Profile of a unique community-based clinical pharmacy family practice program

The provision of clinical pharmaceutical services in family practice offices has aroused considerable national interest among both pharmacists and physicians. Many of these clinical pharmaceutical services and educational programs have been university-funded and/or rely on colleges of pharmacy for fiscal support. Few examples of community-funded, ambulatory care clinical pharmaceutical programs have been reported. Community Health Care, Inc., and Davenport Medical Education Foundation, Inc., are two health care programs which sponsor an innovative ambulatory care clinical pharmacy program. Community Health Care is a nonprofit corporation which utilizes a multidisciplinary team concept to provide comprehensive ambulatory care services to patients. Davenport Medical Education Foundation is a nonprofit corporation that provides a community-based family practice residency program. Because the two separate parent organizations have distinct goals requiring individualized clinical pharmaceutical services, the responsibilities of the clinical pharmacist have evolved to be comprehensive in scope.     

Pharmacy residency training in academic medical centers.

PURPOSE: A survey of U.S. academic medical centers (AMCs) was conducted to identify the most important and challenging issues in pharmacy residency training. METHODS: A questionnaire addressing program characteristics and residency training concerns was sent electronically to pharmacy directors at 130 AMCs that are members or associate members of the University HealthSystem Consortium (UHC). Residency coordinators for both pharmacy practice and specialized programs were asked to complete the questionnaire, with input from other pharmacists involved in the residency program. Respondents were asked to rate the importance and degree of challenge for all issues on a 5-point Likert scale, where 1 = least important or least challenging and 5 = most important or most challenging. RESULTS: Responses were received from hospitals representing over 60% of all residency positions offered by UHC member hospitals. Recruitment was rated the most important issue (mean importance score, 4.8) facing residency programs in AMCs, but with over 85% of budgeted positions filled, programs appear to be successful in overcoming this concern. The most challenging issue (mean challenge score, 4.2) was compliance with the evaluation and documentation elements of the ASHP Residency Learning System (RLS), a system often used to meet requirements for pharmacy practice residency accreditation. The completion of resident research requirements was ranked as both an important and a challenging issue (mean importance score, 4.5; mean challenge score, 3.9). CONCLUSION: A survey of AMCs showed that they offered a wide variety of pharmacy residency programs and filled most budgeted resident positions. Resident recruitment, the RLS, and research requirements are the most important and challenging residency concerns facing the respondents.     

Historical development and emerging trends of community pharmacy residencies

Clinical pharmacy services necessitate appropriately trained pharmacists. Postgraduate year one (PGY1) community pharmacy residency programs (CPRPs) provide advanced training for pharmacists to provide multiple patient care services in the community setting. These programs provide an avenue to translate innovative ideas and services into clinical practice. In this paper, we describe the history and current status of PGY1 community pharmacy residency programs, including an analysis of the typical settings and services offered. Specific information on the trends of community programs compared with other PGY1 pharmacy residencies is also discussed. The information presented in this paper is intended to encourage discussion regarding the need for increasing the capacity of PGY1 community pharmacy residency programs.     

湖北省494家医疗机构临床药学发展及临床药师培训现状调研

目的：调查湖北省各级医疗机构中临床药学发展及临床药师培养现状。方法：基于湖北省临床药师培训管理中心平台,由湖北省卫生健康委员会向全省各市、州及部省属医疗机构下发调查问卷,内容包括医院基本信息及情况、药学部门情况、专职临床药师情况、师资带教药师情况及临床药学工作情况。结果：共收到全省494家医疗机构有效调查问卷,其中三级医疗机构75家（15.18%）,二级137家（27.73%）,一级282家（57.09%）。不同级别医疗机构之间临床药学发展及临床药师培养情况存在较大差异。其中,三级、二级、一级医疗机构药学专业技术人员分别占比4.18%,4.76%,6.96%,均小于8%,且临床药师的数量短缺。开展临床药学工作困难的原因主要集中在科室人员不足、缺乏医院资金支持及缺少医院政策支持等方面。结论：各级医疗机构要根据功能定位加大药学人员配备和培养力度,强化临床药师配备与培养,合理运用信息化手段,以进一步提升医疗机构开展高质量药学服务的能力和水平。     

The pharmacist and family planning: review and report of a study

A Canadian government health committee recommended that pharmacists should be allowed to prescribe oral contraceptives because of their pharmaceutical and medical knowledge about drugs; their active roles in counseling patients about prescribed medication and because of their visibility and accessibility to the public. Several surveys on the attitudes of pharmacists about family planning were conducted in Washington, Hawaii, Pennsylvania, Utah, Maryland, and Mississippi. The results suggested that pharmacists recognized family planning as part of their practice, although some were constrained by religious, moral, and legal factors. The studies also revealed, however, that the public do not regard pharmacists as sources of family planning services, and the pharmacists themselves do not feel that they have adequate training for such a role. The Mississippi study did confirm that the pharmacists are involved to a certain degree in providing family planning services to the public. The need for inexpensive and effective family planning counseling in the United States had been well documented. By all standards, with the exception of formal training, the community pharmacist is the best choice for meeting this need. Professional pharmaceutical institutions, social and government agencies should utilize pharmacists for family planning services.     

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.     

患者及其家属对临床药师与药学服务认知和需求情况调查研究

目的：了解患者及其家属对临床药师与药学服务的认知和需求情况,为临床药师职业健康发展和药学服务工作深入开展提供参考。方法：以问卷调查形式,采用分类随机抽样法对在上海市30家三级医院就医的患者及家属进行实地问卷调查,并对调查结果进行统计分析。结果：患者及其家属对临床药师与药学服务认知不足,47.98%的患者和家属不知道临床药师;56.56%的患者和家属不知道临床药师与药房药师的区别;91.92%的患者和家属在遇到用药问题时,希望得到药师的专业帮助;90.41%的患者及其家属在住院时希望临床药师前来关心用药情况,提供药学监护;超过90%的患者及其家属欢迎、支持临床药师下临床,开展药学服务,并认为这样有助于疾病的治疗。结论：应通过加强宣传、推进临床药师制建设等措施提高患者及其家属对临床药师与药学服务的认知,并通过提高临床药师的药学服务质量和水平来满足公众不断增长的健康服务需求。     

英国儿科药师培养模式对中国的启示

目的:介绍英国儿科药师培养及药学服务模式,为我国儿科药学工作者提供参考.方法:通过笔者在英国儿童专科医院培训的经历,介绍英国儿科药师培养模式和药学服务模式.结果:英国儿童专科医院儿科药师培养模式在组织架构、规范化培养等方面值得我们借鉴.结论:药师作为儿科医疗团队的一员,通过借鉴学习英国成熟经验,完善儿科药师专业素质培养...     

Residency training--the profession's forge for leadership development

The concept of leadership may be the most widely studied and least understood topic in the domain of social services. Leadership has been described as a major force in the profession's transition to pharmaceutical care and effective program development. Pharmacy practice residency programs are a major means of developing and sustaining leadership for the growth of the profession. Three concepts that are explored include: (1) some insight into noncognitive elements of residency training that are critical to the development of professional practice, (2) analysis of leadership perceived to be critical for pharmacists, and (3) a definition of how residency training can develop professional leaders to meet the challenges for pharmacy.     

我国基层医疗机构药学服务现状及问题研究(二):药师队伍建设现状分析

目的： 通过调查了解我国基层医疗机构药师队伍建设情况，分析其现有问题，并提供相关政策建议。方法： 采用问卷调查形式收集我国基层医疗机构药师的高等教育背景、药学培训情况、从业现状和职业认知等信息，并通过描述性统计分析相关数据。结果： 样本内基层医疗机构药师的最高学历主要为大专（38.1%）和本科（36.9%）；大多数药师接受过药品政策相关培训（87.1%）和合理用药相关培训（92.6%）；药师职称主要集中于中级职称（43.6%）；药师的收入主要介于2 000~5 000元之间（78.4%），超过三分之一的药师不满意当前工作收入（39.3%）；药师的日常工作主要为发药（94.2%），认为需要参与用药方案制定（42.0%）、药学查房（29.9%）的药师所占比例较低。结论： 我国基层医疗机构药师的总体学历层次相对较低，药师培养制度、激励制度有待进一步完善，药师职业认知有待增强。     

基层医疗机构药学服务对口帮扶的实践与探索

目的:促进医联体内药学服务同质化发展,提升基层医疗机构药学服务能力.方法:与3家社区医院共同构建药学帮扶体系.根据社区医院药事管理方面存在的问题、基层药师的专业能力以及药师、医师对药学信息的需求和培训意愿等,对社区医院开展持续性药事管理改进和药学专业技能培训,提高社区药学人员的业务能力.结果:经过18个月的药学帮扶行动,加强了社区医院药事管理建设,提高药师专业水平.基于工作实践,对目前社区医院药学服务现状进行分析,对药事管理、药品供应、药学服务等方面提出改进建议.结论:在"医联体"模式的药学对口帮扶下,社区医院的药学服务能力得到提升,有利于社区医院药学服务的创新发展.     

Pharmacy practice in the United States Air Force

The current status of pharmaceutical services in the United States Air Force Medical Service is described. The mission of the USAF Medical Service is to provide medical support to combat forces and to deliver health care to active duty and retired military members and their dependents. The USAF operates 121 medical treatment facilities (MTFs) worldwide. Pharmaceutical services in these MTFs are governed by federal law, recognized standards of professional practice, Department of Defense directives, and Air Force regulations. Ambulatory-care services are emphasized, and clinical services are provided in many MTFs. Pharmaceutical services are supported by the TRIPHARM computer system. In addition to other professional opportunities, USAF pharmacists have the opportunity to pursue graduate-level academic training or residency training under Air Force Institute of Technology sponsorship. The USAF Medical Service will continue to ensure that contemporary pharmaceutical services are available in all MTFs by providing graduate-level training to pharmacists, encouraging the adoption of new technologies, and facilitating the exchange of information among MTFs.     

Clinical privileges program for pharmacists.

A clinical privileges program for pharmacists is described. In 1985 and 1989 the Department of Veterans Affairs (VA) issued circulars defining policy on clinical privileges for pharmacists at its medical centers. Pharmacists at one large VA medical center responded by developing a clinical privileges program. Bylaws under which medical staff members are granted clinical privileges were used as a model for the pharmacist program. A pharmacist seeking privileges prepares an application detailing his or her background and the practice areas involved in the request; the applicant also drafts a quality assurance protocol. The application is reviewed by a pharmacist clinical privileges review board (PCPRB). The PCPRB uses the quality assurance plan to verify that adequate measures are in place to meet standards of care. If a question of patient safety arises, the board meets to review the pharmacist's activities. Each pharmacist who is granted privileges must have a physician sponsor. Since the first meeting of the PCPRB in 1990, clinical privileges have been requested by all 24 clinical pharmacy specialists at the center. No pharmacist has been denied privileges, although the board has required additional training or improved quality assurance protocols for many. Acceptance of the program by the medical staff has been good. A clinical privileges program at a VA medical center offers pharmacists the opportunity to practice pharmaceutical care.     

新时代下广州市城区社区卫生服务中心药学服务建设现状调查研究

目的 调查广州市城区社区卫生服务中心药学工作现状,为提升基层医院药学服务能力提供参考.方法 采用问卷调研方式对广州市城区社区卫生服务中心的基本服务情况、药学部门建设、设施设备、药事管理和药学服务开展进行调查,评价广州市城区社区卫生服务中心药学服务能力.结果 98.4％的社区卫生服务中心配有专职的药学技术人员,其学历主要...     

Leadership in a clinical profession

The contributions of residency training programs to pharmacy's development into a clinical profession are described. Residency programs supply institutional pharmacy with mature, highly skilled clinical and managerial practitioners, and ASHP's accreditation process ensures the programs' quality. Residents develop values, philosophy, and vision that breed innovation and advancement of the profession. As pharmacy departments strive to meet the standards set by the accreditation program, the level of services rises; subsequently, higher standards are established and practice advances accordingly. Future residency training for community practice and the movement toward the Pharm.D. as the sole entry-level degree for practitioners must be evaluated in terms of effect on patient care and on pharmacy school and hospital resources. Planning for future pharmacy education and manpower needs should involve the whole profession, but the needs of community and hospital pharmacy may differ. A goal for the future is entry-level residency training for all hospital pharmacists, with the Pharm.D. degree as a prerequisite. Such a residency program would focus on clinical practice and provide experience in all pharmaceutical services and the overall management of a pharmacy department; it would be a prerequisite for advanced specialized residency programs. Managers of departments providing clinical services will need an entry-level clinical residency followed by a specialized residency in administration. In their 25-year history, residency programs have contributed greatly to the profession. Efforts to develop quality residency training sites and promote them to pharmacy graduates should continue.     

Assessing the structure and process for providing pharmaceutical care in Veterans Affairs medical centers.

The structure and process used in providing pharmaceutical care to ambulatory care patients at nine Veterans Affairs medical centers (VAMCs) were studied. Institutions participating in the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) study were selected. To assess the level of pharmaceutical care services provided to ambulatory care patients, 10 critical domains were identified. Six instruments with questions related to each domain were then designed, including a clinical pharmacist survey and an outpatient pharmacist survey. Each center was assessed through three surveys and an onsite visit. The investigators used both direct observation and a consensus approach to score the level of ambulatory care pharmaceutical services provided. The clinics in which IMPROVE study patients would be seen were run by pharmacists (33%), physicians (44%), and multidisciplinary teams (22%). Of the 51 clinical pharmacists surveyed, 23 (45%) had prescribing authority via protocols, 14 (28%) had unrestricted prescribing privileges, and 14 did not have prescribing authority. The sites varied greatly in referral patterns, methods of identifying patients, and whether patient visits were scheduled or on a walk-in basis. There was a strong correlation between observed activities by clinical pharmacists and their self-reports and between observed activities by outpatient pharmacists and their self-reports. Activities reported by clinical pharmacists were moderately but not significantly correlated with consensus scores, and activities reported by outpatient pharmacists were poorly correlated with consensus scores. The structure and process for providing pharmaceutical care to ambulatory care patients at VAMCs were evaluated with surveys, direct observation, and a consensus-based scoring system.     

Family practice physicians' perceptions of the usefulness of drug therapy recommendations from clinical pharmacists

Family practice physicians' perceptions of the usefulness and clinical outcome of drug therapy recommendations made by clinical pharmacists in a family medicine clinic were determined. For 15 weeks, pharmacists in the clinic recorded all consultations in which they made recommendations about the drug therapy of specific patients. At the time of each consultation, the pharmacists gave the physician a questionnaire designed to gauge the physician's opinion of the usefulness of the consultation. Physicians who implemented the recommendations were sent a second questionnaire and asked to indicate the extent to which the clinical pharmacist influenced their decision to implement the recommendation, the effect the recommendation had on the patient's clinical status, and the usefulness of the recommendation to the patient in ways unrelated to clinical status (such as greater patient acceptance, safety, or lower cost). Five clinical pharmacists provided 59 consultations to 33 physicians. The physicians rated 51 (88%) of the consultations as very useful, and they implemented 78 (98%) of the 80 recommended actions. Of the 56 physicians who attributed their decision to implement the recommendation to their consultation with the clinical pharmacist, 43 believed that the recommendations had improved the clinical status of the patient, and 38 believed that the recommendations were useful to patients in ways unrelated to clinical status. Physicians in a family medicine residency training program had positive perceptions of the usefulness of drug therapy recommendations made by clinical pharmacists. A majority of the physicians believed that the recommendations had a positive effect on patients' clinical status.     

我国基层医疗机构药学服务现状及问题研究(三):药学服务开展现状分析

目的：通过调查分析了解我国基层医疗机构药学服务开展的基本情况，发现其中存在的问题并寻求改进措施。方法：以面对面访谈的形式发放调查表，对全国各地基层医疗机构开展药学服务的内容、医师药师对药学服务的态度、药学服务的需求以及患者的认可与满意度情况等进行统计、分析。结果：发药（91.1%）、患者用药咨询（90.0%）、处方审核（79.6%）和药品管理（78.7%）是基层医疗机构药师开展频率最高的药学服务工作；几乎所有的药师（98.7%）和医师（96.5%）都认为基层医疗机构需要药师提供药学服务，绝大多数医师（85.3%）会对药师的用药建议予以不同程度的采纳；大部分患者服药前会仔细阅读药品说明书（78.6%）和留意药品保质期（82.1%），约一半的患者会主动了解相关药物知识（55.6%）；患者在出现药物不良反应时咨询药师（13.7%）以及从药师处获取药物信息（11.0%）的比例偏低，接受药学服务相对不足；患者在医保报销比率（17.6%）、合理用药宣传（9.9%）和购药配药便利性（7.0%）方面的满意度相对欠缺。结论：我国基层医疗机构药学服务已有初步开展，具有一定的社会效益，但仍存在转变药师工作模式、提高药师与药学服务认可度以及满足患者更多服务需求等提升空间。