Community pharmacists' identification of natural health product/drug interactions in older persons

Objective To document the prevalence and significance of potential natural health products (NHPs)/prescribed drug interactions in a sample of older adults; to determine whether community pharmacists detected these drug interactions; and to characterise users and non‐users of NHPs. Setting The project involved 15 community pharmacists providing pharmaceutical care to 213 non‐institutionalised older adults. Method The study was a subanalysis of a prospective, non‐randomised, before‐and‐after trial of the provision of pharmaceutical care. Pharmacists documented each time medication‐specific information or advice was provided to subjects. The numbers and types of NHPs that clients reported taking and the number of potentially significant NHP/prescribed drug interactions were determined. Whether pharmacists identified such drug interactions and made the necessary interventions were also documented. Results Forty‐two NHPs were reported 96 times by 49 (23%) clients, most commonly glucosamine (n = 10), garlic (n = 10), prune juice (n = 9), and Ginkgo biloba (n = 6). There was a total of 446 possible NHP/prescribed drug combinations in the 49 clients, of which 53 (12%) were considered to be of potential clinical significance. Of these 53 combinations, three pharmacists identified four (8%) potential interactions in three different patients. Although gender, mean age and number of reported medical conditions did not differ between users and non‐users of NHPs, users reported taking fewer prescribed drugs compared with non‐users (5.0 ± 3.2 vs 6.0 ± 2.9, respectively, P = 0.043) and more non‐prescribed drugs (4.2 ± 2.5 vs 2.1 ± 2.0, respectively, P < 0.0001). Conclusion The reported prevalence of NHP and the potential for NHP/prescribed drug interactions in our sample of older adults were high. Pharmacists providing pharmaceutical care did not commonly identify potentially significant NHP/prescribed drug interactions.     

药师对1例转移性乳腺癌术后伴癌痛患者的药学监护

目的 通过参与1例癌症疼痛患者的药物治疗和药学监护过程,临床药师参与制订药物治疗方案,并提出合理化用药建议,同时对患者进行健康教育,以减少或避免药物不良反应的发生.方法 药师通过参与审方、发现问题,对不当处方及时干预,与医生沟通、更改用药方案,对患者进行健康教育等方式,参与患者的药学监护过程.结果 在药师的干预下,医生...     

Evaluation of mental health care interventions made by three community pharmacists — a pilot study

Objective — To assess the clinical significance of drug‐related interventions made by three community pharmacists (CPs) in the pharmaceutical care of 30 long‐term mentally ill patients in the UK. Method — Three CPs (“study pharmacists”) participated in a nine‐month study in which they collaborated with the community mental health team (CMHT) to provide pharmaceutical care for long‐term mentally ill patients in the community. In particular, they liaised with the patients' keyworkers, accompanying them on home visits. The pharmacists had previously attended a specially organised training course. Their primary tasks were to assess patient need and identify medication‐related problems, intervene as appropriate and document patient outcome. An expert review panel (two specialist hospital mental health pharmacists and a consultant psychiatrist) evaluated the appropriateness of the interventions and the level of clinical significance of the interventions (using a validated four‐point rating scale). Key findings — Thirty‐eight patients consented to participate in the study and 35 were contactable. Ninety‐four medication‐related problems were identified involving 30 patients (mean number of recorded problems per patient=3), of which full data were available for 92. Eighty‐four problems (91 % n=92) were said to have had appropriate interventions, and eight (9 per cent) inappropriate interventions. In 35 per cent of problems the three reviewers agreed that the interventions were clinically significant. Inter‐rater agreement for paired agreements (assessed by the kappa statistic) was fair in all cases except one, where it was poor. Conclusions — The reviewers considered the study pharmacists to have made a valuable pharmaceutical contribution to mental health care through clinically significant interventions, although they identified cases in which further clinically significant interventions could have been made. The reviewers saw the work undertaken as providing a positive way forward in primary mental health care.     

PIVAS审方药师对不合理用药医嘱的干预与分析

目的：通过静脉药物配置中心（PIVAS）审方药师对吉林大学第一医院内科住院患者不合理医嘱的干预,以保证临床用药更加合理和患者用药更加安全。方法：以2016年5月-9月我院静脉用药集中调配中心内科医嘱作为研究对象,审方药师对不合理医嘱进行分析。结果：在2016年5月-9月,PIVAS内科医嘱共有1047581条,其中不合理医嘱381条,不合理率为0.04%;在不合理医嘱中,干预成功368条,干预成功率为96.59%。不合理医嘱的主要类型包括溶媒选择错误、溶媒用量错误、医嘱录入错误、药品用量错误、药品给药途径错误、配伍禁忌和药物相互作用。结论：我院应加强静脉用药的管理力度,审方药师应提升自身业务能力,有效干预不合理医嘱,保证患者用药合理、安全、有效。     

中国药师药学服务转型效果的meta分析

目的 系统评价中国药师药学服务转型的工作效果,为今后开展药学服务提供参考。方法 计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库、中国知网、万方和维普数据库,收集中国药师为转型而开展药学服务、并有明确服务效果评价指标的文献,包括随机对照试验(randomized controlled trial,RCT)和非随机干预性研究(non-randomized studies of interventions,NRSI)。筛选文献、提取资料并采用相关量表对纳入文献质量进行评价,采用RevMan5.4软件进行meta分析。结果 纳入RCT 8篇、NRSI 43篇,共计51篇文献。Meta分析结果显示,试验组抗菌药物的处方合理性[OR=5.17,95%CI(4.10,6.52),P<0.000 01]和单药使用率[OR=2.87,95%CI(2.16,3.81),P<0.000 01]、患者的依从性[OR=3.40,95%CI(1.73,6.66),P=0.000 4]和满意度[OR=2.54,95%CI(1.58,4....     

临床药师审查口服药疗单情况分析

目的:探索适合临床药师发展的模式。方法:采用回顾性调查方法,对我院2006年7月～2007年7月神经科临床药师参与审核及调配的神经内科病房79例口服药疗单进行分析。结果:发现不合理用药问题占调配总数的8.9%,临床药师干预临床不合理用药的成功率达96.2%。不合理用药中有34.2%为专科用药,其他科室用药占65.8%。不合理用药包括用法不正确、选药不正确、重复用药、剂量差错等。结论:临床药师参与审查药疗单是确保患者合理用药的重要方法。     

Evaluation of a mobile health intervention to support asthma self-management and adherence in the pharmacy

Background Several effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however hardly any is implemented in clinical practice. Process evaluations and user experiences are therefore important for further implementation. Objective To explore experiences, barriers, and facilitators of pharmacists and patients towards the use of the interactive ADolescent Adherence Patient Tool (ADAPT). In addition, the perceptions of pharmacists towards mHealth interventions in general were explored. Setting Dutch community pharmacies. Methods Pharmacists (N?=?24) and adolescent asthma patients (N?=?87; age 12–18) completed a questionnaire about the ADAPT intervention. Pharmacists who did not have access to the ADAPT intervention (N?=?26) completed a questionnaire on their perceptions towards mHealth. Main outcome measure Experiences, barriers, and facilitators of pharmacists and patients. Results Most patients (78%) would recommend the ADAPT intervention to others, and thought that the pharmacy was the right place for mHealth aiming to support adherence (63%). The possibility to monitor asthma symptoms was highly appreciated by patients and pharmacists. Pharmacists were satisfied with ADAPT intervention (96%), and using the intervention was not time consuming (91%). The ADAPT intervention promoted contact with patients (74%) and facilitated the healthcare providing role of pharmacists (83%). Pharmacists who did not have access to the ADAPT intervention mentioned time constraints and funding as main barriers for using mHealth. Conclusion Pharmacists and patients perceived many beneficial effects and were positive about the the use of the interactive ADolescent Adherence Patient Tool (ADAPT) intervention. This study emphasizes opportunities for mHealth in improving the quality of care, which supports the need for further implementation in clinical practice.

     

基于潜在不适当用药标准分析心内科老年患者出院带药处方情况及其影响因素

目的 探讨心血管内科老年患者出院带药处方的情况,并对其影响因素进行分析,以提高老年患者合理用药的水平。方法 回顾性分析2023年1～12月从泰州市人民医院心血管内科出院的老年患者,根据2023年版Beers标准及《中国老年人潜在不适当用药判断标准（2017年版）》,应用多因素Logistic回归分析,对影响潜在不适当用药（PIM）的因素进行分析。通过对患者所在病房是否有临床药师参与进行分组,比较PIM的发生率。结果 纳入老年患者共1 982例,Beers标准筛选出PIM病例1 518例（76.59%）,《中国老年人潜在不适当用药判断标准》筛选出PIM病例1 276例（64.38%）;多因素Logistic回归分析结果表明,按照2023年版Beers标准和《中国老年人潜在不适当用药判断标准（2017年版）》,疾病种数、患者用药的种类均是影响PIM发生的因素（P<0.05）。临床药师干预后,PIM发生率降低（P<0.05）。结论 疾病种数、用药种类是影响PIM发生的因素,临床医师及药师应该尤为重视多重慢病患者,降低老年人多重用药的危险。临床药师对老年患者的出院带药进行用药管理,...