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.     

Obtaining and providing health information in the community pharmacy setting

Community pharmacists are a valuable information resource for patients and other healthcare providers. The advent of new information technology, most notably the Internet, coupled with the rapid availability of new healthcare information, has fueled this demand. Pharmacy students must receive training that enables them to meet this need. Community advanced pharmacy practice experiences (APPEs) provide an excellent opportunity for students to develop and master drug information skills in a real-world setting. Preceptors must ensure that students are familiar with drug information resources and can efficiently identify the most useful resource for a given topic. Students must also be trained to assess the quality of resources and use this information to effectively respond to drug or health information inquiries. This article will discuss key aspects of providing drug information in the community pharmacy setting and can serve as a guide and resource for APPE preceptors.     

Strategic planning for clinical services: panel discussion

A panel of hospital pharmacy managers representing three institutions discussed issues related to planning for patient-oriented pharmacy services. The panelists discussed organizational benefits of strategic planning, ways to gain momentum for change among pharmacy staff members and from others within the institution, the need for setting realistic goals, and problems in differentiating roles for pharmacy staff. They also discussed the funding of strategic-planning programs. The panelists advocated an integrated approach to providing drug distribution and clinical services. Management must provide whatever support is necessary for integrating patient-oriented services into the daily activities of all pharmacists. That support may be in the form of additional personnel, better use of supportive personnel, staff development programs, or automation. Pharmacists, too, must recognize their combined responsibilities for drug distribution and clinical services. Only by having all pharmacists clinically trained can a department provide clinical services when needed. The experiences of these panelists may be useful to other institutions planning patient-oriented pharmacy services.     

中国药事管理研究热点及其影响因素分析

目的探究我国药事管理研究的热点问题,并分析科技、社会、教育、经济、医药行业、药品法律法规对药事管理研究产生的影响,以期总结过去、分析现状。方法通过教育部、药监部门及相关高校的官方网站,《中国药学年鉴》、《药学学科发展报告》以及中国知网数据库、Web of Science数据库、百度搜索引擎获取资讯,采用文献研究方式,内容分析、二次分析、对比分析以及现存统计资料的研究方法,对中国药事管理研究的热点问题进行分析。结果与结论 （1）药事管理研究紧跟医药卫生重点、热点问题,制定国家药物政策,实施基本药物制度,实施医药卫生体制改革,这些宏观大环境的巨变,深刻影响着医药行业的发展,也为药事管理研究带来了机遇与挑战。药事管理研究热点紧跟国内外医药行业内的重大改革、国内药监重要问题以及民生关注的热点问题。（2）雄厚的科学、教育资源为药事管理研究提供基础,20世纪以来,自然科学、社会科学均处于不断发展的阶段,取得了大量的成果。基础学科不断强化,交叉学科不断涌现,软科学受到重视,都为药事管理这一新兴交叉边缘学科的发展、成熟提供了基础。（3）良好的经济、社会环境给予研究保障,改革开放以来,中国经济持续增长,人民生活水平有了极大的提高。社会环境稳定,为药事管理学科在内的各种自然、社会学科均提供了良好的发展环境。（4）医药产业、行业发展带动药事管理研究,被喻为＂朝阳产业＂的制药业,以及关系到民生重点问题的医药行业是社会各界关注的领域。几十年来,中国的医药行业处于快速发展阶段,行业的发展提供了人员岗位的需求,带动了药学人才的培养。近年来,药学研究对象由药品向人的转移,对药学工作人员的专业知识及职业素养提出了新的要求,复合交叉型人才的需求,?     

Evidence-based core clinical pharmacy services in United States hospitals in 2020: services and staffing

We developed a model for the provision of clinical pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing clinical pharmacy services. To provide 14 specific clinical pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core clinical pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core clinical pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core clinical pharmacy services could be provided with only modest increases in clinical pharmacist staffing.     

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Qualitative interviews

Qualitative approaches have gained an increased prominence in health services and pharmacy practice research in recent years. Although the numbers of qualitative studies are small compared with those using survey methodology, a substantial body of work has been undertaken in pharmacy practice and related settings. The aim of this paper is to review research employing qualitative interviews in terms of the methodological issues and problems that this approach presents and to explore how these have been addressed. Study objectives, sampling procedures, data collection, processing and analysis and issues of validity, reliability and generalisability will be discussed.     

Teaching patient-centered care to pharmacy students

The concepts of pharmaceutical care are distinctively different from the responsibilities of dispensing pharmacists and in accordance with the standards of practice of other professionals in the health care system. By taking direct responsibility for individual patient's medication-related needs, pharmacists can make unique contribution to the outcome of medication therapy and to their patients' quality of life. If the pharmacists are to contribute effectively to the new patient-centered pharmaceutical practice they must have the opportunity to acquire the new knowledge and skills required for their new role. To do this they must become life-long learners, one of the roles of the new pharmacist. Therefore, an important outcome for pharmacy education is to perform graduates capable to provide patient-centered pharmaceutical services. The purpose of this paper is to stimulate reflection on the relevance of teaching patient-centered care to pharmacy students, consistent with the practice of pharmaceutical care as a current trend in the pharmacy practice.     

Integrated patient-specific model of pharmacy practice

The deficiencies of traditional models for the provision of clinical pharmacy services are discussed, and a patient-specific model that integrates drug distribution and clinical pharmacy functions is proposed. Traditional models have either designated specific individuals as providers of clinical pharmacy services or have combined distributive and supportive services with clinical services. In both cases, clinical services have been of secondary importance. Such models have resulted in inconsistent clinical services for which the patient is not necessarily the primary focus and have made it difficult for pharmacists to understand their mission. The lack of a well-defined primary clinical role for pharmacists has confused health-care providers and created problems for managers attempting to evaluate pharmacists and justify clinical services. The integrated patient-specific model is based on the ethical imperative that the patient must be central to any health-care endeavor. Under this model, clinical pharmacy services are of central importance and distributive services are integrated as a secondary but still very important aspect of comprehensive institutional pharmacy services. Critical elements of the integrated model include a patient-centered philosophy of practice, a definition of clinical pharmacy work, and a managerial framework. The integrated patient-specific model of pharmacy practice puts pharmacists in a professional relationship with patients and explicitly defines clinical services and priorities.     

Financial management of health system pharmacy practice

The financial management of pharmacies and health systems is a combination of the traditional management of personnel and drug and supply costs with the management of the total costs of care. It includes determining the consequences of less than optimal drug therapy, improving drug therapy, and reengineering pharmacy departments and services across all patient care settings to deliver optimal pharmacotherapy. Prevention and reduction of adverse drug events, disease state management, and other methods to improve quality of care are of major importance. Future articles in this series on the financial management of pharmacy practice in health care systems will provide examples of applications of financial management in acute care, ambulatory care, long term care, and across sites of care. They also will include the justification of the development of new types of patient care services.     

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Focus groups and observation studies

This paper reviews research undertaken in pharmacy practice and related settings employing focus groups and observation methods. The aim of the review is to identify the main methodological considerations of these approaches to enable pharmacy practice researchers to benefit from the experiences of their colleagues when conducting their own research. The paper is in two parts. Focus groups have become increasingly prominent in pharmacy practice and health services research. They are an attractive and effective alternative to individual qualitative interviews for particular problems in pharmacy research. In this paper, the use of focus groups by researchers in pharmacy practice and related settings is reviewed. Observation studies have been applied widely to address many research questions. They are a valuable method of obtaining data, documenting actual events and activities rather than relying on self-reports of behaviours and events. Observation methods have been used both as a sole method for a research study and in combination with other methods. In the pharmacy practice literature there are examples of participant and non-participant observation studies and both quantitative and qualitative approaches. Through the experiences of pharmacy practice researchers, the methodological and ethical issues that these studies present are identified and ways in which they have been addressed are explored.     

Drug information centers: future trends

The future of drug information centers (DICs) is discussed in light of current problems and future needs. DICs are not being used to their full potential in supplying drug information to health professionals, and the entire system appears to be inefficient. The efficiency of answering nonjudgmental questions in DICs is questionable, especially since community and hospital pharmacists could answer these questions using readily available references. There is no minimum standard of quality for DICs, and DICs do not use computer technology to its fullest extent. Many DICs have had funding problems. In spite of these problems, DICs will continue to perform useful functions, such as providing support for clinical pharmacy services, teaching undergraduate and graduate pharmacy students, and performing reviews for pharmacy and therapeutics committees. Quality assurance guidelines must be instituted for all DICs, as well as standards for facilities, resources, and personnel. The establishment of regional DICs, which are self-supported through fees charged to hospitals, pharmacies, health professionals, consumers, and corporate users, is a possible means of improving the efficiency and providing consistent quality in DICs. Since routine drug information will be readily available online to health practitioners, in the future DICs will provide primarily consultative drug information services.     

Pharmacists experience of and perspectives about recruiting patients into a community pharmacy asthma service trial

BackgroundResearch trials testing the impact of community pharmacy services require adequate and appropriate recruitment of patients by participating pharmacists, however, this step presents an ongoing challenge.ObjectiveTo identify factors affecting recruitment of patients in community pharmacies participating in a multi-center trial of a pharmacy asthma service in Australia (Pharmacy Trial Program – Asthma and Rhinitis Control (PTP-ARC).MethodsThe PTP-ARC protocol required identification and recruitment of seven eligible asthma patients per pharmacy. Pharmacists responsible for sites that failed to recruit or retain any patients into the PTP-ARC trial participated in a semi-structured telephone interview about their experiences with these elements of the trial. The interviews were recorded, transcribed and coded using QSR International's NVivo 11 software. The analysis was conducted with reference to the COM-B framework (Capability, Opportunity, Motivation).ResultsPharmacists from 47 of 50 eligible pharmacies were interviewed. Seventeen factors were isolated and mapped to the COM-B framework. Psychological capability (recruitment hesitancy, research literacy and health literacy), physical capability (technological barriers, staffing issues and pharmacy busyness), physical opportunity (patient busyness, trial timing, study protocol, support and location), social opportunity (health literacy and supportive milieu), reflective motivation (incentive for participation, simplification) and automatic motivation (patient attitudes and pharmacist-felt experience) were factors affecting pharmacists' participation. Challenges identified included: issues with the software, unfamiliarity with research procedures generally (and specifically with the PTP-ARC protocols), the patients' lack of interest and pharmacists’ lack of time.ConclusionsTo the best of our knowledge, this is the first study to focus on issues affecting patient recruitment into a pharmacy health services (asthma) trial in real time. To propel evidence-based trials towards practice implementation, user-friendly software, pharmacists’ training on research and patient-engagement and adequate remuneration to address pharmacist time issues need to be key foci for health services design and implementation research.     

Pharmacy,pharmaceuticals and public policy: Solving the puzzle

Increasing pressure on healthcare demand and delivery has resulted in the development of new roles and services for pharmacists. As current models of pharmacy practice continue to be evaluated, pharmacists must be involved in identifying new areas that may require research. In order to do so, the current vision of the future of pharmacy practice is discussed in this commentary. Issues such as adequate funding, professional competency and building strong interprofessional relationships are still identified as major barriers to change. These barriers have been grouped into the themes that form a conceptual model of the factors affecting the future of pharmacy practice, which have led to the development of key questions for the future.     

The North Carolina Area Health Education Center program: an overview

North Carolina has been at the forefront of the planning, development, and operation of area health education centers (AHECs). These centers have dramatically improved health manpower education and training at all professional levels. In effect, the North Carolina Area Health Education Center Program is a major decentralization and coordination of medical, dental, pharmacy, and public health education and regionalization of nursing, allied health education, medical residency training, and continuing education. The program links each of the university health science centers in North Carolina to major community hospitals that form a regional network with other institutions. The University of North Carolina at Chapel Hill School of Pharmacy has a major role in the AHEC program. A full-time faculty is located in each AHEC. In addition to providing and coordinating clinically oriented pharmaceutical services and functioning as a resource in all matters relating to drugs, they are extensions of the school's faculty. The North Carolina AHEC Program approach offers pharmacy an excellent opportunity to maximize the pharmacist's contributions to society through education and practice.     

Marketing an investigational drug service

The customer survey was a useful tool for marketing the IDS. It provided guidelines for making decisions about the best use of limited human and material resources. Analyzing the results of the survey provided new priorities and directions for the IDS. These results were then used in conjunction with pharmacy financial and operational data to focus on areas of greatest importance to the customers and the pharmacy. Physicians should not be reluctant to pursue compassionate use treatments because of the administrative programs responsibilities that accompany such programs. Every patient should have the opportunity to benefit from alternative therapies that are investigational. For the quality of patient care to be maintained or even enhanced when studies are conducted, nurses must be well trained. The marketing survey fulfilled its purpose of identifying service gaps and allowing us to improve our services.     

Drug information centers: an overview.

Drug information centers have existed for more than 20 years. Well over 100 centers function across the country, primarily affiliated with hospitals and/or colleges of pharmacy. The centers serve an audience of primarily health professionals but in some settings meet consumer needs. Three general areas of responsibility exist: service, education and research. In the area of service, specific functions such as answering questions, supporting the Pharmacy and Therapeutics Committee, and preparing newsletters are frequent. Educational responsibilities often include teaching pharmacy students drug information skills. Evaluation of the services has focused mostly on answering questions and Pharmacy and Therapeutics (P&T) Committee functions. Commercial information systems used by Drug Information Centers (DICs) are increasingly sophisticated and offer the opportunity to improve efficiency. Funding generally is provided by the institution with which the center is affiliated. Attempts to charge for services have provided only modest revenue. Drug information centers continue to mature and offer a useful service.     

我国临床药学的发展机遇与挑战

目的:探讨我国临床药学发展的机遇与挑战。方法:介绍并分析我国医院药师工作内涵的变化、药师在促进合理用药中的作用、临床药学发展存在的问题及解决方案、临床药学发展的机遇与挑战。结果与结论:我国药师的工作已从药房内的调剂、制剂配制扩展为全程化药学服务、个体化用药指导、上市后药品再评价等多方面内容。药师作为保障药品安全、促进合理用药的主体,是医疗团队中不可缺少的重要部分。我国目前依然存在重医轻药、药师结构不合理、药师在医疗保险中未能发挥作用、激励机制不完善等诸多问题。应加快药师立法、优化药师队伍结构、提高药师素质、完善激励机制。我国药师的成长应以"八星药师"为标准,即成为健康服务的提供者、决策者、沟通者、引导者、管理者、教育者、终身学习者和研究者,力争使每个药师成为不可替代者。