糖尿病患者药学服务探析

目的探讨实施药学服务对糖尿病患者的临床疗效。方法 2011年2月至2012年2月期间,本院诊治的80例糖尿病患者,专业药学技术人员给予1年的药学服务,对干预前后服药率、规律服药率、血糖知晓率、血糖控制率,进行观察和比较。结果与干预前相比,干预后服药率、规律服药率、血糖知晓率、血糖控制率均明显升高,P〈0.05,差异有统计学意义。结论对于糖尿病患者,有效的药学服务有利于血糖控制,值得临床推广。     

高血压患者的社区药学服务效果评价

目的：对社区高血压患者实施药学服务并进行效果评价。方法：对《中国高血压防治指南》为标准确定的高血压患者开展药学服务。在服务模式上以农民健康体检为契机,以联村社区责任医生团队为基础,以药学专业技术人员为主导力量,对高血压患者进行定期随访和药学咨询服务。结果：经过一年社区药学服务,348名高血压患者的服药依从率、知晓率和控制率得到了较大的提高,其中服药依从率由干预前65．2％上升到干预后的87．9％,知晓率由67．5％上升至98％,血压控制率由43．6％上升到61．8％。药品不良反应明显减少,群众的用药知识显著提高,群众对社区卫生服务的信任、满意度增加。结论：实施高血压患者社区药学服务是控制高血压的有效措施。     

社区糖尿病患者的药学监护

目的：探讨药学监护在社区糖尿病防治中的作用。方法：对本社区卫生服务中心确诊的220例糖尿病患者进行药学监护，监护内容包括药物来源的正确性、选药合理性、服药的规范性和依从性、服药时间的合理性、服药剂量的准确性，并对监护前、后进行相关调查。结果：通过药学监护，患者糖尿病知识知晓率由64．8％上升到91．3％，规范服药者的比例从41．8％上升到75．2％，用药依从性较好者由37．3％上升到61．4％，用药时间适宜者由73．2％上升的94．5％，用药剂量准确者由83．2％上升到93．6％，用药对象适宜者由90．45％上升到98．65％，血糖控制率从38．6％上升到80．2％。结论：药学监护可提高糖尿病的防治效果。     

芦潮港社区200例糖尿病患者社区综合防治效果分析

目的：探讨对糖尿病患者实施社区综合防治的效果。方法：本研究对芦潮港社区200例2型糖尿病患者进行社区综合防治干预措施,对千预前、后患者的糖尿病知识知晓率、健康行为形成率以及血糖监测率等进行比较。结果：200例患者经过6个月的干预,糖尿病相关知识知晓率、饮食控制率、坚持锻练率、血糖定期监测率及糖化血红蛋白达标率均较防治前明显上升;空腹血糖、餐后2h血糖、糖化血红蛋白的平均值较防治前有显著下降。结论：糖尿病患者社区综合干预,不仅有利于控制血糖,而且能够养成健康的生活方式,适用于社区推广。     

浅析药学干预对糖尿病患者的影响

目的 探讨药学干预对糖尿病患者的影响.方法 回顾性分析我院60例糖尿病进行药学干预的全部资料,并对药学干预前后的用药依从性、指导满意度和血糖知晓率、血糖控制率进行探讨.结果 药学干预前用药依从性和指导满意度分别为（81.4±2.4）和（80.5±3.4）,药学干预后用药依从性和指导满意度分别为（95.6±3.5）和（95.4±3.3）,结果 具有统计学意义（P＜0.05）,药学干预前患者的血糖知晓率和血糖控制率分别为73.8％和47.5％,药学干预后患者的血糖知晓率和血糖控制率分别为94.5％和90.0％,结果具有统计学意义（P＜0.05）.结论 药学干预能够使糖尿病患者自觉规律用药,促进患者的健康,值得临床推广应用.     

全科医师团队在社区糖尿病患者健康管理中的应用效果分析

目的探讨全科医师团队在糖尿病患者健康管理中的应用效果。方法随机选取2012年10月~2013年11月深圳市宝安区西乡街道管理的4家社区作为实验组,其1219名糖尿病患者采用全科医师团队进行健康管理;同时选取社区类型、人口构成、经济水平等相一致的5家社区作为对照组,其1283名糖尿病患者延续以前的健康管理模式。比较两组的效果。结果两组干预后的血糖控制率、规律服药率、血糖自我监测率显著高于干预前,差异有统计学意义(P<0.05)。实验组干预后的血糖控制率、规律服药率、血糖自我监测率显著高于对照组,差异有统计学意义(P<0.05)。实验组的危险行为改变率为33.0%,显著高于对照组的25.0%,差异有统计学意义(P<0.05)。结论全科医师团队模式是新型且高效的社区健康服务模式,将会成为全科医学发展的重要方向。     

老年高血压患者社区护理干预模式的构建及应用

目的探讨社区人群原发性高血压病干预措施的可行性和有效性。方法2007年1月至2008年1月对本社区≥60岁的110例老年高血压病患者采取护理干预,对患者高血压知识、生活行为和规律用药进行干预,并对患者进行实施服务前后的依从性调查,评估其血压控制情况。结果通过社区干预管理,使血压控制率由干预前17.5%上升至96.9%,高血压诊断标准和危险因素知晓率由干预前30.0%上升至97.5%,显著高于干预前(P<0.01)。结论实施社区护理干预对控制患者的血压水平有积极作用。     

药学服务应用于糖尿病患者的效果观察

目的 探讨药学服务在糖尿病患者中应用的临床效果.方法 2011年3月-2012年3月,我院诊治88例糖尿病患者,经专业药学技术人员提供相应的药学服务,1年后对比干预前后糖化血红蛋白水平,患者的服药依从性和血糖知晓率.结果 干预后糖化血红蛋白水平为（6.9±1.1）mmol/L低于干预前的（7.8±1.5）mmol/L,差异有统计学意义（P＜0.05）;患者的服药依从性和血糖知晓率均高于干预前,差异均有统计学意义（P＜0.05）.结论 对于糖尿病患者,药学服务能提高患者对疾病的认知度,增强治疗的依从性,有效控制血糖水平,改善患者的预后质量,值得临床广泛推广.     

社区卫生服务中心家庭医生慢性病预约门诊的实践

目的:探索社区卫生服务中心家庭医生实施慢性病预约门诊的方法和效果.方法:每个社区居民区配备1名家庭医生和1名社区护士实施慢性病预约门诊管理,考核对高血压和糖尿病的患者治疗依从性、规范管理率和控制率.结果:实施社区卫生服务中心家庭医生慢性病预约门诊1年后,高血压患者预约管理率达61.08%,高血压控制率由实施前的42.12%上升到68.17%;糖尿病患者预约管理率达68.85%,控制率由29.95%上升到37.89%.结论:社区卫生服务中心慢性病预约门诊与二、三级医院预约门诊有所不同,是提高患者管理依从性的重要途径,是家庭医生开展慢性病管理的重要措施,是提高社区慢性病管理效果的重要手段     

对社区糖尿病患者实施综合护理干预的效果评价

目的观察对社区糖尿病实施护理干预的效果,探讨价值。方法选取2009年6月至2010年12月社区中心确诊的100例2型糖尿病患者,随机分为观察组及对照组各50例,对照组在进行一般血糖监测,自行锻炼和饮食控制;观察组建立慢性病档案,实施实施下列护理干预健康教育、饮食指导、运动指导、心理护理。结果两组实施护理干预前依从性(54.0%VS 56.0%)、疗效(44.0%VS 46.0%)、糖尿病病知识知晓(58.0%VS 54.0%)、自我管理(40.0%VS 42.0%)比较无显著性差异(P>0.05),实施护理干预6个月后观察组依从性好80.0%、血糖达标82.0%、糖尿病知晓率92.0%、自我管理78.0%均高于对照组的64.0%、50.0、64.0%、50.0%(P<0.05)。结论社区糖尿病病例护理管理对于提高服药依从性,提高血糖控制率方面是有重要作用,是社区糖尿病综合防治的重要手段。     

Descriptive analysis of pharmacy services provided after community pharmacy screening

Background Community pharmacies are promising locations for opportunistic screening due to pharmacist accessibility and ability to perform various health and medication management services. Little is known as to the provision of pharmacy services following screening initiatives. Objective To describe provision of pharmacy services for participants following a community pharmacy stroke screening initiative. Setting The Program for the Identification of “Actionable Atrial” Fibrillation Pharmacy initiative took place in 30 pharmacies in Alberta and Ontario, Canada. 1149 participants?≥?65 were screened for atrial fibrillation, type 2 diabetes, and hypertension. Method Retrospective, secondary analysis of data using participant case-report forms, pharmacy data, and pharmacy claims to describe pharmacy services received by participants post-screening. Main Outcome Measure Number and types of remunerated pharmacy services received by participants post-screening. Results A total of 535/1149 (46.6%) participants screened at their regular pharmacy were included in this analysis. Of these, 165 (30.8%) participants received 229 pharmacy services within 3 months post-screening, including 146 medication reviews, 57 influenza vaccinations, and 21 pharmaceutical opinions. A median (interquartile range, IQR) of 6 (2–11) pharmacy services were delivered, and median (IQR) reimbursement was $187.50 ($67.50–$342.50). Conclusions Approximately one-third of participants received a pharmacy service within 3 months post-screening. Relatively large numbers of annual and follow-up medication reviews were delivered despite low eligibility for annual-only reviews and despite many missed opportunities for pharmacy service provision in at-risk patients. In-pharmacy screening may facilitate provision of some services, namely medication reviews, by providing opportunities to identify patients at-risk.     

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.     

以药物治疗管理为核心的社会药房糖尿病管理实践研究

目的了解社会药房开展糖尿病管理的现状、成效和存在的问题,并提出改进建议。方法采用观察和访谈的方法了解河北省容城镇某社会药房糖尿病管理模式和现状,回顾性分析2型糖尿病患者的用药档案和服务记录,评估社会药房开展糖尿病管理的成效和存在的问题。结果社会药房提供的是以药物治疗管理为核心的糖尿病管理服务。2018年9月至12月,共有119例2型糖尿病患者完整接受糖尿病管理服务;共发现189种药物相关问题,人均1.59种;共进行221次干预,人均1.85次;干预前后,患者的空腹血糖值基本保持不变,餐后2 h血糖值略有下降(由11.8 mmol/L降至11.4 mmol/L);干预后总体血糖达标率偏低(20.16%),血糖达标人数无明显变化(P>0.05),饮食和运动达标人数上升(P<0.05),饮食达标人数偏低(39.50%)。结论社会药房糖尿病管理服务对于患者用药合理性和安全性及饮食、运动控制有积极意义,可通过构建执业药师专科化制度,增设药事服务费,制订执业药师与医师协作指导规范,加强对执业药师跨学科知识的培训及设计合适的薪酬模型,确保社会药房糖尿病管理服务的有效性和可持续性。     

Effectiveness and acceptability of community pharmacy‐based interventions in type 2 diabetes: a critical review of intervention design,pharmacist and patient perspectives

Objective It is generally accepted that greater use could be made of community pharmacy‐based interventions. Diabetes care has been proposed as an area for enhanced community pharmacy involvement. However there is no published structured review of available evidence of either effectiveness or acceptability. This review aims to identify and assess such evidence and to synthesise findings to inform the design and delivery of future community pharmacy‐based interventions in diabetes care. Method A systematic search of published literature was conducted using a defined search strategy, electronic databases and targeted hand searching of non Index Medicus journals. The search dates were 1990–2003. The scope was international and we included only articles in the English language. Key findings Seven experimental studies which tested community pharmacy‐based interventions were reviewed. Four different primary outcomes were studied: diabetes control (three studies), adherence (two studies), medication problems (one study) and patient knowledge (one study). Six studies showed positive outcomes, and the findings were statistically significant in two. The theoretical basis of the interventions was unclear. Only one study included a cost‐effectiveness analysis, and the interventions were provided free of charge to patients in all seven studies. Nine attitudinal studies were included, five involving pharmacists and four with patients. Members of the public do not currently expect community pharmacists to become involved in discussions about diabetes treatment and its monitoring, but when such services are offered they are well used by patients. Pharmacists were positive about the provision of services for people with diabetes. Patients' experiences indicated that community pharmacists overestimate their current provision of information and advice to people with diabetes. Conclusions There is limited evidence of effectiveness of community pharmacy‐based interventions in diabetes care. Components of pharmacy‐based intervention which appear to contribute to effectiveness include: elicitation and discussion of patient beliefs about their diabetes and its treatment; discussion of how patients are using their medicines; review of haemoglobin A_1c (HbA_1c) levels; and assessing and supporting necessary lifestyle changes. Further research is needed and future interventions need to incorporate evidence from the literature on patient and pharmacist perspectives on diabetes. The findings of this review will be useful to researchers and service planners involved in developing community pharmacy‐based diabetes care.     

Diabetes care in Norwegian pharmacies: a descriptive study

OBJECTIVE: To describe Norwegian pharmacies' involvement in diabetes care, to investigate pharmacists' views on future services and to investigate whether the recommendations in the Norwegian diabetes declaration for pharmacies have been implemented. Setting Hospital and community pharmacies in Norway. METHOD: All 543 pharmacies in Norway, of which 511 were community pharmacies and 32 were hospital pharmacies, received a link to a web-based questionnaire. One pharmacist from each pharmacy was asked to complete the questionnaire. The questionnaire covered subjects ranging from the diabetes declaration and the pharmacists' views on which services the pharmacy should offer in the future, to demographic characteristics. RESULTS: In total 358 (66%) questionnaires were completed. The diabetes declaration was read by 37% of the pharmacists. Almost all pharmacies complied with the declarations' recommendations regarding glucose monitoring services. Twenty four percent of the pharmacies could offer medication reviews, and roughly 10% could offer screening for undiagnosed diabetes. Counseling on lifestyle issues was the least implemented recommendation. Eighty one percent of the pharmacists reported a wish to expand their services towards diabetes patients. Services in regard to glucose monitoring had the highest score, however the views on which services should be offered varied a great deal. Already performing a service increased the chance of the pharmacist being positive towards offering it. CONCLUSION: Norwegian pharmacists report that they are involved in a wide range of diabetes related services, although only 37% report to have read the diabetes declaration. The pharmacists generally wish to actively support patients with diabetes, and further research should concentrate on identifying the areas where their involvement is most productive.     

山东省社会药房慢性病管理现状调查研究

目的 调研山东省内社会药房开展慢性病管理的现状,为提高管理水平提供参考。方法 选择山东省5个地市155个社会药房为研究对象,问卷调查慢性病管理的人员配备、服务项目和阻滞因素等;分地市选取1 155例慢性病患者为研究对象,调研患者对药房慢性病管理的认知、需求、参与和认可情况。结果 社会药房主要围绕高血压(90.5%)、糖尿病(87.5%)和慢阻肺(75.2%)等慢性病开展服务,管理项目主要有用药指导(90.3%)、健康教育(89%)和生化指标检测(85.8%),阻滞性因素是缺少专业管理人员(61.3%)、患者依从性差(52.9%)和对药房缺少信任(48.4%)。患者对慢性病的认知度(65.2%)低,参与药房管理的积极性低(56.5%);期望药房建立慢性病管理专区(57.7%),检测生化指标(56.2%),提供用药指导(50.8%);73.6%的患者信任药房的管理,满意度为86.7%。结论 慢性病管理在一定程度上满足了患者的疾病康复需求和健康管理需求,但仍面临多重挑战,社会药房需要利用好各类利好政策,从发展方向、发展路径和发展模式上大胆创新、不断探索。     

Advancing patient care through innovative practice: the Clinical Partners Program.

PURPOSE: The development, implementation, and outcomes assessment of an innovative pharmacist-managed ambulatory care and community pharmacy practice clinic are described. SUMMARY: The Clinical Partners Program at The Ohio State University (OSU) provides an active learning environment for students and residents, offers a patient-focused practice model based on pharmaceutical care principles, and serves as an arena for applied research in pharmacy practice. The program offers multiple services, including anticoagulation management, diabetes self-management, cholesterol management, hepatitis C education, herbal product and dietary supplement consultations, medication management, smoking cessation, and wellness. The practice is currently staffed by two faculty members from the college of pharmacy, with a 0.8 full-time-equivalent (FTE) pharmacist and a 0.65 FTE community pharmacy resident. It has served as a training site for 17 pharmacy residents, 28 bachelor of science (B.S.) in pharmacy students, 30 post-B.S. doctor of pharmacy (Pharm.D.) students, and 132 entry-level Pharm.D. students at various levels of training. The most successful methods of reimbursement for programs have been contracted services with OSU Managed Health Care Systems, Inc., which serves OSU faculty and staff and fee-for-service billing, charged directly to non-OSU patients. Numerous studies have shown that Clinical Partners has consistently demonstrated improved therapeutic outcomes over those achieved in traditional practice. Faculty are exploring outreach services, including the development of advanced practice community sites for the college, establishing patient care services within physician offices, and providing disease management services for self-insured employers. CONCLUSION: The Clinical Partners Program has improved patient care and provided education and training opportunities for pharmacy students and residents.