常规诊疗流程,每月电话咨询其药物使用情况;药师干预组现场记录患者一般情况,与医生讨论处方优化并决定是否执行,对患者进行用药指导。就诊后1个月内每2周随访1次,其后每4周随访1次,随访期间药师可根据情况与医生讨论是否调整降压方案并作出最终决定,患者根据药师建议或自己意愿回医院随诊,随访时间1年。主要终点事件为12个月后血压≤130/80 mmHg;次要终点事件为药物调整情况、药师建议采纳率、药物持有率(评估患者依从性)。结果:最终378例完成随访。对照组68名(36.4%)及干预组152名(79.6%)患者血压≤130/80 mmHg,P<0.01;干预组收缩压与舒张压降幅显著>对照组(P<0.01)。对照组药物调整35次,干预组调整129次,药师建议采纳率为85.18%。1年后,对照组药物持有率为0.22±0.04,干预组为0.77±0.11,P<0.01。结论:临床药师参与治疗管理有助于优化降压方案,提升用药依从性,提高了门诊Ⅱ型糖尿病合并高血压患者的血压控制达标率。     

高血压出院患者微信随访药学服务模式评价

目的:比较微信随访的药学服务对患者依从性、高血压知识知晓率及高血压控制率的影响。方法:高血压出院患者随机分为药师干预组与无药师干预组,药师干预包括出院时出院带药教育及出院后3个月的微信随访,在第1个月和第3个月利用微信平台进行高血压知识问卷和依从性问卷调查。结果:纳入高血压患者49例,微信随访组血压达标率13/26(50%)优于对照组6/23(26%)。微信随访组高血压问卷得分(39±4.89)和高于对照组(29.74±7.19),依从性评分分别为(2.96±0.66)和(1.87±1.18),差异均有统计学意义(P<0.01)结论:药师利用现有的微信平台进行高血压患者教育及跟踪随访,能显著提高治疗效果、增加患者对疾病的认识程度并且提高依从性。     

临床药师干预对脑卒中合并高血压患者用药依从性的影响

目的 探讨合理的干预措施对提高患者用药依从性的影响.方法 将120例脑卒中伴高血压病患者随机分为干预组和对照组,每组60例.干预组实施个体化给药、用药指导和科学合理的干预措施等,对照组不予干预,分别在干预前和干预1年后对两组患者进行用药依从性和血压达标率等调查.结果 干预组用药依从性由干预前18.33％提高到干预后的68.33％,血压达标率由31.67％提高到71.67％,两组在干预后药物依从性和血压达标率方面比较差异有统计学意义(P＜0.05).结论 科学合理的干预措施有助于提高患者用药依从性及血压达标率.     

药学干预对心内科冠心病患者出院后用药依从性 及其预后的影响

目的:探讨临床药师干预对心内科冠心病患者用药干预模式,评价出院后药学干预对用药依从性及预后的影响.方法:选取2019年1～6月期间我院心内科冠心病患者80例,随机分为观察组和对照组,其中观察组40例实施出院时及出院后药学干预,包括出院时发放用药指导单、建立出院后药学服务档案、出院后电话随访用药情况等,对照组40例仅给予住院期间常规药学监护及用药教育,两组患者均于出院6个月后进行电话随访,比较分析其用药依从性、病情控制情况、再住院率.结果:干预6个月后,与对照组相比,观察组患者的用药依从性、再住院率均得到明显改善,血压及血脂达标率更高,差异有统计学意义.结论:临床药师干预可以有效改善心内科冠心病患者用药依从性及预后.     

临床药师对高血压患者的药学服务及其效果

目的：探讨临床药师为高血压患者提供药学服务的效果和意义。方法：100例依从性差、血压控制不佳的高血压病患者,随机分为干预组和对照组各50例。临床药师通过问卷调查了解患者高血压用药知识和疑难问题,对干预组患者实施个体化药学服务,对照组不予干预,并分别在干预前和干预后3个月对患者的治疗结果、用药依从性、用药知识等进行随访调研。结果：干预组患者的用药依从性、血压控制情况较对照组有明显改善,高血压用药知识水平也较对照组有明显提高。结论：临床药师通过面向高血压患者的药学服务可及时发现和解决患者治疗过程中的疑难问题,有助于提高患者的治疗效果、依从性和用药知识水平,避免严重药物不良反应的发生。     

药师主导的药学服务对社区高血压病人疗效的影响

目的:评价药学服务团队对社区高血压病人药物治疗的干预效果。方法:对社区高血压病人进行高血压病的相关知识、合理用药和保健知识教育,结合随访、用药指导等干预措施,以病人血压水平、对高血压知识的认知程度和用药依从性为指标,评价干预效果。结果:干预1年后,病人血压达标率从27.59%提高到93.10%,收缩压和舒张压平均下降14.26、9.01mm Hg;用药种类和金额略有下降;病人对高血压知识的答卷分数从干预前的63.41分提高到97.27分;用药依从性显著提高;部分血液生化指标超标率下降,身体质量指数(BMI)下降(P<0.05)。干预结束后的第5、第14个月,病人血压达标率分别为89.66%和81.48%,用药依从性有所下降,但仍能维持在较高水平。结论:资深药师主导的药学服务团队实施以高血压及其药物治疗相关知识教育、随访和用药指导为核心的综合干预措施,有助于大幅提高病人的药物治疗知识水平,增强居民合理用药意识,提高病人的用药依从性、血压达标率和生活质量,而持续的干预对于长期维持血压达标率是必需的。     

临床药师对高血压患者的药学服务及效果比较

目的：探讨临床药师为高血压患者提供药学服务的效果和意义。 方法：100例依从性差、血压控制不佳的高血压病患者随机分为干预组和对照组各50例。临床药师通过问卷调查了解患者高血压用药知识和潜在问题,对干预组患者实施个体化药学服务,对照组不予以干预,并分别在干预前和干预后3个月对患者的治疗结果、用药依从性、用药知识等进行随访研究。结果：干预组患者的用药依从性、血压控制情况等较对照组有明显改善,高血压用药知识水平也较对照组有明显提高。结论：临床药师通过面向高血压患者的药学服务可及时发现和解决患者治疗过程中的潜在问题,有助于提高患者的治疗效果、治疗依从性和用药知识水平,避免严重药物不良反应的发生。     

临床药师参与治疗管理对门诊2型糖尿病合并高血压患者 血压控制的影响*

目的：探究临床药师参与治疗管理及对门诊Ⅱ型糖尿病合并高血压患者血压控制的作用。方法：纳入2017年6月至2018年6月500例心内科门诊Ⅱ型糖尿病合并高血压患者,随机分为对照组和药师干预组,各25例。对照组完成常规诊疗流程,每月电话咨询其药物使用情况;药师干预组现场记录患者一般情况,与医生讨论处方优化并决定是否执行,对患者进行用药指导。就诊后1个月内每2周随访1次,其后每4周随访1次,随访期间药师可根据情况与医生讨论是否调整降压方案并作出最终决定,患者根据药师建议或自己意愿回医院随诊,随访时间1年。主要终点事件为12个月后血压≤130/80 mmHg;次要终点事件为药物调整情况、药师建议采纳率、药物持有率（评估患者依从性）。结果：最终378例完成随访。对照组68名（36.4%）及干预组152名（79.6%）患者血压≤130/80 mmHg,P<0.01;干预组收缩压与舒张压降幅显著＞对照组（P<0.01）。对照组药物调整35次,干预组调整129次,药师建议采纳率为85.18%。1年后,对照组药物持有率为 0.22±0.04,干预组为0.77±0.11,P<0.01。结论：临床药师参与治疗管理有助于优化降压方案,提升用药依从性,提高了门诊II型糖尿病合并高血压患者的血压控制达标率。     

The substance‐abusing patient and primary care: Linkage via the addiction treatment system? 1

Our objective was to describe and assess the prevalence and characteristics of substance‐abusing persons without primary care physicians. We interviewed a convenience sample at one point in time. Patients/participants were persons presenting for addictions treatment in a public substance abuse treatment system. Of 5824 respondents, 41% did not have a physician. In a multivariable analysis, the following were associated with not having a physician: no health insurance [adjusted odds ratio (OR), 2.05; 95% confidence interval (CI), 1.79–2.35], no history of a chronic (OR, 1.70; CI, 1.47–1.97) or an episodic (OR, 1.20; CI, 1.05–1.39) medical illness, male gender (OR, 1.49; CI, 1.29–1.71), and younger age (by decade) (OR, 1.12; CI, 1.04–1.38). Prior addictions or mental health treatment or a recent emergency‐room visit were not significantly associated with having a physician. Many patients with addictions serious enough to prompt presentation for treatment stated that they did not have physicians. Although younger persons, males, and those without insurance or past medical illness were more likely to report not having a physician, neither prior addictions or mental health treatment nor a recent emergency‐room visit decreased this likelihood. To achieve improved linkage of substance‐abusing patients with primary medical care, all health‐care contacts should be utilized.     

药学健康教育

药学作为社会医疗体系的重要组成部分，目前在健康教育中的重要性日益得到体现，药师的社套职能也逐渐向健康教，拓謦‘孽苎借助健康教育和医院健康教育的理论定义了药学健康教育的概念，探讨了药学健康教育的特点、作用、实施和展望，提出了建立全新的药学健康教育理论将成为未来药学研究内容的观点。     

汽车生产中电焊工健康调查

目的了解汽车生产中电焊工的健康状况。方法对车身厂110名电焊工人进行职业健康体检,包括血压、心电图、ALT、血常规、尿常规、高仟伏X线胸片、肺功能,根据不同检查项目的结果分别分为异常组和健康组,进行分析。结果无尘肺病发生;肺功能均正常;高血压21.8%,心电图异常18.2%,转氨酶升高22.7%,血红蛋白升高6.4%,异常组和健康组之间在年龄、工龄方面无显著性差异。结论汽车生产中电焊工的健康损害与年龄、工龄无关,其主要危险因素可能是接触一氧化碳、噪声等有害因素、精神紧张;其健康监护要重视心血管系统等的改变,加强职业健康教育。     

Health Care Among Insured Drug Users and Nonusers

This paper analyzes data on medical needs, utilization, and access collected during 1997–1999 in Houston from 117 drug users and 55 nonusers living in the same neighborhoods. Results indicate that drug users in Houston did not have a different level of medical needs than did nonusers, nor were they disadvantaged in terms of utilization or access to medical services. Part of the difference in results from previous studies may be because the longitudinal design of the study selected for relatively stable drug users and nonusers (for example, all study participants reported some form of publicly funded health insurance). Thus we suggest that, among persons with stable life situations, drug use does not significantly influence medical need, access, and utilization.     

Meeting the Needs of Underserved Patients in Western Kenya by Creating the Next Generation of Global Health Pharmacists

Objective. To describe a novel training model used to create a sustainable public health-focused pharmacy residency based in Kenya and to describe the outcomes of this training program on underserved populations.Design. The postgraduate year 2 residency was designed to expose trainees to the unique public health facets of inpatient, outpatient, and community-based care delivery in low and middle-income countries. Public health areas of focus included supply chain management, reproductive health, pediatrics, HIV, chronic disease management, and teaching.Assessment. The outcomes of the residency were assessed based on the number of new clinical programs developed by residents, articles and abstracts written by residents, and resident participation in grant writing. To date, six residents from the United States and eight Kenyan residents have completed the residency. Eleven sustainable patient care services have been implemented as a result of the residency program.Conclusion. This pharmacy residency training model developed accomplished pharmacists in public health pharmacy, with each residency class expanding funding and clinical programming, contributing to curriculum development, and creating jobs.     

天津市蓟县农村社区居民卫生服务需要与利用分析

目的:探讨蓟县农村居民健康状况、卫生服务需要及利用的特点,为当地11生部门制定相应的卫生政策提供依据.方法:采用分层整群随机抽样方法,对该地区两个行政村2 000例居民进行问卷调查.结果:所调查地区居民两周患病率19.5%,两周患病病种前3位依次是呼吸系统疾病、消化系统疾病和循环系统疾病.两周就诊率8.4%,患者未就诊率57.1%;慢性病患病率14.4%,疾病前3位依次是高血压、脑血管病和类风湿性关节炎;年住院率为3.2%.居民卫生服务需要量较大,相应的卫生服务利用率低.居民患病就医场所首选村卫生室.住院场所首选乡镇卫生院.结论:基本医疗卫生服务仍是农村社区居民卫生服务需要的主要内容,应完善农村卫生服务体系建设并加强健康教育,提高农村居民卫生服务利用程度.     

Weekly marijuana use and health-related measurements among adults in the United States: a longitudinal study

Abstract

The present study aims to investigate the associations of weekly marijuana use with health-related measurements, including overall, physical, and mental health, and quality of life among adults, in a single research effort with panel analysis. The two latest Waves (2014–2015 and 2015–2016) of the Population Assessment of Tobacco and Health study (PATH) were used for this work. Weekly marijuana use was defined as marijuana use at least one time per week. Propensity score matching was applied at the previous wave to control selection bias and unobservable differences. Logistic regressions were estimated to investigate the associations of weekly marijuana use with health-related measurements. The analysis also considered the interaction of race and weekly marijuana use. The majority of participants reported good health outcomes. Based on the regression models without the interaction term, weekly marijuana use was only negatively associated with mental health and overall health, but was not associated with physical health and quality of life. With the interaction effect of race in the overall sample, weekly marijuana use was negatively associated all with health measurements. However, weekly marijuana use among non-white respondents was positively associated with health outcomes (all ps?<?0.01), except mental health. Further policy and research directions are discussed.     

健康管理模式下药学服务的实践

通过论述与比较药学服务和健康管理的理念,分析两者在提出背景、实施过程中的内在联系,探讨如何结合健康管理模式,拓宽药学服务的内容,加强药学服务的实践。     

“There&#x27;s very little that you can do other than refer them to the doctor if you think they&#x27;ve got postnatal depression”: Scoping the potential for perinatal mental health care by community pharmacists

BackgroundTwenty percent of women in the UK develop perinatal mental health (PMH) problems, which have widespread effects on maternal and child health. Community pharmacists are ideally placed to identify PMH problems and refer to other trained healthcare professionals.ObjectiveThis study explored community pharmacists’ attitudes, current counselling practices, and barriers to providing mental health advice to perinatal women.MethodsA qualitative focus group study was performed virtually with community pharmacists (n = 11), working in urban settings across London. A topic guide was used to cover current counselling practice, barriers to and confidence in counselling women, and thoughts on potential pharmacist-led perinatal mental health services. The focus groups were recorded, transcribed, and analysed using thematic analysis.ResultsThree themes were identified: Doing Mental Health Care; Willing, but Unable; and Introspection and reflection, which were related through a central organising concept of ‘Perinatal mental health care as a new frontier for community pharmacy’. It was found that while community pharmacists provide mental health advice to perinatal women and their partners, they lacked confidence, which was related to a lack of knowledge and inadequate training opportunities. Organisational barriers were identified including a lack of a formal referral pathway to existing mental health services and other trained healthcare professionals. Perceptions of opportunities and recommendations for service improvement and change were also garnered.ConclusionThis study demonstrates community pharmacists have a potential role within community mental healthcare in identification of PMH problems and providing appropriate advice and support. Upskilling community pharmacists in mental health should be considered to increase knowledge and confidence while formal referral pathways to other trained healthcare professionals and existing services should be established and made available to pharmacists.     

健康宣教在公务员健康体检中的作用

目的了解公务员健康状况,加强自我保健意识,提高公务员健康水平。方法对2010年1月至2010年12月来我院体检的296名公务员的临床资料进行回顾性分析。结果本次接受体检的296名公务员都查出了某些疾病或者异常,大部分是慢性非传染性疾病。其中心脑血管系统疾病最多,有192例,占体检人数的64．86％;消化系统的疾病150例,占体检人数的50．68％;代谢性疾病81例,占体检人数的27．36％;泌尿系统疾病42例,占体检人数的14．19％;呼吸系统疾病7例,占体检人数的2．36％。结论通过健康体检,使公务员正确的对待自己的身体,从此开始健康的生活方式,提高自身的身体素质。