How do general practitioners manage alcohol-misusing patients? Results from a national survey of GPs in England and Wales

The appropriateness of the primary care setting to undertake health promotional activities has been emphasized, but little is known about the clinical work of GPs with patients misusing alcohol. This study examines how GPs managed alcohol-misusing patients. A 20% random sample of all general practitioners in England and Wales were surveyed using a postal questionnaire. A 44% response rate was achieved. GPs reported managing different levels of severity of drinking problems differently. Basic interventions, such as reporting the alcohol misuse diagnosis and the provision of advice and information, were routine. Health promotion leaflets were not used uniformly, even with the less severe problem drinkers. Detoxification, prescribing of drugs and the management of medical complications were undertaken mainly with dependent patients. Dependent drinkers were the most likely group to be referred to specialist services, while internal practice referrals occurred with all drinking status categories. Anti-depressants were the drugs most usually prescribed to alcohol-misusing patients. The data point to a need for basic guidelines, not only on how to manage and refer dependent drinkers, but also on how to detect and manage those who are not yet manifesting problems but are drinking above recommended guidelines. One of the most evident areas in which there appears to be a need for guidelines is that of prescribing within primary care.     

Some patient experiences with drugs and adverse drug reactions in an African teaching hospital

One hundred and seventy patients regularly attending a general medical outpatients' clinic at the Parirenyatwa Central Hospital (PCH) in Harare, Zimbabwe were interviewed about their knowledge of their present drug therapy and possible adverse drug reactions (ADRs), history of previous ADRs and action taken on experiencing them, information source and satisfaction with their therapy. Sixty seven patients knew what drugs they were taking and this level of awareness was associated with age, occupation and level of education of the patient. Only 19 patients knew about the possible ADRs of their drugs and this knowledge was associated with language ability, disease knowledge and knowledge of what drugs they were taking. Seventy eight patients had experienced ADRs and this was linked to age and knowledge of ADRs. Eighty one patients said that they would continue their drug treatment on experiencing ADRs, and this behaviour was associated with knowledge of disease and ADRs. More than half of the patients were not satisfied with the information given about their drugs, and very few had read about this subject. These results suggest that overall knowledge of drugs and ADRs amongst patients at the PCH is low, and that there is a need to increase patient education regarding therapy. This training should take into account the patient's demographic and socioeconomic background. Knowledge of ADRs was shown to increase the potential for compliance.     

Safety and risk communication to patients

Comprehensive and accurate information about the medicines available to them is a key issue for patients to participate in the decision making process of their own healthcare. One aspect of this information is the patient information leaflet provided by the manufacturer, according to national and international guidelines. The comprehensibility and user-friendliness of these manufacturers' leaflets has been tested and criticised. In addition to this information under the laws of national and international authorities, consumer-oriented websites of self-help groups are becoming a more and more relevant source of information. For most patients, the primary sources of information are healthcare professionals, such as the prescribing physicians and/or nurses or the dispensing pharmacist. The information provided for by healthcare professionals has to be tailored according to the patients' needs, where law suits against physicians often address the comprehensiveness and a lack of documentation. Improvement of individualised drug information has been shown to increase patients' satisfaction and treatment adherence, whereas the overall influence on outcome (i.e., reduction of adverse drug events) has still to be demonstrated. However, in order to achieve such a goal, striking changes in the whole system of pharmacovigilance have to be implemented with special emphasis on patients and consumers representation.     

Development and assessment of the pharmaceutical management and guidance services for inpatients considering clinical value and economy]

We developed pharmaceutical management and guidance services for inpatients in a ward of circulatory medicine, considering clinical and economical standpoints. In these services, pharmacists deliver drugs prescribed for inpatients with individual drug information papers, explain to them about their drugs using information papers and give counsel. Since most of the patients were aged people, developing many kinds of diseases and taking many kinds of drugs, they had many problems such as lack of knowledge of the effects of drugs. First, we surveyed views of patients, physicians and nurses on these services. Consequently, all of them advised us that "pharmacists should explain to patients about the prescribed drugs using information papers." The patients preferred pharmacists as expositors of drugs to physicians or nurses. The physicians considered that "pharmacists have to attach importance to clinical information and package-inserts of drugs and explain to patients about drug information using pamphlet in response to the understanding of patients." The nurses wanted to cooperate with pharmacists in "improving medication compliance." On the basis of these views, we improved our services. Next, we made a survey of patients' knowledge about their drugs. We found that in the patients the level of knowledge concerning "ways," "effects" and "reasons" of taking drugs and that of "compliance" and "satisfaction in taking drugs" were improved through these services. The patients reentered in the hospital kept a high level. The ratio of patients taking drugs by themselves increased. Last, we also applied this method to wards of "blood and collagen diseases" and "pediatrics." The demand for these services increased smoothly. We compared these services based on our method with all other services by hospital pharmacists from the viewpoint of economy. We found that only our service method was beneficial.     

美国FDA新版《全身用抗菌药品和抗菌敏感性试验装置说明书的敏感试验资料指导原则》内容简介

目的 介绍美国食品药品管理局(FDA)新版《全身用抗菌药品和抗菌敏感性试验装置说明书的敏感试验资料指导原则》的要点,希望对我国抗菌药品说明书中该部分内容的撰写、使用和监管有所启迪.方法 抗菌药品生产企业可参考该《指导原则》,及时更新药品说明书中的抗菌药敏感性资料内容,将抗菌药敏感性试验结果及时准确的告诉医生,以选择合适的抗菌药治疗感染性疾病,减少耐药性的发生.结果 该《指导原则》能有效地指导生产抗菌药品的企业撰写及更新抗菌药敏感试验资料.结论 抗菌药物敏感性试验结果是抗菌药品说明书中的重要内容,为指导医生患者合理用药,减少抗菌药耐药性的蔓延,该项内容应引起相关药品生产企业、医生及药品监管部门的高度关注.     

老年脑梗死住院患者治疗用药合理性分析

目的评价首都医科大学宣武医院老年脑梗死住院患者治疗用药的合理性。方法收集2011年1月1日至12月31日我院60岁及以上老年脑梗死住院患者的病历资料,描述性分析患者一般情况,计算每种药物的药物利用指数（DUI）、限定日剂量的费用（DDC）、人日均费用。检索国内外公开发表的与脑梗死有关的诊疗指南,并将我院老年脑梗死患者用药情况与中国指南对比,分析其合理性。结果共收集到老年脑梗死住院患者430例,其中男272例,女158例;年龄为60-92岁,平均（71±7）岁。平均患病种数为5.4种,住院期间共用药物243种,平均用药种数为17种。共检索到美国、日本、中国、南非、新西兰、英国、欧洲、巴西发表的8个与脑梗死相关的诊疗指南。这些指南中涉及的药物有溶栓药、抗血小板药、抗凝药、降纤药、扩容药、扩血管药和神经保护药共7类。中国指南推荐的治疗药物有3类,分别是溶栓药、抗血小板药和降纤药,其中有2类4种在我院使用,分别是阿替普酶、尤瑞克林、阿司匹林、氯吡格雷,其 DUI 值分别为1.0、1.2、1.2、1.2。我院老年脑梗死患者用药涉及神经保护药13种,所需费用1782343.6元,占药费总和4599576.7元的38.75%,是指南推荐用药费用103779.7元的17倍。结论我院老年脑梗死住院患者治疗用药与指南推荐用药一致性高,但是非指南推荐的神经保护药使用数量过多、费用过高,需进一步规范。     

Public understanding of drug therapy

Knowing some basic principles about medicines would help patients to understand drug therapy and to help and encourage them to use it well. These principles relate to the categories and names of drugs, their different uses, how they reach the site of action (absorption, distribution, fate), how they produce their effects, both beneficial and harmful, the time courses of drug actions, how the pattern and intensity of the effects of a drug depend on dose and timing, drug interactions, how drug effects are demonstrated and investigated and sources of information and their trustworthiness. These basic principles are an essential part of health literacy and understanding them would enable individuals to comprehend better the information that they are likely to receive about medicines that they will take. Different populations need different types of education. For schoolchildren, the principles could fit into biology and domestic science teaching, starting in the later years of primary school or early in secondary school. A teaching package would also be needed for their teachers. For adults, web-based learning seems the most practical option. Web-based programmes could be supported by the NHS and professional bodies and through public libraries and local community health services. Specific groups for targeting could include young mothers and carers of chronically ill people. For retired people, one could envisage special programmes, perhaps in collaboration with the University of the Third Age. Conversations between patients and professionals would then become more effective and help shared decision making.     

临床药师参与心内科老年患者会诊情况调查及典型案例分析

目的 调查焦作市第二人民医院临床药师参与心内科老年患者的会诊情况并分享典型案例,为进一步提高临床药学服务提供参考。方法 收集焦作市第二人民医院2017年1月-2018年6月临床药师会诊或主动监护的心内科老年患者的药物使用情况及典型案例进行分析。结果 临床药师共参与心内科老年患者会诊或主动监护病例57例,会诊常见疾病为高血压、心律失常、冠心病等,会诊常见药物为抗高血压药物、抗菌药物、抗心律失常药物等,会诊意见采纳率为78.95%（完全采纳43.86%,部分采纳35.09%）,会诊意见有效率为75.44%。结论 临床药师应积极参与临床实践,与医师形成一个治疗团队,及时发现并解决用药中出现的问题,促进临床合理用药。     

国产中成药说明书现状调研与修订完善建议

摘 要 目的：梳理国产中成药说明书现状,提出修订完善的思考与建议。方法：文献检索、实地收集相结合获取1 618份国产中成药说明书,按照药品说明书相关条例规定,对处方药说明书25项条目、非处方药说明书18项条目内容的标注情况分类统计。结果：共纳入1 618份说明书,其中处方药1 000份,非处方药618份。处方药与非处方药说明书的基本信息、用药指导信息,如药品名称、成分、功能主治、用法用量等项标示率为100%、内容齐全;临床试验、药理毒理、药代动力学与药物相互作用项目内容标示率不高;安全性信息项目如警示语、不良反应、禁忌、注意事项、特殊人群用药等标示不全。结论：国产中成药说明书对保障临床合理用药至关重要,其项目内容的修订完善亟待从多方面开展。     

眼科门诊患者用药依从性多中心调查

目的:调查眼科门诊患者的用药依从性及其影响因素,并提出相应对策,提高眼科门诊药房的药学服务水平。方法:在北京大学第三医院、北京协和医院、浙江大学附属第二医院、浙江大学邵逸夫医院的眼科门诊患者中,随机发放610份调查问卷,将收回的问卷汇总,应用Primer软件对相关因素进行统计学分析。结果:依从性好的眼科患者占82.55%。用药依从性与性别、年龄、教育程度、医生和药师是否告知、是否会正确使用滴眼剂、用药前是否认真阅读说明书等因素有显著的相关性。造成患者不依从的原因,按患者感觉已痊愈、经常忘记用药、害怕药物不良反应、药价太贵及用药后出现药物不良反应降次排序。结论:四所医院眼科门诊患者总体用药依从性良好,影响患者不依从性的主要原因是患者感觉已痊愈和药物的不良反应。     

Exploring drug users' attitudes and decisions regarding hepatitis C (HCV) treatment in the U.S

Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. Therefore, this paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals examined the advantages and disadvantages of starting the HCV medications. Interviews were conducted with 164 patients from 14 drug treatment programmes throughout the United States, and both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider, initiate HCV treatment or both. Gaining a better understanding of drug users' perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future.     

慢性阻塞性肺疾病住院患者药物相互作用调查

目的:了解慢性阻塞性肺疾病住院患者药物治疗及不良相互作用的发生情况。方法:从清华大学第一附属医院2006年10月～2007年2月所有被诊断为慢性阻塞性肺疾病的住院病历中随机抽取54份,调查患者的基本情况及用药情况。结果:慢性阻塞性肺疾病住院患者超过20%的时间应用8种以上药物,70%的患者存在不良相互作用。结论:该院慢性阻塞性肺疾病住院患者用药种类过多,产生不良相互作用情况较多,应采取干预措施。     

家长对儿童药物临床试验认知与态度调查

目的:了解家长对儿童药物临床试验的认识和态度,为开展儿童药物临床试验提供参考。方法:选择2017 年1-8 月在上海交通大学医学院附属新华医院、复旦大学附属儿科医院、上海交通大学附属儿童医院、哈尔滨儿童医院住院患儿家长,自愿参加问卷调查,收集有效问卷468 份。重点调查内容为儿童药物临床试验目的、意义、必要性、现状以及家长顾虑等。结果:9.4%的家长了解儿童药物临床试验目的,不同学历家长的认识差异有统计学意义(P<0.05);71.6% 的家长认为儿童用药缺乏依据,66.2%家长认为有必要开展药物临床试验,不同学历家长的认识差异有统计学意义(P<0.05);17.9% 的家长认为临床试验管理比较规范,不同学历家长的认识差异无统计学意义(P>0.05);不需要及不知道药物临床试验需要医院伦理委员会审查的家长小学学历占比最高,分别为13.6% 和50.0%,不同学历家长对医院伦理委员会审查的认知差异有统计学意义( P<0.05);担忧孩子身体受伤害的家长占78.8%,担心药物副作用大的家长占69.0%,不同学历的家长对这两方面的认识差异均有统计学意义(P<0.05)。结论:大部分家长对儿童药物临床试验的认识存在偏差,针对不同学历的家长通过加强宣传、沟通,提高家长对儿童药物临床试验的正确认识,是顺利开展儿童药物临床试验的前提条件。     

2015-2017年华中科技大学同济医学院附属协和医院肿瘤中心麻醉性镇痛药品的应用分析

目的 了解华中科技大学同济医学院附属协和医院肿瘤中心麻醉性镇痛药品的用药情况及用药趋势,为临床合理用药提供依据。方法 对2015-2017年华中科技大学同济医学院附属协和医院肿瘤中心麻醉性镇痛药品的用药品种、销售金额、用药频度（DDDs）、日均药费（DDC）和排序比（B/A）进行统计分析。结果 2015-2017年,麻醉性镇痛药品的销售金额逐年增加。芬太尼透皮贴剂的用量逐年下降,盐酸羟考酮缓释片的用量逐年上升,盐酸吗啡注射液、盐酸哌替啶注射液和盐酸布桂嗪注射液3种注射液的用量略有浮动,但总体用量都较少。两种规格盐酸羟考酮缓释片的销售金额一直位于第1、2位,两种规格芬太尼透皮贴剂的销售金额一直处于第3、4位。盐酸羟考酮缓释片、芬太尼透皮贴剂和硫酸吗啡缓释片的DDC值偏高,且B/A值小于或等于1.00,其他麻醉药品的DDC值均较小。结论 华中科技大学同济医学院附属协和医院肿瘤中心麻醉性镇痛醉药品的使用情况与《麻醉药品临床应用指导原则》所规定的基本相符合,但仍有必要对癌痛的规范化治疗进行培训,加强对"三阶梯治疗"相关知识的认识和理解。     

复旦大学附属华山医院2005--2007年乳腺科用药分析

目的：分析复旦大学附属华山医院2005—2007年乳腺科的用药情况，为临床合理用药提供参考。方法：收集本院医院信息系统中2005—2007年乳腺科的用药数据，分析药品类别、销售金额、限定日剂量（DDD）和用药频度（DDDs）。结果：所用药品中，天然抗肿瘤药、抗肿瘤抗生素、内分泌调节剂和生物靶向制剂用量大，且多为进口药或合资企业所产药品。结论：应开发高效、低毒、价廉的药品，满足临床需要，减轻患者经济负担。