Drug‐related problems at discharge: results on the Spanish pharmacy discharge programme CONSULTENOS

Objectives The aim of this study was to describe the most common drug‐related problems (DRPs) found after discharge, pharmacist interventions and their results for the patients enrolled on the CONSULTENOS programme. Methods An observational, prospective, multicentre study was conducted to evaluate the results of a pharmaceutical care programme at discharge. Patients from 10 hospitals participating in the CONSULTENOS programme were enrolled. Pharmacists conducting this programme were newly graduated and worked under the supervision of a pharmacy staff member; only two pharmacists had previous hospital pharmacy experience. DRPs were identified and classified according to the Iaser methodology. Frequencies, types of DRP, interventions and outcomes were registered prospectively, at discharge and during a follow‐up call 7 days after leaving the hospital. Key findings A total of 7711 patients were included in the study. DRPs were detected in 23.7% of the patients, with a total of 2120 DRPs (1788 at discharge and 332 in the follow‐up). The most common problems identified at discharge were twofold: firstly the need of an additional treatment (34.1%) and secondly an unnecessary treatment (18.1%). In the follow‐up phone call the most frequent DRPs were adverse effects (29.2%). Besides the standard educational interventions at discharge, 3313 extra interventions were performed, of which 85% were accepted. The outcomes for the patients were positive in 80% of the cases, although documentation with objective or subjective data was rare. Conclusions DRPs occur frequently after patient discharge. A pharmaceutical care programme can identify and solve DRPs in this scenario. The clinical impact of the pharmacists' interventions should be better addressed.     

A clinical knowledge measurement tool to assess the ability of community pharmacists to detect drug-related problems

Introduction Drug‐related problems (DRPs) are associated with significant morbidity and mortality, with most DRPs thought to be preventable. Community pharmacists can detect and either prevent or resolve many of these DRPs. A survey‐based clinical knowledge measurement tool was designed and validated to estimate a community pharmacist's clinical knowledge and ability to detect and appropriately resolve DRPs. Methods Nine clinical cases with seven multiple‐choice statements (63 statements in total) were constructed, based on scenarios that were found to occur frequently in Australian community pharmacies. The statements aimed to assess a pharmacist's ability to identify, gather relevant information about and make appropriate recommendations to resolve, a DRP. The survey was pilot tested with 18 academics at three Australian pharmacy schools, resulting in the removal of 23 statements. The survey was then administered to undergraduate pharmacy students (28 fourth‐year, 41 third‐year and 42 first‐year students) and to 433 Australian community pharmacists who were participating in an intervention documentation trial. The pharmacists' resultant survey scores were correlated against their actual rate of documenting clinical interventions. Results The tool had relatively good internal consistency. Significant differences were seen between the three groups of students (P < 0.01). Community pharmacists with additional clinical qualifications had a significantly higher score than other participating pharmacists (P < 0.01). A moderate, but significant, correlation was seen between the pharmacists' survey score and their clinical intervention rate in practice during the trial (P < 0.01). Conclusion The clinical knowledge measurement tool appeared to estimate a pharmacist's ability to detect and resolve DRPs within the community pharmacy environment.     

药师在处方自动监测系统临床干预中的作用

目的：探讨临床药师利用处方自动监测系统(PASS)平台开展临床药学工作的方法。方法：结合全军“PASS临床干预影响因素分析与评估”研究，将临床药师工作分为“PASS以内”和“PASS以外”两个部份，从理论和实际两个角度分析临床药师在PASS临床干预中的作用。结果：PASS以内工作为合理解释警示信息，提供正确处理意见。PASS以外工作包括药物治疗方案评价和监护等多方面的内容。结论：PASS系统是临床药学工作的一种重要工具，但不能替代临床药师工作。     

探讨临床药师在动静脉内瘘术中规范化使用抗菌药物的作用

目的 探讨临床药师在实施单病种动静脉内瘘术临床路径中的作用,摸索在有限的卫生资源条件下,通过规范化诊疗过程、标准化用药行为,来降低抗菌药物的使用率,减少耐药菌的产生,降低医疗费用,最终达到改善医疗质量,使患者的临床用药能够做到安全、有效、经济.方法 根据研究项目的需要自行设计点评表,对实施临床路径前后应用抗菌药物情况进行对比分析研究.结果 实施临床路径后,抗菌药物的不合理使用率由路径前的98.51％下降至路径后的5.3％ （P ＜0.001）,预防用抗菌药物的平均金额由443元降至5.01元（P ＜0.001）,预防用抗菌药物总费用占总住院费用比例由4.1％降至0.093％（P＜0.001）,平均用药天数由4d降至0.06 d（P ＜0.001）.西药总费用占总住院费用比例由36.57％降至15.89％（P＜0.001）.结论 临床药师在肾内科动静脉内瘘术临床路径实施中对抗菌药物使用的干预是行之有效的,应进一步在该院推广.     

临床药师在临床合理用药中的价值分析

目的:分析临床药师在开展临床合理用药实践中的价值。方法:结合深入临床实践开展药学服务的具体内容,分析临床药师促进合理用药的价值。结果:临床药师为医师提供了合理用药的专业知识,加强了医师的药学知识积累,完善了临床药师的知识结构,为促进临床合理用药做出努力,体现了临床药师的价值。结论:临床药师对安全、有效、合理使用药物起到了有益的推进作用。     

临床药师参与经皮冠状动脉介入治疗术后普通肝素致重度血小板减少的药物治疗分析

目的 为临床药师参与肝素诱导血小板减少症(HIT)治疗提供参考.方法 临床药师参与1例普通肝素诱导重度血小板减少患者的诊断与治疗,包括肝素相关的血小板减少的危急情况下急救处理、后续抗凝药物选择,并给予患者全程化的药学监护.结果 患者病情好转出院,出院时血小板已经恢复至正常值,住院期间患者未见明显出血.结论 临床药师可以协助医师处理药品严重不良反应,保证患者临床用药的安全、减少临床药品不良事件的发生.     

临床药师在重症监护病房中开展药学工作的体会

获得医护人员的认可并融入到临床治疗团队中,是临床药师开展临床药学工作的关键。本文以药物浓度监测和用药剂量调整为重点,针对特殊人群用药监护等环节,综述药师在临床治疗中的作用。     

An exploration of work‐related stress in Northern Ireland community pharmacy: a qualitative study

Objectives The aim of this study was, through qualitative methodology, to explore the factors which contribute to job‐related stress in community pharmacy in Northern Ireland. Methods All community pharmacists in Northern Ireland were invited to participate in one‐to‐one semi‐structured interviews. Interview schedules explored pharmacists' attitudes to job‐related stress and the situations that may contribute to stress. All interviews took place at participants' work sites between December 2007 and April 2008, were audio‐taped, transcribed verbatim, read independently by the authors and analysed using thematic analysis. Key findings Seventeen pharmacists participated in the interviews. The main themes that emerged in relation to job‐related stress were workplace issues, issues regarding professional expansion, recognition and responsibility, and a demanding public. Although there was general support for development in community pharmacy, this was tempered by concerns as to how expectations would be met and how all services would be delivered. Conclusions The themes that emerged from this work reflect what was reported from a survey conducted in 2007 and reinforce the tension between developments in practice and the ability to deliver. Developments in professional practice can be positive; however, commissioners and policy‐makers need to consider whether community pharmacists have the infrastructure in terms of environment, personnel and multi‐professional support to deliver what is required of them.     

The effect of early in-hospital medication review on health outcomes: a systematic review

AimsAdverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in-hospital pharmacist-led medication review on patient-oriented outcomes based on observed data.MethodsWe systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi-random methods to allocate subjects to pharmacist-led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta-analysis.ResultsWe retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] –0.04 days, 95% confidence interval [CI] –1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design.ConclusionsWide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes.     

中药新药临床研究方案设计中相关问题探讨

临床研究是新药研发过程中的重要环节,临床研究成功的前提是科学、合理的方案设计。本文针对中药新药临床研究方案设计过程中的关键问题,如证型的确立、中药治疗水平的定位、盲法实施中存在的问题,临床研究分期的实施、诊断标准与疗效判定标准的运用、安慰剂的使用以及安全性评价等相关问题进行了探讨,对中药新药临床研究方案设计有一定的参考作用。     

临床药师在神经病理性癌痛患者镇痛治疗中的作用

目的：优化癌痛药物治疗,促进癌痛患者合理用药。方法：临床药师参与癌痛患者治疗方案的制定,结合患者癌痛特点,充分考虑其不良反应,建议医师调整相关治疗药物。结果：临床药师在本病例中凭借自身的专业知识,从混合性疼痛的滴定及不良反应方面,积极配合医师,为患者提供了合理的用药方案。经治疗后,患者的疼痛控制良好,不良反应得以缓解。结论：抗肿瘤专业临床药师参与临床实践,可从药学的角度发挥优势,优化治疗方案,预防不良反应的发生。