台湾地区医院药学模式介绍及对大陆地区的启示

Introduction of Hospital Pharmacy Mode in Taiwan Region and Its Enlightenment to Mainland of China

目的:促进大陆地区医院药学服务质量的持续改进。方法:介绍台湾地区医院药学的相关制度、药品管理(包括药品调剂和医院制剂配制)、临床用药管理(包括临床药学和用药疏失管理及循证医学信息服务)与大陆地区的差异,并提出对大陆地区医院药学工作的启示。结果与结论:台湾地区执行全民健康保险制度,引入总额支付制度;执行医院评鉴制度和药害救济制度。台湾地区医院门诊和住院药品调剂均采取拆零调配模式,调配流程合理且高效;医院制剂配制方面,一般均提供全静脉营养剂配制服务,中草药均为瓶装粉末,对于儿童用药品提供粉碎和分装服务;对于频繁使用且剂量较恒定的品种医院也会委托企业批量生产;单设化疗药房。台湾地区的临床药学工作内容与大陆地区基本相同,药事服务在院内网络上进行记录;医院药师(包括临床药师和药房药师)可随时将各类用药疏失填报至院内网络,填报者能获得院方奖励。台湾地区医疗品质策进会已将医院循证工作开展情况视为质量控制的一项指标,纳入医院的评鉴系统。启示大陆地区需要推动药学服务的信息化、注重临床药学人员的培养与考核、加强人性化服务。

OBJECTIVE： To improve the quality of the hospital pharmaceutical care in mainland of China continually. METH- ODS： The difference of pharmaceutical care in Taiwan and mainland of China were introduced in terms of institutional environ- ment, drug management （drug dispensing and hospital preparation）, clinical medication management （clinical pharmacy, medica- tion error management, EBM information service）. Its enlightenment to hospital pharmacy of mainland of China were put forward. RESULTS ＆ CONCLUSIONS： National health insurance has been carried out and total payment system has been introduced in Tai- wan area; hospital evaluation system and drug relief system have been conducted. The dismounting mode is used for outpatient and inpatient drug dispensing, and the dispensing process is reasonable and effective in Taiwan Region. Total parenteral nutrition prepara- tion is commonly provided by pharmacy in Taiwan Region; Chinese herbal medicines are almost ground into power and put into bot- tle; smashing and subpackage service is provided for drugs for children; the drug types which are used frequently with constant dose are also manufactured on a large scale by enterprise entrusted with hospital; pharmacy for chemotherapy has been established separately. The contents of clinical pharmacy in Taiwan Region are similar to in mainland of China, and pharmaceutial care are all recorded on the hospital network. Hospital pharmacists （including clinical pharmacist and pharmacy pharmacist） can report medication erorr to hospital network, and the reporter can get reward. The development of evidence-based medicine is regarded as a index of quality control by institute for health care quality in Taiwan Region and included in hospital evaluation system. It is suggested main- land of China to promote pharmaceutical care informationization, focus on pharmacy staff training and examination and strengthen personalized service.