药学监护:医院药学未来发展的趋势

本文提出药学监护(Pharmaceutical Care)是我国医院药学未来发展的趋势.药学技能和知识的巨大发展给了药师一个历史性机遇即对药物治疗转归分担应承担的责任.药师应具备提高药物治疗转归(Outcomes)的技能、知识和为达到这一目标所具备的责任感.药学监护不只是关心提供服务的行为本身,而更应关注患者的生命质量.药师与其他医务人员平等地工作以保证达到药物治疗目标,避免发生药源性疾病,或能尽快发现和及时解决已发生的药源性疾病.通过政府机构、药学院校和药师个人的共同努力,才能将有必要实施药学监护转变为患者、保险公司、政府卫生组织对药学监护的直接需求.本文从药学监护的起源、定义(正确理解“监护”;为治疗转归负责;功能、技巧和模式)、药师的能力、市场需求和实施药学监护等方面来把握药学监护的内涵.     

Teaching patient-centered care to pharmacy students

The concepts of pharmaceutical care are distinctively different from the responsibilities of dispensing pharmacists and in accordance with the standards of practice of other professionals in the health care system. By taking direct responsibility for individual patient's medication-related needs, pharmacists can make unique contribution to the outcome of medication therapy and to their patients' quality of life. If the pharmacists are to contribute effectively to the new patient-centered pharmaceutical practice they must have the opportunity to acquire the new knowledge and skills required for their new role. To do this they must become life-long learners, one of the roles of the new pharmacist. Therefore, an important outcome for pharmacy education is to perform graduates capable to provide patient-centered pharmaceutical services. The purpose of this paper is to stimulate reflection on the relevance of teaching patient-centered care to pharmacy students, consistent with the practice of pharmaceutical care as a current trend in the pharmacy practice.     

Opportunities and responsibilities in pharmaceutical care

Pharmacy's opportunity to mature as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality is explored. Pharmacy has shed the apothecary role but has not yet been restored to its erst-while importance in medical care. It is not enough to dispense the correct drug or to provide sophisticated pharmaceutical services; nor will it be sufficient to devise new technical functions. Pharmacists and their institutions must stop looking inward and start redirecting their energies to the greater social good. Some 12,000 deaths and 15,000 hospitalizations due to adverse drug reactions (ADRs) were reported to the FDA in 1987, and many went unreported. Drug-related morbidity and mortality are often preventable, and pharmaceutical services can reduce the number of ADRs, the length of hospital stays, and the cost of care. Pharmacists must abandon factionalism and adopt patient-centered pharmaceutical care as their philosophy of practice. Changing the focus of practice from products and biological systems to ensuring the best drug therapy and patient safety will raise pharmacy's level of responsibility and require philosophical, organizational, and functional changes. It will be necessary to set new practice standards, establish cooperative relationships with other health-care professions, and determine strategies for marketing pharmaceutical care. Pharmacy's reprofessionalization will be completed only when all pharmacists accept their social mandate to ensure the safe and effective drug therapy of the individual patient.     

Research--the cornerstone of pharmacy practice. Harvey A.K. Whitney lecture

Hospital pharmacy's need for a new commitment to research and the attendant sharing of responsibilities between pharmacy educators and pharmacy practitioners are described. Guided by the same philosophy of professional service that motivated early hospital pharmacists, individual pharmacists should work within their differentiated roles to advance the profession as a whole. For this advancement, research to acquire new knowledge and develop and evaluate new services is required. Research enhances the prestige and societal support of a profession. Pharmacists with differentiated skills and practice areas must support each other to advance the profession, particularly because of limited financial resources in both education and practice settings. Universities, including schools of pharmacy, have a responsibility for research as well as for the transmission of knowledge, and pharmacy faculty members should conduct research that supports the advancement of practice. To support research by faculty members, pharmacy practitioners can assume greater teaching responsibility. Schools of pharmacy and practicing pharmacists can work together to support research that will benefit the whole profession and society. Pharmacy practice faculty members who maintain a practice base and are involved in research have a critical role in this cooperative effort.     

Future practice roles in pharmacy

The blurring of distinctions between community and institutional pharmacy practice is described, and future practice roles are discussed. As ambulatory-care services, such as home-care programs, long-term-care programs, and nursing-care facilities, assume greater importance in the provision of health care, the roles of hospital-based and community-based pharmacists become blurred. The roles of health-care providers are changing from an inter-professional perspective also. Pharmacist prescribing, physician dispensing, and therapeutic interchange are examples. The issue of therapeutic interchange, as a collaborative arrangement between pharmacists and physicians, will become crucial as managed-care systems grow if pharmacists are to retain responsibility for drug-use control. Challenges facing both institutional and community pharmacy in the future include meeting man-power needs, ensuring quality educational opportunities for pharmacy students and practicing pharmacists, and justifying the cost benefits of progressive pharmaceutical services. The pharmacy profession should set standards of quality for pharmaceutical services in emerging care settings. Although practice roles in pharmacy are changing along with the health-care system, pharmacists in all settings should work together in furthering their common goal of providing quality patient care.     

医院药学工作模式与药学保健

Ｐｈａｒｍａｃｅｕｔｉａｌｃａｒｅ是最近医院药学领域的热门话题，不仅概述新颖，而且包含丰富的内容，使人耳目一新，给沉闷了许久的医院药学研究带来了改革的新气象。     

Improving patient-oriented pharmacy services: what the director can do

How pharmacy directors can further the development of patient-oriented services is described. A philosophy of responsibility for patient outcomes instead of for specific functions is necessary for achieving pharmacy's full potential. Overall, pharmacy practice today does not reflect this sense of responsibility for drug-use control. Management that encourages greater accountability; a mission statement and goals; specific definitions of performance criteria; evaluation of services in terms of patient-care outcomes; and increased interaction with physicians, nurses, and hospital administrators are needed. A director can guide pharmacists in a recommitment to professional services that will result in positive patient-care outcomes.     

Harvey A. K. Whitney Lecture. To a new beginning from converging paths

The implementation of the pharmaceutical care concept is discussed. Current activities of professional pharmacy organizations are laying the groundwork for the new emphasis on patient outcomes, which is seen in the mission statements of the American Pharmaceutical Association (APhA) and the Joint Commission of Pharmacy Practitioners (JCPP). APhA is revalidating its standards of practice; the American Association of Colleges of Pharmacy (AACP) has formed a Commission to Implement Change in Pharmaceutical Education; the American Council on Pharmaceutical Education (ACPE) is revising its standards to be consistent with entry-level practitioners' ability to provide pharmaceutical care and seeking ways in which pharmacists currently practicing in all sites can upgrade their skills. These groups are called on to implement pharmaceutical care: To make known the "value-added services" encompassed in pharmaceutical care, JCPP should market to the public its concept of pharmacists' mission. APhA should analyze pharmaceutical services currently provided and promote postgraduate training programs in pharmaceutical care. ACPE must focus on ways pharmacists can achieve the competencies required for pharmaceutical care, and AACP must ensure that academic programs are consistent with the needed competencies. ASHP should hold a national conference on implementation of pharmaceutical care, create a commission for this purpose, direct more effort at pharmacists practicing in nonhospital settings, and accelerate its clinical skills development program. Employers should put less emphasis on "clinical" designations and Pharm.D. degrees and more on the ability to provide pharmaceutical care. Implementation of pharmaceutical care is imperative.     

Unresolved issues in the future of pharmacy

The effect of the major forces shaping pharmacy's future--technology, economics, and social values--is discussed. Pharmacy can best respond to these forces by expanding the informational component of pharmacy practice and by returning to its fundamental relationship with society--that is, by accepting responsibility for drug-use control. To accomplish this, pharmacy must go through a process of occupational reconstruction and self-renewal. Technological forces shaping pharmacy practice include computers and robotics, communications, and therapeutics. Regarding economic changes, medical-care decisions are shifting away from individuals toward "third parties." This factor, combined with output-based payment systems, may lead to a consolidation of service providers. Marketing pharmaceutical services and organizing pharmacy's internal structure will become important. Some of the social forces affecting pharmacy's future include the aging population, the weakening of professional authority, and pharmacy's public image. Just as society goes through the "information revolution," pharmacy will need to undergo a "reprofessionalization." Pharmacy's societal function should involve "pharmaceutical care," a concept that includes both drug-product control and clinical pharmacy services. Pharmacy should return to its preindustrial origins in valued, complex, specific, and committed public service if it wishes a happy postindustrial future.     

Dual degree programs at the University of Kentucky College of Pharmacy

The rapid growth and evolution of the pharmacy profession has created a wide array of opportunities for graduating pharmacists beyond traditional community pharmacy or hospital practice. Management and leadership positions in federal and state healthcare agencies, pharmaceutical companies, hospitals, retail pharmacies, academia and managed care organizations increasingly require the pharmaceutical knowledge obtained through a doctor of pharmacy (PharmD) degree combined with financial, organizational, and management skills. In these innovative positions, pharmacists are being called upon to assume responsibilities as executives and administrators in systems providing pharmacist care services to patients. To endow students with knowledge and skills required to perform the duties required in these decision-making positions, the University of Kentucky College of Pharmacy has established 3 joint degree programs: the PharmD/Master of Business Administration (PharmD/MBA), PharmD/Master of Public Administration (PharmD/MPA), and PharmD/Master of Science in Economics (PharmD/MS). This paper describes these joint degree programs.     

Pharmacy: a profession in transition or a transitory profession?

Areas in pharmacy that are in transition are described, and ways to prevent the perception of pharmacy as a transitory profession are detailed. Pharmacy has adapted itself over the past 75 years to changes in the health-care system and in societal demands of the profession. The evolution of pharmacy functions has included drug product preparation, establishment of standards, drug distribution, and clinical pharmacy. The profession is continuing to change in reaction to economic and social forces. Hospital pharmacy flourished when it shifted from a profit to a cost center because pharmacy practice researchers documented the contribution of clinical pharmacy to patient care and because hospital pharmacy administrators developed sound management procedures to maintain efficient inventories. Current controversies in pharmacy practice are discussed, including pharmacist prescribing, physician dispensing, and therapeutic substitution. These terms inadequately describe the concepts, especially when they are taken out of context of the total health-care process involving a physician-pharmacist team. Because of the success of this teamwork in acute-care institutions, ambulatory pharmaceutical services should involve cooperative activities of pharmacists in professional service administrative organizations (PSAOs) and physicians in independent practice associations. The cost-effectiveness of PSAOs is discussed. Marketing of drug products is changing as the physician-pharmacist interaction becomes integral to the drug therapy decision-making process. Drug distribution should not be viewed as less professional than clinical activities. Although the pharmacy profession is reorienting itself toward patient care and the rational use of drugs in society, it must maintain its authority over the drug distribution system.     

县级医院临床药师工作技能的培养及规范化考核

目的 探讨县级医院临床药师的工作技能培养和规范化考核指标。方法 通过我院临床药师参与临床药物治疗实践,分析总结县级医院临床药师知识结构的重要性和细化量化临床药师工作指标的必要性。结果 临床药师的知识转型是参与查房与会诊、用药监护和用药指导的必备条件,实施规范化考核是深入开展临床药学工作并持续提升药学服务质量的保障。结论 县级医院临床药师需参与临床多学科的药学服务,在实践中丰富临床知识,在落实考核指标中持续提升工作质量。     

某院护士药学服务能力、认知与需求的调查分析

目的 了解护士药学服务能力、认知与需求,为提高药学服务水平和护理质量提供建议.方法 采用方便抽样法,于2016年7—8月,选取成都医学院第一附属医院护士180人,采用自行设计的问卷进行调查.结果 护士药学服务能力平均得分为(9.87±1.27)分,理论知识平均得分为(2.94±0.691)分.护士对药学服务持肯定态度.护士对药师服务的需求度较高.结论 必须加强护理相关药学服务教育,药师必须帮助护理人员提高药学服务所需的知识与技能,计算机技术也可以用于辅助护士药学服务,从而提高药学服务的整体水平.     

儿科临床药师开展创新药学服务的思考与实践

目的:探讨儿科临床药师针对儿童患者及家长进行创新药学服务的实践及思考.方法:通过开展儿科专科药学门诊、床旁用药教育、社区儿童用药宣教和线上服务等创新药学服务项目,探讨儿科专科临床药师在药学转型发展中的作用.结果:37.4％的儿科药学门诊患者来自医师转诊,可实现临床医师和药师在专业知识上的互补,充分发挥专科临床药师的作用...     

Organizing for drug-usage evaluation

Because QA is the chief interest of the Joint Commission, hospital pharmacists must strive to have a well-organized DUE plan and process. However, merely satisfying a Joint Commission surveyor is not a good enough reason to invest in the DUE process. DUE is deceptively complex and labor intensive for hospital and medical staff alike. A better reason to plunge into DUE is to enable pharmacists to concurrently monitor pharmacotherapy, to intervene on behalf of patients, and to positively affect patients' therapeutic outcomes. Thereby, DUE really fits pharmacy's responsibility for pharmaceutical care.     

药学监护的实施

医药科技的飞速发展与药师保障病人用药安全、有效、经济，造福病人身心健康的社会责任，推动了医院药学的改革。８０年代中期提出的药学监护，使医院药学实践迈向了新的高度，美国医院药师学会在１９９２年提出了把药学监护作为药房工作质量标准，要求药房进行以药学监护为中心的组织机构与业务实践改革。药学监护作为跨世纪发达国家药房工作的中心，应受到我国药学工作者的高度重视。本文就药学监护的实施方案与我们的思考与对策作简要论述。     

开展专科临床药学的工作体会

目的探讨临床药师在临床治疗中的作用。方法通过临床药师对病人实施药学服务实践,开展分析评价并总结经验。结果药师下临床可以降低医疗成本,减少不良反应,降低医疗风险,提高药物治疗水平。结论临床药学是一门实践性学科,深入临床,以病人为中心是开展临床药学的必经之路。     

Pharmacy practice in 2040.

Pharmacy practice 50 years in the future is discussed. The practice of pharmacy in 2040 will be influenced by many trends and issues, such as increasing cultural diversity, the aging population, evolving drug and information technology, rising drug costs, and increasing third-party coverage. Pharmacy may take one of two paths. In the first scenario, institutional and community practice would drift further apart, with community pharmacy becoming more involved with retailing than with health care. In the second scenario, all pharmacists would become a vital component of an integrated, patient-centered system of health care; pharmacists, like physicians, would be salaried professionals, paid for by health-care programs financed through health insurance. The difference between the two scenarios is the degree to which pharmacists actively participate in their creation: The first will happen if pharmacists do not take action; the second will require a considerable amount of work. If pharmacists wish to see an active system of patient-centered pharmaceutical care in 2040, they must begin to create it now, regardless of their practice setting. Pharmacists must work to create a future in which they are an integral part of the health-care system.     

Transitions, part 1: beyond pharmaceutical care.

A systems view of the amalgamation of existing pharmacy practice models is proposed. Pharmacy's evolution is traceable as a series of stages. The stages in pharmacy's evolution have been manufacturing pharmacy, compounding, distribution, clinical pharmacy, and pharmaceutical care. Good pharmacy practice (GPP) represents an international attempt to unite various conceptualizations of practice, including pharmaceutical care. GPP in turn provides a foundation for a model to explain current and changing practice, the total pharmacy care (TPC) model. TPC combines five existing practice models: drug information, self-care, clinical pharmacy, pharmaceutical care, and distribution. TPC, as the sum of these models, asserts that there will be an ongoing need for all five existing models of practice, that the proportion of pharmacists employing each model will reflect the needs of a given health care environment at a given time, and that if changes in health care provide more opportunities for pharmaceutical care, pharmacists will shift increasingly toward that type of practice. Total pharmacy care is the delivery of a comprehensive range of services that result in the maximum possible contribution to the health of a nation's population within the limits of the health care delivery structure.