Views of pharmacist prescribers,doctors and patients on pharmacist prescribing implementation

Aim The aim of this study was to explore the perspectives of pharmacist supplementary prescribers, their linked independent prescribers and patients, across a range of settings, in Scotland, towards pharmacist prescribing. Method Telephone interviews were conducted with nine pharmacist prescribers, eight linked independent prescribers (doctors) and 18 patients. The setting was primary and secondary care settings in six NHS Health Board areas in Scotland. Key findings In general, all stakeholders were supportive of pharmacists as supplementary prescribers, identifying benefits for patients and the wider health care team. Although patients raised no concerns, they had little idea of what to expect on their first visit, leading initially to feelings of apprehension. Pharmacists and doctors voiced concerns around a potential lack of continued funding, inadequate support networks and continuing professional development. Pharmacists were keen to undertake independent prescribing, although doctors were less supportive, citing issues around inadequate clinical examination skills. Conclusions Pharmacists, doctors and patients were all supportive of developments in pharmacist supplementary prescribing, although doctors raised concerns around independent prescribing by pharmacists. The ability of pharmacists to demonstrate competence, to be aware of levels of competence and to identify learning needs requires further exploration.     

我院药师从事临床药学实践的方法与体会

目的为药学工作者提供参考。方法介绍我院药师从事临床药学实践活动的方法与体会,即药师下临床前须准备的相关知识,确定工作目标;下临床后要确定工作路径参加医师查房和药师查房,阅读病历发现问题,参加病例讨论和会诊来参与制订治疗方案,对重症患者书写药历,注意新剂型的临床疗效,向医师讲课和提供新药信息来与医师进行多方面合作;以案例分析谈实践体会。结果与结论按照上述方法和路径,我院药师从事临床药学实践已初步取得积极效果,受到临床医师的好评。     

青光眼患者用药风险防范与干预策略研究

目的建立青光眼患者用药风险防范计划与干预策略,保障患者用药安全。方法归纳我院药品说明书中禁忌项内明确注明青光眼患者禁用的药品。通过统计2014年门诊青光眼患者用药处方数据库,发现多个科室医生为青光眼患者处方不适宜的药物。为患者编写教育材料及开展面对面患者教育,为医生和药师分别编写了青光眼患者禁忌药品的品种,分别对医生、药师和患者进行问卷调查与用药教育。完善医院信息系统,增加对青光眼用药的提示信息。结果医生为16.2%的青光眼患者使用了不适宜的药物。88%的医生在处方前会询问患者青光眼病史,78%的医生了解青光眼禁忌药物的品种,98%的医生希望借助医院信息系统提示;29%的药师在审核处方时会询问青光眼患者病史,80%的药师了解青光眼禁忌药物的品种,51%的药师会主动告知患者使用禁忌用药的风险;30%的患者会主动告知医生青光眼病史,11%的患者了解青光眼禁忌用药的品种,72%的患者坚持青光眼药物治疗。结论无论是医生、药师还是青光眼患者,对青光眼患者禁忌用药品种的认知水平不高,制定青光眼患者用药风险防范计划与干预策略,具有必要性和有效性。     

肾内科临床药师在药物整合服务中的实践探索

目的通过临床药师在肾内科对药物整合(medication reconciliation)的实践,探讨临床药师在药物整合中的重要作用。方法对2014年1月18日-2月18日入院的20名患者进行药物整合,主要通过询问患者近1年内的用药情况,对比入院医嘱和药师询问结果,分析存在差异的原因。结果药品数量与入院医嘱不相符率占60%,药品产地不同占55%,药师问诊的准确率更高。结论临床药师在药物整合中起到重要的作用,通过加强医生和患者对药物整合的重视,以及加强医院系统网络建设等措施可以更好地帮助医务工作者实行药物整合服务,减少用药差错的产生。     

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.     

Pharmaceutical services in hospital-based home health-care agencies--1982

A survey of Medicare-certified hospital-based home health-care agencies was conducted in May 1982 to determine the type and extent of pharmaceutical services provided. A 12-page questionnaire was mailed to 243 directors of U.S. agencies that were identified from a 1976 directory. The questions elicited information about the characteristics of the director and agency, personnel, reimbursement, and scope of services. The overall response rate was 73.7%. Ninety-five percent of the agency directors were nurses. The median patient census of the agencies was 110. All agencies reported offering visiting-nurse services, 92% provided home health-aide services, and 46% offered home hospice services. Ninety-nine percent and 91% reported receiving reimbursement from Medicare and Medicaid, respectively. One fourth of the agencies provided home services that traditionally involve hospital pharmacists, including intravenous therapy (29%), home chemotherapy (18%), and total parenteral nutrition (18%). Although 85% of the agency directors reported using the services of a pharmacist, only 4% actually employed a pharmacist on their staff. The directors viewed educational programs, drug regimen review, and drug information services as the most important functions of pharmacists in home health-care agencies. Although these agencies provided an array of pharmaceutical services in 1982, very few pharmacists were actually employed. Additional studies are needed to re-evaluate the current status of pharmacy involvement in home health care.     

Hospital pharmacy practice in Saudi Arabia: Prescribing and transcribing in the Riyadh region

PurposeThe purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia.MethodsA modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey’s purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database.ResultsTwenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system.ConclusionHospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia.     

Community Pharmacists as Patient Advocates: Physician Attitudes

ObjectivesTo assess physician attitudes toward community pharmacists acting as patient advocates with respect to drug-related matters, and to correlate physician attitudes with physician characteristics and physician–pharmacist interactions.SettingState of Utah.ParticipantsPhysicians in family practice, internal medicine, pediatrics, and psychiatry.InterventionsMail survey.Main Outcome MeasuresPhysician attitudes toward community pharmacists performing 15 patient advocacy activities, as well as physician–pharmacist interaction and respondent demographics.ResultsFavorable attitudes were identified for pharmacists monitoring drug use, counseling patients, advising physicians, contacting physicians to discuss patients’ pharmacotherapy, and recording over-the-counter product use in patient profiles. Attitudes were less favorable toward pharmacists helping patients manage adverse drug reactions, suggesting drug regimen alterations, providing health screening services, selecting drugs by a protocol, discussing therapeutic equivalents with patients, and changing dosage forms to better suit patient needs. Physician age was negatively correlated with attitude toward a pharmacist aiding a physician in selecting a drug to be prescribed. The helpfulness of physician–pharmacist interactions was positively correlated with physician attitudes.ConclusionFrom the physician’s perspective, the most appropriate areas for expansion of the community pharmacist’s role into patient advocacy are in monitoring pharmacotherapy, assisting physicians in coordinating pharmacotherapy, and providing patients with medication information. Physician resistance is more likely in areas where community pharmacists assume a more autonomous role in patient care.     

基层医院门诊药师开展主动药学服务的实践与体会

目的:探讨基层医院门诊药师开展药学服务的方法。方法:回顾我院药师在门诊开展药学服务的情况,总结具体内容和模式。结果与结论:药师在门诊开展主动药学服务切实可行。门诊药师可从处方审核、用药咨询、静脉用药监护等方面开展工作,为医师、护师、患者三方提供即时的、直接的药学服务。     

药师处方权认知度和支持度的初步调查

目的：了解医护人员、药师和公众对药师"部分"处方权的认知度和支持度。方法：对医护人员、药师以及公众进行问卷调查。结果：医生、护士和公众对药师"部分"处方权非常清楚或比较清楚的分别占35.70%、36.24%、33.44%，药师占57.05%，医生、护士和公众对赋予药师"部分"处方权完全同意或同意的分别占82.01%、76.74%、83.12%，药师占94.82%，而且认知度与支持度在0.01水平上显著相关，不同年龄、学历、职业、职称、医院级别等的支持度有统计学意义。结论：医护人员、药师和公众对于药师"部分"处方权的概念、资格准入等内容认知不足，但认可赋予药师"部分"处方权的好处，并且对赋予药师"部分"处方权持积极态度，认知情况越好支持度越高；医护人员、药师和公众对于赋予药师"部分"处方权的支持度，存在"老年高于青年，高职称高于低职称，高级别医院高于低级别医院，学历差异较大"等现象。     

Clinical pharmacy service: contributions on a part-time basis

Staffing a majority of hospitals with full-time clinical pharmacists is an aim that will not be attainable for many years. In an effort to demonstrate an interim approach to clinical practice that could be applied to a large percentage of hospitals, a part-time clinical pharmacist's services were documented. Serving a teaching hospital with an average census of 97 patients, the pharmacist, with a 50 percent time allotment for clinical services, monitored 229 total admissions during an eleven week period. The majority of patients were on either a pulmonary medicine or urology service. The total number of actions taken as a result of pharmacy consultations was 106, with 70 percent of these being related to dosing problems. It was concluded that a pharmacist providing clinical services to a large patient population on a less than full-time basis can have a positive impact on drug therapy.