360例慢性病药物的咨询分析

目的 调查并分析我院慢性病药物咨询,特指高血压、糖尿病的药物咨询情况.方法 将2010年3月至2011年9月于我院就医的360例咨询者进行完整的药物咨询收集并分析.结果 咨询人群以患者居多,占61.7％,以40 ～ 49岁(占78.1％)的城镇居民(占67.8％)为主,相对关心药品的基本信息(药品名10.59％、适应症12.33％、不良反应13.54％、医保10.94％)等信息.结论 咨询者本身为药物咨询的主体,比较关心药物的基本情况及价格,却忽略了日常饮食和药物的相互作用,通过调查及整理相关特点,以达到更有效的实现临床用药指导.     

我院临床药师参与一例感染病例会诊实践

目的介绍我院药师参与病原菌不明感染性病例会诊的情况,探讨临床药师在感染性病例药物治疗过程中的作用。方法回顾性分析我院临床药师参与的1例感染性病例药物治疗过程。结果临床药师通过干预用药,配合医生为患者提供最佳用药方案,患者感染得到有效控制。结论临床药师参与感染性疾病的药物治疗,可确保抗菌药物的合理应用,提高了抗菌药物的疗效。     

Do older patients feel able to cope with illness following telephone consultations? A multi-practice survey in the UK

ABSTRACT

Background: Worldwide, patients are offered a telephone consultation as a first point of access to a health care professional. Whilst older patients form a significant proportion of callers, this group has expressed reservation about consultations that preclude a physical examination.

Objective: This study compares how two groups of patients (< 70 years, ≥ 70 years) perceive their ability to cope with illness following a telephone consultation.

Methods: Nine hundred and fifty-six patients from deprived inner city areas receiving telephone consultations with a General Practitioner (GP)/Family doctor or nurse at five practices in South Yorkshire, UK were surveyed within 24?h of the consultation. A 49% response rate was achieved; the mean age of respondents in the respective groups was 78.5 years and 48 years. The questionnaire included the Patient Enablement Instrument (PEI), a self-reported measure of patients' ability to cope with illness and supplementary questions on access to GPs in the practice.

Results: There was a low response rate from younger patients and males in particular. Ethnic minority groups were hardly represented among the respondents. How ever, scores on the PEI following telephone consultations were no different between older and younger respondents (Mann–Whitney U test, p = 0.56). Regression analysis with PEI scores as the dependent variable and fitting age and differences in responses to the questionnaire as explanatory variables yielded an R² of 0.02 suggesting that ‘age’ per se was a poor predictor of ‘enablement’.

Conclusions: These data support an inclusive policy in the provision of telephone access to health care professionals in primary care. We conclude that older patients are not disadvantaged by consulting a primary care professional by telephone.     

多学科联合门诊会诊工作实践与探索

目的 探讨开展多学科联合门诊会诊工作制度在妇幼保健医院中的实施策略.方法 医院服务中心对申请会诊患者进行预约登记,并与医务部组织3位或3位以上的产科、遗传优生科、超声科、妇科等多学科专家进行会诊作出诊断,服务中心追踪随访并提供帮助和指导.结果 42例患者通过多学科会诊:6例分娩正常新生儿,9例引产终止妊娠,1例稽留流产,24例继续妊娠(其中4例多胎妊娠实施了减胎术),2例门诊治疗观察.结论 妇幼保健医院开展多学科联合门诊会诊对早期干预出生缺陷儿、改善胎儿预后有积极意义.多学科联合门诊会诊让门诊患者及时得到了合理、有效的综合诊疗,并且加强了各个学科间的交流协作,促进了学科的发展.多学科联合门诊需完善信息化建设,会诊工作的发展需要医院给予激励措施.     

GPs' perspectives on managing time in consultations with patients suffering from depression: a qualitative study

BACKGROUND: Although there is widespread concern that general practice consultations are too short for doctors to provide a high quality of care for patients, the relationship between the length and outcome of these consultations remains unclear. Research to date has neglected the subjective experience of consultation time of both patients and GPs. OBJECTIVES: Our aim was to investigate GP perspectives on consultation time and the management of depression in general practice. METHOD: A qualitative interview-based study was carried out of 19 GPs from eight West Midlands general practices. RESULTS: The GPs in this study acknowledged the pressure of work and resource constraints in general practice. However, they did not feel these prevented them from providing good support and treatment for depression. They were confident in the effectiveness of antidepressants and their own skills in providing counselling support, and were able to utilize time flexibly in responding to patients' variable needs. Depression was viewed as a relatively straightforward problem that usually could be managed within the resources available to general practice. CONCLUSION: The doctors generally did not experience time to be a limiting factor in providing care for patients with depression. This is in contrast to the more acute sense of time pressure commonly reported by patients which they felt undermined their capacity to benefit from the consultation. GPs need to be more aware of patient anxieties about time, and to devise effective means of raising patients' sense of time entitlement in general practice consultations.     

542例儿科电话药物咨询分析

目的:了解儿科药物咨询服务和药品不良反应发生的特点。方法:对我院2006年2月～2008年4月的药物咨询电话记录进行分析,并对其中药品不良反应问题进行分类。结果:542例药物咨询电话记录中,列前3位的分别为药物的用法用量(29.15%)、药物推荐与选择(13.28%)、药物相互作用(10.52%);其中,41例药品不良反应问题主要与抗感染药和中成药的使用有关,最常见表现为消化系统损害。结论:开展电话药物咨询,不仅能提高患儿的用药依从性,促进合理用药,而且对于儿科临床药师的学习提高也有很大帮助。     

The role of general practitioners in migraine management

Lantéri-Minet M. The role of general practitioners in migraine management. Cephalalgia 2008; 28:1–8. London. ISSN 0333-1024
General practitioners (GPs) play a pivotal role in managing migraine and ensuring that patients have a positive first experience when seeking treatment. A large proportion of migraineurs do not consult a GP, preferring to rely on over-the-counter remedies to reduce pain and disability. For those who do consult, receiving a satisfactory outcome at their first consultation is important for ensuring subsequent effective management of their migraine. If patient expectations are not met at their first visit (prescribed treatment is ineffective or GP does not empathize with their suffering), patients may not return for further consultation. There remains a need to improve migraine diagnosis and treatment, and GPs require continuing medical education and neurologist support to ensure that they are providing the best migraine treatments and outcomes. More widespread use of diagnostic tools, standardized management guidelines and individualized treatment regimens will help GPs successfully manage both migraine symptoms and patient expectations.     

The GRIM2005 study of migraine consultation in France I. Determinants of consultation for migraine headache in France

The aim of this study was to evaluate determinants of consultation for migraine in a representative sample of the French general adult population. We interviewed 10 032 subjects, of whom 1534 fulfilled the International Headache Society diagnostic criteria for migraine. These were categorized into migraine, probable migraine and chronic migraine. Information was collected on consultation experience; 436 subjects (28.4%) had never consulted for headache, 473 (30.8%) were in active consultation and 625 (40.7%) had previously consulted but lapsed. Subjects with chronic migraine showed the highest active consultation rates (51.8%). All subjects completed rating instruments for headache [Headache Impact Test (HIT)-6], psychiatric (Hospital Anxiety and Depression Scale scale) and psychological [Brief Illness Perception Questionnaire (BIPQ), Brief COPE Inventory and Coping Strategy Questionnaire] variables. The strongest determinants of active consultation were BIPQ scores, HIT-6 scores and migraine type. Consultation was associated with maladaptive coping strategies (social support, emotional expression and acceptance). Determinants of remaining in consultation were catastrophizing coping scores and previous consultation experience.     

木丹颗粒新药咨询与药品生产企业药学服务

通过对本企业创新药物木丹颗粒用药咨询与药学服务的具体实施方略,分析目前所做工作取得的成绩和存在的不足。进而探究药品生产企业如何充分利用自身优势,在新药进入临床初期直接参与和提供药学服务,对该药物更快更好地发挥疗效、研究发现更多的适用范围、保障人民的用药安全发挥积极的作用。