丹参川芎嗪注射液临床应用药物相关问题的调查分析

目的：探讨丹参川芎嗪注射液临床应用的药物相关问题（DRPs）,为该药的合理使用提供参考。方法：利用医院临床药学管理系统,抽取本院2018年出院患者中使用丹参川芎嗪注射液的病例312份,采用药物相关问题研究方法Granada-Ⅱ分类法,对其用药必要性、有效性及安全性进行调研。结果：在312例丹参川芎嗪注射液病例中,213例（占68.3%）发生了DRPs,累计发生269次DRPs,包括135次DRP2,54次DRP5,39次DRP6,41次DRP4。DRP2主要表现为无适应症用药;DRP5表现为有禁忌症用药、联用两种或两种以上抗血小板药物、存在有配伍禁忌的药物（泮托拉唑）接瓶输注无冲管;DRP6表现为重复、超疗程用药;DRP4表现为给药疗程短。结论：加强对该药应用的监测和干预,提高用药的必要性、有效性和安全性。     

Drug-related problems in general practice: results from a development project in Denmark

Objective The objective of the study is identify and document drug-related problems and other possible quality problems in primary care through a pharmacist-run medication review and screening service. GPs’ acceptance and implementation rates of the pharmacist’s recommendations are evaluated.Method A community pharmacist worked 20 h per week for 18 months in a GP practice with three GPs.Results The pharmacist completed 40 reviews and identified 103 drug-related problems. GPs had a high rate of acceptance of the pharmacist’s suggested interventions (83%), and 77% of the recommendations had been implemented. 765 (12.5%) possible quality problems were identified after screening 6094 medical records. The physicians accepted 86% of the recommendations to initiate low dosage ASA and treatment was implemented for 63% of the patients. 76% of the recommendations to initiate Statin treatment were agreed on and 56% were implemented.Conclusions The pharmacist was able to identify drug-related problems and other possible quality problems with regard to quality assurance of individual patient’s drug treatment. The GPs accepted and implemented the pharmacist’s recommendations. It was feasible to implement the services and to establish well-functioning co-operation between the pharmacist and the GPs.     

539例老年住院患者不合理用药原因分析

为研究老年住院患者用药现状及不合理用药原因,在2015年5月~2016年12月期间,药师对我院1325例老年住院患者指导用药,将此过程中发现的不合理用药案例进行回顾性分析。研究发现,1325例患者中有539例（40.68%）患者存在不合理用药情况,共涉及978种次用药问题,其中涉及患者不合理用药高达713种次（72.90%）,医生不合理用药150种次（15.34%）,护士不合理用药115种次（11.76%）。经药师干预后,不合理用药种次比例下降了90.70% 。国内不合理用药相关研究多数为医嘱回顾分析,对住院患者合理性用药的研究较少。而本研究中药师在审核医嘱同时也指导患者用药,作为药物使用终端的患者不合理用药占比最多,这一结果不能孤立地认为是某一方的原因,防止不合理用药,保证患者用药安全需要医生、药师、护士、患者四方共同努力来实现。     

临床药师在抗菌药物合理应用中的作用探讨

目的:探讨我国临床药师在抗菌药物合理应用推行过程中所起的作用。方法:以临床药师、抗菌药物、合理用药为关键词,检索中国医院知识仓库(CHKD)2009年1月-2011年4月的相关文献,并进行分析、归纳、总结。结果:得到关于临床药师参与临床抗菌药物应用的文献81篇。临床药师分别从围术期预防用药、危重症患者及特殊人群抗感染治疗、抗菌药物与合并用药的相互作用及整体上干预临床合理应用抗菌药物等方面促进临床合理应用抗菌药物。结论:我国临床药师在促进抗菌药物的合理应用中发挥了重要作用。     

老年慢病患者用药相关性问题的识别与分析

探索临床药师对老年慢病患者用药相关性问题的识别与干预。选取我院2017年2~7月老年慢病门诊132例病人,对其用药相关性问题进行回顾性分析。发现132例患者中有药物相关性问题191项,主要集中在“药物疗效不佳（37.2%）”和“无适应证用药（24.1%）”等方面。临床药师分析了191项药物相关性问题的形成原因,并讨论了识别的效果与不足。患者是药物相关性问题的承受者,医药患三方面共同努力可减少多重用药的负面问题,保证用药安全合理。     

Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study

Objective The aim of this study was to describe the changes in medicine use, polypharmacy and excessive polypharmacy between 1998 and 2003 among a cohort of elderly Finns. Methods For this prospective follow-up study, a random sample of 700 participants aged ≥75 years was drawn from the City of Kuopio, Finland. Of them, 601 participated in the study at baseline in 1998. The changes in medicine use among the survivors (n=339), who were re-examined in 2003, were recorded and are described here. Statistical significance of changes in medicine use was evaluated by Student’s paired-samples and independent-samples t-test and Fisher’s exact test. Results From 1998 to 2003, the mean number of medicines in use per individual increased from 6.3 to 7.5 (p<0.001). The prevalence of polypharmacy (>5 medicines in use) increased from 54% to 67% and excessive polypharmacy (≥10 medicines in use) from 19% to 28%. The increase was due to increased use of regularly taken medicines, whereas the use of medicines taken as needed decreased during the follow-up in both sexes. At the time of follow-up survey, persons in institutional care used significantly more medicines (10.9) than community-dwelling elderly persons (7.0) (p<0.001). Central nervous system medicines and cardiovascular medicines were the most commonly used medicines in both years. Conclusion The number of medicines and the prevalence of polypharmacy and excessive polypharmacy increases with advancing age. In order to avoid possible harmful effects and to optimize medication it is necessary to assess the medication regimen at regular intervals.     

药物利用评估的研究及在老年患者合理用药中的作用

随着我国逐渐进入老龄化社会,老年人合理化用药问题成为社会关注的焦点。本文介绍了药物利用评估的兴起与发展,并阐述药物利用评估的概念及在老年人合理化用药中的作用。     

开展社区老年患者药学服务的体会

我国已全面进入老龄化社会,老年患者成为社区就诊的主要群体,社区药师要不断探索老年患者药学服务的新模式,使社区药学服务不断完善的同时,提高老年患者的生活质量。本文结合作者的日常工作,总结了社区就诊患者的特点和开展社区药学服务的体会,以供同行参考。     

住院患者应用注射用丹参(冻干)药物相关问题调查与分析

目的 探讨注射用丹参（冻干）临床应用的药物相关问题（drug-related problems,DRPs）。方法 通过住院系统电子病历平台,选取蚌埠市第三人民医院2016年1月-2017年9月出院患者中所有使用注射用丹参（冻干）的相关病例,采用国际通用的西班牙DRPs研究方法Granada-Ⅱ分类法,对住院患者注射用丹参（冻干）用药必要性、有效性及安全性进行研究。结果 397份注射用丹参（冻干）病例均发生了DRPs,累计发生1 019药次DRPs,包括413药次DRP5,317药次DRP2,227药次DRP6,62药次DRP4。DRP5主要表现为溶媒量过少,DRP2表现为无适应证用药,DRP6表现为超剂量使用药,DRP4表现为疗程不足。结论 依据DRPs的调查结果,医院应加强注射用丹参（冻干）合理用药干预,提高注射用丹参用药的安全性、必要性及有效性。     

临床药师在抗菌药物应用专项整治中的作用及其绩效

探索临床药师对医院抗菌药物合理应用的促进作用.针对我院临床抗菌药物使用的多种误区及不合理现象,充分发挥临床药师在遴选抗菌药物、点评处方与病例、监测Ⅰ类切口用药、参与会诊、合理用药宣教中的作用.通过多方面的干预和服务,全院抗菌药物使用日趋合理,抗菌药物使用率、使用强度显著下降.临床药师为促进合理应用抗菌药物发挥了良好作用.     

从药品分布链中用药差错案例谈药师在合理用药中的作用

目的:讨论药师在用药错误管理中的重要地位以及对合理用药的推动作用。方法:对典型用药错误案例进行描述并根据国际用药错误报告和预防联合委员会(NCCMERP)的用药错误分类级别对案例进行归类。结果:用药错误事件分类级别大都较高,但都得到妥善解决。结论:提高药师在药品分布链中用药差错的防范能力可促进合理用药的发展。     

莫西沙星有效治疗老年人社区获得性肺炎

社区获得性肺炎是老年人常见的感染性疾病。新一代的氟喹诺酮类药物莫西沙星临床疗效确切、安全性高,可作为老年人社区获得性肺炎经验治疗用药。     

临床药师在促进抗菌药物合理应用中的作用

目的 探讨临床药师在促进抗菌药物合理应用中的作用.方法 对临床药师在抗菌药物合理应用中的临床实践进行总结分析.结果 临床药师通过健全抗菌药物管理制度、参加查房会诊、参与医疗质量检查及药品不良反应监测等工作,使抗菌药物临床应用进一步规范.结论 临床药师应在工作中不断总结和探索,发挥专业特长,促进抗菌药物的合理应用.     

Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Drug-related problems and associated variables

BackgroundA medication use review (MUR) aims to optimize medication use, patient knowledge and can improve health outcomes. This pharmaceutical care service is not yet available in Belgium.ObjectivesTo describe drug-related problems (DRPs) detected during a MUR, subsequent interventions proposed by pharmacists and evolution of DRPs until follow-up and to identify patient-related variables associated with the number of reported DRPs.MethodsBelgian community pharmacists provided a MUR to older polymedicated ambulatory patients and registered DRPs, interventions and resolution at follow-up using the PharmDISC classification. The relationship between 14 patient-related variables and the number of reported DRPs was investigated with univariate analysis. A prediction model was developed with significant variables using negative binomial regression analysis.ResultsAcross 56 pharmacies, 453 patients received a MUR and 1196 DRPs were registered (median 3DRPs/patient, range 0–10). Only for 11.7% of patients no problems were identified. The top-3 causes were interaction (15.2%), inappropriate timing or frequency (13.5%) and adverse effect (11.9%). The top-3 recommended interventions by pharmacists were transmission of information (25.1%), in-depth patient counselling (15.0%) and therapy stop (8.2%). After six weeks, 42.6% of DRPs were resolved; data was missing for 33.3%. A higher number of chronic drugs, female gender and living alone were associated with more DRPs. The prediction model found that per additional chronic drug, the number of problems increases by 4.3% (95% CI: 2.0–6.6%). Male gender decreases DRPs by 22.1% (95% CI: 10.4–32.0%). Living alone provided no additional predictive value in the prediction model. Confounding process- and pharmacist-related variables also influenced the number of reported DRPs.ConclusionA MUR appears an effective strategy to detect and resolve DRPs. The number of chronic medications and female gender predict a higher number of DRPs. These findings are a starting point for evidence-based eligibility criteria for a MUR service in Belgium.     

An assessment of the current practice of community pharmacists for the disposal of medication waste in the United Arab Emirates: A deep analysis at a glance

ObjectiveThe study aimed to identify the current practice carried out by community pharmacists to dispose of expired medications in their workplace and assess any practical steps utilized to reduce medication waste.MethodA cross-sectional study was conducted among community pharmacists in the United Arab Emirates (UAE). The participants were asked about their routine practice in disposing of different expired medications and the current actions taken to reduce the number of disposed medicines.ResultsThe study included (n = 418) community pharmacists. More than a third of expired liquid, solid, and semi-solid dosage forms were collected by licensed contractors. In addition, more than a third of the pharmacists disposed of different dosage forms via unauthorized methods (general garbage, sink and toilet). Most expired drugs were skin and hair products, antibiotics and analgesics. The majority of pharmacists (68.4 %, n = 286) agreed that expired pharmaceutical and non-pharmaceutical products, other than those disposed of via contractor, should be done through a specialized centre. This opinion was found to be strongly associated with years of practice as community pharmacists (P < 0.05).ConclusionPart of the existing disposal practices for expired pharmaceutical products in the UAE is carried out by contractors licensed by health authorities. However, concern remains regarding some pharmaceutical and non-pharmaceutical products that have not been disposed of correctly. Additionally, there is a need for a specialized center for medication disposal (p < 0.05). A stock limitation is the best practice for managing medication quantities in stock (p < 0.05).     

临床药师医嘱审核干预对我院普外科不合理静脉用药的影响分析

目的:考察临床药师医嘱审核干预对普外科不合理静脉用药的影响。方法:临床药师依据药品说明书资料并结合大通医药"药物咨询及用药安全监测系统",对临床静脉用药医嘱进行审核和干预,对干预前、后的不合理用药情况进行分类统计,利用统计学方法分析。结果:干预后抗菌药物使用的剂量和用法显著改善,较干预前差异有统计学意义,用药逐步趋于规范;不合理联用差异无统计学意义,但不合理例次明显减少;未发现有抗菌药物溶媒不合理使用现象。其他药物不合理的剂量、用法、溶媒及不合理联用差异均有统计学意义,干预后的用药较干预前更为合理。结论:临床药师医嘱审核干预有利于促进临床合理用药。     

重庆市江津区老年高血压患者降压药物使用情况的调查分析

目的：为促进老年高血压患者合理用药提供参考。方法：自拟调查问卷,对重庆市江津区几江镇、广兴镇、永兴镇的5个社区的部分老年高血压患者进行调查,了解其降压药物使用情况及存在问题,并分析原因。结果：共设15个调查点,发放问卷2968份,回收有效问卷2543张,有效回收率为85．7％。调查发现,受访者文化水平及经济收入低,对疾病重视程度及相关知识知晓率低,且缺少规律的专业性用药指导,导致降压药使用后不良反应发生率高（46．7％）,高血压控制率低（5．4％）,用药不合理比例高（75．5％）。结论：老年高血压患者药物治疗存在较多问题,社区高血压防治工作亟待加强。建议完善社会医疗保障体系,提高基层医疗单位医务人员的知识水平,提高基层患者群防治意识,扩大治疗覆盖面,以促进老年患者合理使用降压药物。     

某社区老年高血压患者的综合干预研究

目的探讨社区综合干预对高血压患者的健康行为、血压控制水平及脑卒中事件发生的影响。方法广外社区高血压患者90例,随机分为综合干预组和对照组,综合干预组进行健康教育、生活方式等社区综合干预,对照组则进行一般健康教育,1年后对两组患者的高血压健康知识的知晓率及健康行为形成率、血压控制情况及脑卒中事件的发生率进行比较。结果干预组患者的生活方式有明显改善,血压控制率及健康行为的形成情况明显提高,与对照组相比差异有统计学意义(P<0.05),脑卒中的发生率低于对照组,差异有统计学意义(P<0.05)。结论社区综合干预能够促进社区高血压患者健康行为形成,有效控制患者血压水平,降低高血压患者脑卒中的发生率。