新体制下基层社区药学服务模式探讨

对我国社区药学服务的发展现状、存在问题,以及国外发展现状和特点进行分析,进而就建立基层社区药学服务模式提出建议。目前,我国基层社区药学服务存在以下问题:尚未形成服务规范和衡量标准、未充分利用网络媒介、缺少资金保障、缺乏专业人才。针对基层社区药学服务提出以下建议:制定适宜的服务规范、充分利用网络媒介、保障资金投入、建立专业人才培养机制等,以满足社区居民的药学服务需求。     

医院全程化药学服务的开展现状与建议

目的:初步探讨全程化药学服务的实施意义,并基于对药学服务的现状提出实施建议.方法:通过文献的检索与研读,根据现有的实证调研结果,分析我国全程化药学服务的发展现状.结果与结论:全程化药学服务的发展现状仍有不足,改进建议相关实施以促进全程化药学服务的合理开展.     

关于医院发展药学服务工作的思考

分析当前医院开展药学服务工作的现状,阐述开展药学服务的必要性,指出药师素质的提高、临床药学的开展及药学服务环境的改善,是推动医院药学服务工作发展的必要条件.     

药店开展公益性社区药学信息服务势在必行

目的探讨我国药店开展社区药学信息服务的必要性。方法分析开展社区药学信息服务对社区居民、药店以及社会三方的影响和意义。结果与结论药店开展社区药学信息服务，不仅符合社区居民和药店双方的利益，有利于提高人们的健康水平，建立药店的可持续发展能力．而且也符合国家医疗改革的目标，有助于促进我国医疗服务体系的完善。     

医院药师如何开展社区药学服务

目的:探讨医院药师如何开展社区药学服务.方法:适应社区服务模式,提高药学服务能力和水平等3个方面进行论述.结果:在与群众沟通和在服务中做到热心、耐心和关心,获得群众认可.再以帮助社区群众合理用药为核心,进一步提高药学服务的水平.结论:医院药师能够利用自身的优势开展社区药学服务,并有可能通过长期的努力为医院药师的发展开辟一片新天地,导致一种新的职业即家庭药师或个人药师的出现.     

社区医院倡导药学服务的必要性

目的探讨社区医院开展药学服务的方向。方法分别从社区医院管理、医师、患者、护理方面探讨社区药学服务的必要性。结果社区医院开展药学服务工作有利于指导合理用药,促进患者恢复健康。结论社区医院应当积极倡导药学服务工作,充分满足社区民众医疗保健需求。     

我国临床药学服务现状及发展策略

目的 探讨我国临床药学服务现状及相应的发展策略,以提高我国临床药学服务.方法 本文力求从宏观角度,通过分析我国开展临床药学工作的必要性,审视现状和存在的问题,对我国临床药学的未来发展趋势加以预测,并提出有关临床药学体系建设的合理性建议.结果 借鉴国外临床药学研究的先进知识,发展具有我国特色的临床药学是与世界接轨,是我国临床药学的发展重点.结论 社会各相关部门共同努力,相互配合,促进相关政策、教育、环境及制度等多方面不断完善和发展,才能更好地推动临床药学服务发展.     

医院开展社区药学服务需求的调查研究

目的:为医院深入、真实了解社区药学服务工作的需求提供参考。方法:通过设计调查问卷对不同社区开展社区药学服务的需求现状调研,并分析调研结果。结果:调查发现社区居民得到的药学服务非常少,亟需了解药品价格、真假等方面内容,其中多数还不知道社区药学服务的重要性和迫切性。结论:可充分利用医院药学部门的专业技术优势,从定点、定期深入社区开展药学服务,对门诊或住院患者延伸社区药学服务,利用现代化通讯工具拓展社区药学服务等角度,进行不同方式、内容和对象的社区药学服务,以建立一个满足需求的社区药学服务模式。     

我院门诊药房开展药学服务的方法探讨

目的:探讨我院门诊药房开展药学服务的必要性及方法。方法:通过文献调研并结合我院特色,分析开展门诊药学服务的必要性及方法。结果与结论:门诊药房开展药学服务可降低药品费用,提高患者的用药依从性,促进用药安全,缓解医患关系。我院门诊药房可从就诊患者特点考虑用药教育通俗化、借鉴敞开式药房经验、提供电子化药学服务、丰富药学服务内容等方面开展药学服务。     

借助药历提高我国社区零售药店药学服务水平的策略分析

目的:为我国社区零售药店开展药历管理与提高药学服务水平提供建议。方法:介绍药历的涵义与作用,分析社区零售药店开展药历管理的现状,进而提出建议。结果:我国药店建立药历才刚刚起步,为推广药历管理,社区零售药店应树立药历管理与药学服务的意识,提高药师的药学服务专业知识与技能,探索创新药历记录与管理的技术与方式。结论:社区零售药店可以借助药历大力提高药学服务水平。     

A systematic review of the role of community pharmacies in improving the transition from secondary to primary care

Aim

We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings.

Method

We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes.

Results

We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered.

Conclusions

There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.     

对结核病患者实施药学关怀的探讨

目的探讨对结核病患者的药学关怀,提高用药依从性,减少耐药性的发生,以利结核病治疗。方法采用多种形式,对不同的对象采用不同的关怀方法,给予不同的关怀内容,把群体关怀中的用药关怀作为药学关怀的重点。结果与结论药学关怀的实施,有助于结核患者正确认识疾病,正确对待化学治疗过程中抗结核药带来的不良反应,增强战胜疾病的信心,积极配合治疗。对结核病患者实施系统的药学关怀,能有效保证结核病患者做到早期、联用、适量、规律、全程服药,对结核病的治愈起着至关重要的作用。     

Evaluation of medication reviews conducted by community pharmacists: a quantitative analysis of documented issues and recommendations

Aims

To describe issues noted and recommendations made by community pharmacists during reviews of medicines and lifestyle relating to coronary heart disease (CHD), and to identify and quantify missed opportunities for making further recommendations and assess any relationships with demographic characteristics of the pharmacists providing the reviews.

Methods

All issues and recommendations noted by 60 community pharmacists during patient consultations were classified and quantified. Two independent reviewers studied a subsample of cases from every participating pharmacist and identified and classified potential issues from the available data. The findings of the pharmacists and the reviewers were compared. Relevant pharmacist characteristics were obtained from questionnaire data to determine relationships to the proportion of potential issues noted.

Results

A total of 2228 issues and 2337 recommendations were noted by the pharmacists in the 738 patients seen, a median of three per patient (interquartile range 2–4). The majority of the recommendations made (1719; 74%) related to CHD. In the subsample of 169 patients (23% of the total), the reviewers identified 1539 potential issues, of which pharmacists identified an average of 33.8% (95% confidence interval 30.1, 36.4). No relationship was found between the proportion of issues noted and potentially relevant factors such as pharmacists'' characteristics and their experience of doing reviews.

Conclusions

The majority of issues and recommendations noted by pharmacists related to CHD, although pharmacists recorded only a minority of the issues identified by reviewers. Variation between pharmacists in the completeness of reviews was not explained by review or other relevant experience.

What is already known about this subject?

• There is conflicting evidence concerning the potential benefits of pharmacist-led medication review.
• Little work has been published on the completeness of medication reviews provided by community pharmacists.

What this study adds

• The 60 community pharmacists taking part in a large randomized controlled trial showed considerable variation in the completeness of the reviews they recorded for intervention patients.
• Overall, pharmacists recorded only a minority of the potential issues present in these patients.
• The frequency with which pharmacists recorded issues was not related to key characteristics or to the number of reviews completed.

     

Using human patient simulation to prepare student pharmacists to manage medical emergencies in an ambulatory setting

Objective

To implement a simulation-based educational experience focused on medical emergencies in an ambulatory pharmacy setting.

Design

Second-year student pharmacists were assigned randomly to groups and played the role of pharmacists in a community pharmacy setting in which a simulated patient experienced 1 of 5 emergency scenarios: medication-related allergic reaction, acute asthma attack, hypoglycemia, myocardial infarction, and stroke. The students were expected to use patient assessment techniques to determine which emergency the simulated patient was experiencing and the appropriate intervention. Following each simulation, a debriefing session was conducted.

Assessment

Eighty-two student pharmacists completed the simulation activity. Ninety-three percent of student groups correctly identified the emergency. A post-activity survey instrument was administered, and 83% of responders indicated this activity was effective or very effective.

Conclusion

Simulation of emergencies seen in an ambulatory pharmacy setting allowed students to assert knowledge, practice communication skills, apply assessment techniques, and work as a team in a low-risk environment.     

社区药学服务实践及模式创建

介绍从事社区药学服务的工作实践、模式创建、评价指标及该模式产生的各种良好结果等,并就存在的问题进行讨论,指出解决方法。     

儿保社区服务在母乳喂养中的支持作用

儿保社区服务对婴儿家长进行母乳喂养的宣传与喂养指导，对实现２０００年４－６个月婴儿纯母乳喂养率达８０％起着不可忽视的作用。本文详细说明了儿保社区服务在提高母乳喂养率的中支持作用。     

体验式培训在社区舒缓疗护护士上岗前的实践与效果

目的：探讨社区舒缓疗护护士上岗前实施体验式培训的效果。方法：采用目的抽样方法选择40名社区舒缓疗护护士,运用情景模拟、案例分享、总结体会、实践应用等理论与临床实践相结合的体验式培训,并使用自行设计的社区护士舒缓疗护知识调查问卷、人际反应指针问卷（IRI-C）分别于培训前、后对护士进行测评。结果：护士的舒缓疗护知识总分高于培训前,差异有统计学意义（P＜0.01）,其中舒缓疗护概述、心理护理、灵性关怀知识得分高于培训前;人际反应总分培训前、后差异有统计学意义（P＜0.05）。其中,幻想力、身心忧急得分均高于培训前（P＜0.05）。结论：体验式培训是提高社区护士舒缓疗护知识与技能、共情能力的有效培训方法。     

上海市崇明区家庭医生团队对社区药学照护的认知和障碍分析

目的 评估上海市崇明区家庭医生团队对药师加入提供社区药学服务（community pharmaceutical care，CPC）的认知，并分析其中的障碍，为创建适宜郊区特点的CPC管理模式提供依据。方法 本研究在2020年7月进行的一项横断面研究中，通过微信工作群转发的方式向崇明区18家乡镇的家庭医生团队提供了一份在线填写的问卷。问卷收集整理后，使用描述性统计方法对家庭医生团队成员对CPC的认知、态度和障碍数据进行分析。结果 在参与研究的555名被调查者中，女性351人(63.24%），全科医生187人（33.69%），护士226人（40.72%），公卫医师142人（25.59%）。家庭医生团队三类成员在对 CPC 认知上的调查结果差异均有统计学意义（P<0.05）。有126名（51.22%）护士和84名（68.85%）公卫医师“未听过”CPC，11.48%的公卫医师和23.58%的护士对于社区药师的工作内容和职责了解，而全科医生相对较多，占比34.76%。有34.22%全科医生对“CPC可以改善病人的药效”持有“不同意的态度”。“卫健部门的投资不足”和“社区药师人员不足”是CPC开展的主要障碍。结论 崇明地区家庭医生团队对CPC的态度是保守的，公卫医生和护士对CPC的认识很低。由于财政投入和人力的不足限制了CPC的发展。     

上海静安社区老年人群药学服务模式的探讨

目的：探索如何发挥药师的专业优势,构建科学、有效的社区老年人药学服务模式。方法：选择上海市静安区两个街道社区的老年人为药学服务对象,采用问卷调查与用药咨询的形式,根据调查咨询结果制定社区药学服务计划,组织本院药师进行多形式、多样化的社区药学服务实践。结果：初步构建了以老年人健康为中心、家庭为单位、社区为范围,零距离面对病人提供药学服务模式。该服务模式提高了社区老年人在用药安全方面的自我保护意识,同时增加和提高了药师的药学服务知识和交流技巧,培养了药学服务专业人才。结论：社区迫切需要药学服务,药师在社区也可充分展现自身价值。