Community pharmacists'' perspectives on pharmaceutical care implementation in New Zealand

Objective: There were three objectives to this study: to establish New Zealand community pharmacists' level of understanding of the pharmaceutical care process; to determine their attitudes to the concept of pharmaceutical care; and to determine the barriers to commencing pharmaceutical care practice. Comparisons were made between proprietors (pharmacy owners) and employees, males and females, and younger and older pharmacists. Method: The research tool was a questionnaire instrument, encompassing a total of 67 questions designed to determine community pharmacists' understanding, attitudes and appreciation of the opportunities and barriers inherent in the pharmaceutical care process. A total of 490 pharmacists representing 286 proprietors and 204 employees randomly selected from the Pharmaceutical Society register were sent a questionnaire. Results: The total responses numbered 377, which was a 76.9% overall response rate. Over 60% of the pharmacists surveyed had a correct understanding of pharmaceutical care. Approximately the same percentage felt the future of pharmacy would depend on the provision of services other than dispensing. Insufficient time, as a barrier to implementation, was identified by 87% of respondents, and an absence of a reimbursement system by a further 82%. Lack of: therapeutic knowledge; clinical problem solving skills; finance; appropriate space; patient demand; access to patient medical records; and data on the value of PC were identified as major barriers by over 50% of all respondents. There were significant differences in response to a number of issues recorded by males and females, proprietors and employees, and pharmacists above and below the mean sample age of 45 years.Conclusion: This study found that the community pharmacy environment in New Zealand had a high level of understanding of the pharmaceutical care process, but identified some significant barriers to implementation.     

药学保健在传染病防治中的实施策略探讨

药学保健是医院药学发展的更高层次,国内外相关研究和实践也取得了一定成效。在院内传染病防治中开展药学保健,结合传染病防治特点,分析药学保健的服务方式,探讨药学保健的可行性实施策略,规范药物的合理使用,减少不良反应,提高疗效,对提升传染病综合防治能力有积极意义。药学保健可为及时控制和消除传染病提供有力的保障,同时符合新医改和医院“三好一满意”服务的需要。     

药学学生参与社会药房药学服务工作的探索与实践

目的呼吁药学实习生积极参与社会药房的药学服务工作,提高药学人员技术服务能力,为实习企业赢得社会信誉。方法通过对部分社区居民的问卷调查,结合淄博市社会药房药学服务的现状,制订实习基地药学服务计划,引导本专业实习生进行多种形式的药学服务活动。结果与结论初步为实习基地确立了有效的药学服务模式,强化了学生的沟通技巧及药学服务知识,培养了药学服务专业人才队伍。为我院开展药学服务活动提供建议和参考依据。     

From the laboratory to pharmaceutical care research ? Part I

In pharmaceutical care research )PCR) a mass of robust general rules has not yet been found. Consequently, the challenge of PCR is that mainly through induction researchers have to study objects which are learning and which are open to environmental influences and, by doing so, researchers have to contribute to both theory and practice. Therefore the characteristics reductionism, repeatability and refutability originated from natural sciences cannot be applied to PCR on a 1:1 basis. PCR should be imitable, defensible, consistent and relevant in order to enable other researchers to agree or disagree with the conclusions and to stimulate new research.     

开展社区药学服务的实践探讨

目的:探讨开展社区药学服务的途径和意义。方法:药师走出医院,深入社区,针对常见病、慢性病患者进行健康宣教和用药知识讲座,追踪重点患者并定期随访,提供社区药学服务。结果:药师通过多学科知识积累和沟通交流技巧学习,在药学服务实践中,根据患者的具体情况,进行针对性的用药咨询和宣教,指导社区患者了解饮食调整方法、药物作用机理和病程特点,帮助患者了解药物、战胜疾病。结论:开展社区药学服务,能够发挥药师职能,促进用药知识传播,有助于提升合理用药、提高公众健康和生活质量。     

临床药师对主动脉夹层患者进行药学监护的切入点

目的探讨临床药师为主动脉夹层(AD)患者实施药学监护的路径和方法。方法采用美国卫生保健机构联合鉴定委员会批准的药学监护方法,结合我国临床药学特点,拟定主动脉夹层患者药学监护的路径和方法。结果临床药师可为主动脉夹层患者提供药学监护,并对患者进行用药教育。结论通过实施药学监护,可明显提高主动脉夹层患者用药的安全性、有效性和经济性,可改善患者预后。     

试论医药产业的进入壁垒

通过运用产业组织的进入壁垒理论对医药产业进行分析，试图明确医药产业进入壁垒的涵义，种类和度量方法。为今后医药产业政策的制定和企业的进入决策提供了一个分析工具。     

药学服务对支气管哮喘患者用药依从性的影响

目的探讨药学服务干预对支气管哮喘患者用药依从性的影响。方法随机抽取确诊哮喘患者60例,分为2组,药学服务干预治疗组(观察组)30例,常规治疗组(对照组)30例。观察两组患者依从性变化。结果干预前,观察组与对照组患者用药依从率分别为30.00%和33.33%(P>0.05);1、6个月后,观察组患者用药依从率分别为60.00%和56.67%,对照组分别为40.00%和30.00%,两组比较,差异有统计学意义(P<0.05)。结论药学服务能有效提高支气管哮喘患者的用药依从性。     

Cost analysis of pharmaceutical care provided to HIV-infected patients: an ambispective controlled study

Background

Studies have shown that pharmaceutical care can result in favorable clinical outcomes in human immunodeficiency virus (HIV)-infected patients, however, few studies have assessed the economic impact. The objective of this study was to evaluate the clinical and economic impact of pharmaceutical care of HIV-infected patients.

Methods

A controlled ambispective study was conducted in Brazil from January 2009 to June 2012. Patients were allocated to either intervention or control group. The control group was followed according to standard care while the intervention group was also followed by a pharmacist at each physician appointment for one year. Effectiveness outcomes included CD4+ count, viral load, absence of co-infections and optimal immune response, and economic outcomes included expenses of physician and pharmaceutical appointments, laboratory tests, procedures, and hospitalizations, at six months and one year.

Results

Intervention and control groups included 51 patients each. We observed significant decreases in total pharmacotherapy problems during the study. At six months, the intervention group contained higher percentages of patients without co-infections and of patients with CD4+ >500 cells/mm³. None of the differences between intervention and control group considering clinical outcomes and costs were statistically significant. However, at one year, the intervention group showed higher percentage of better clinical outcomes and generated lower spending (not to procedures). An additional health care system daily investment of US$1.45, 1.09, 2.13, 4.35, 1.09, and 0.87 would be required for each additional outcome of viral load <50 copies/ml, absence of co-infection, CD4+ >200, 350, and 500 cells/mm³, and optimal immune response, respectively.

Conclusion

This work demonstrated that pharmaceutical care of HIV-infected patients, for a one-year period, was able to decrease the number of pharmacotherapy problems. However, the clinical outcomes and the costs did not have statistical difference but showed higher percentage of better clinical outcomes and lower costs for some items.     

实施药学监护的探索

运用现代药学理论技术知识,结合日照市人民医院临床药学部对部分患者实施药学监护实例调查对比进行分析评价。通过调查分析及实践探索说明药学监护提高了医疗水平,具有举足轻重的作用。希望可以借此推动中国医院药学监护的实施,推动中国药师的服务水平和服务质量,逐步缩短与发达国家的差距,向国际化、标准化的药学监护靠拢。药学监护势在必行,是医院药学发展的方向,应大力推动其在国内的进展。     

Identification of the pharmaceutical care issues of rheumatoid arthritis patients in secondary care

Objective: To explore the perceptions of multidisciplinary health care professionals (HCPs) and patients of the pharmaceutical care issues (PCIs) relating to rheumatoid arthritis (RA.). Design: Qualitative study using semistructured one to one interviews and focus groups to explore patient perceptions. Interviews and focus groups were taped and transcribed verbatim, then described and coded for meaning to produce 'invivo' codes, which were then grouped to form themes. Nominal group methodology was used to generate and rank a list of HCP perceptions of the key PCIs of RA patients. The PCIs were ranked according to clinical importance and order of occurrence from admission as perceived by the HCP group. Setting: Rheumatology ward and outpatient clinic in a teaching hospital.Main Outcome Measures: Generation and ranking of PCIs, generation of themes from patient interviews. Results: Optimisation of pain control was identified by the nominal group as being the primary aim for patients on admission and was also the most commonly described symptom by patients. Two PCIs not predicted by the HCPs' nominal group was the frequency of infections and the associated discharge and patients described experiencing 'overeducation' by HCPs, which could lead to anxiety. Complementary medicine in conjunction with traditional therapy was raised as a significant health benefit by patients. Conclusion: Many patients' views mirrored the PCIs identified by HCPs, but some were not anticipated; the value of patient interviews to ensure appropriate service development was demonstrated. Several PCIs emerged for future incorporation by the multidisciplinary team into standardised models of pharmaceutical care for use in secondary care and at the secondary/primary care interface for improvement of seamless care. There is a need to target educational interventions and to identify those who will benefit from advice on complementary medicine. Further work is required to develop a tool to identify the educational needs of RA patients and targeting of the information provided. This will help ensure the delivery of pharmaceutical care is designed to match the needs of individual patients.     

Applying health technology assessment to pharmaceutical care: pitfalls and future directions

It has been argued in previous issues of this journal that health technology assessment can be used as a tool to assess the efficiency of pharmaceutical care by linking its impact on clinical and humanistic outcomes to the resources required to achieve these outcomes. Additionally, as policy-makers appreciate the need to evaluate projects on the basis of their costs and benefits, the application of health technology assessment to pharmaceutical care may serve as a way of communicating with policy-makers and informing policy on pharmaceutical care.This article elaborates on this idea by arguing that policy-makers will be more likely to appreciate the value of pharmaceutical care if researchers pay more attention to some methodological principles underlying health technology assessment in the context of pharmaceutical care, and if they take into account the decision-making context facing policy-makers. In order to raise the methodological quality of studies, researchers need to take care to define better the pharmaceutical care intervention; to evaluate the costs of the intervention and its impact on the utilization of other health services; and to aggregate the various clinical and humanistic outcome measures that are commonly used in this type of research. In order to increase the usefulness of study findings to policy-makers, researchers need to identify the multiple objectives that policy-makers pursue, and show how study findings will aid policy-makers in attaining these objectives.     

门诊药房优化药学服务流程的效果观察

目的观察门诊药房优化药学服务流程对患者就诊感受的影响。方法改进与门诊药房相关的服务内涵、服务支持和服务窗口等流程2年,观察患者满意度、医护人员满意度、购药时间、药品投诉率。结果优化服务流程后,患者和医护人员的满意度提高,差异有统计学意义（P〈0．05）;购药等候时间缩短,药品投诉率降低,差异有统计学意义（P〈0．01）。结论优化药学服务流程有利于保证患者服药的安全、经济、有效,并维护医院严谨的工作形象。     

欧洲医药保健网分类系统在呼吸科老年人多重用药中的应用研究

目的采用欧洲医药保键网(Pharmaceutical care network Europe,PCNE)分类系统对老年多重用药患者的药物相关问题(Drug related problems,DRPs)进行分析和评估,从而为药师对老年患者的药学监护模式提供参考。方法回顾性收集2018-2019年在呼吸科住院且年龄≥65岁,服用5种药物以上的老年患者,对发生的药物相关问题的类型、原因、干预、干预接受程度及DRPs解决状态等方面进行分析。结果共纳入152例患者,发现DRPs共300个。平均年龄77.3岁,每人合并疾病的平均种类数3.4个,其中DRPs发生的次数1.97次/人。治疗安全性是主要问题,表现为药物不良事件,占54%。主要原因为药物相互作用,占39.7%。DRPs的干预类型中,针对医生方面占84%。DRPs问题最终解决65%。结论通过PCNE分类能及时发现和解决DRPs,同时有助于对老年多重用药患者的药学监护记录的标准化和规范化,为患者安全、有效、合理使用药物提供依据。     

药学关怀服务与药品不良反应监测关系的探讨

通过对我院开展药学关怀服务与临床药学工作方向及临床药师社会责任的关系的概述。提出了在开展药品不良反应监测工作中应当重视药学服务工作。     

Using health technology assessment to put pharmaceutical care on the political agenda commentary

Pharmaceutical care is a widely accepted strategy in the world of pharmacy, as well as a topic of interest in pharmacy practice research. Most people in the field would agree that it is unfortunate that so little is known about pharmaceutical care outside the world of pharmacy. There is also wide agreement that the further development of pharmaceutical care requires that policymakers become aware of, accept and ultimately support it. Although attempts have been made, we have not yet managed to capture the attention and support of policymakers, including politicians. In this article we argue that the way to get the attention of policymakers/politicians is by changing the way we communicate with them, as a means of overcoming some of the barriers we normally meet when introducing pharmaceutical care. We suggest that one possible way of getting their attention and subsequent support is by gaining a better understanding of the way policymakers work in general and then adjusting our argumentation for pharmaceutical care to better fit into their rationality and work habits. In this article, we elaborate on this idea and discuss how proponents of pharmaceutical care can use 'health technology assessment' to argue their case.