重庆市39家医疗机构临床药学服务发展现状的调查研究

Investigation and Study on Present Situation of Clinical Pharmaceutical Care in 39 Medical Institutions in Chongqing

目的:了解重庆市等级医疗机构临床药学工作的开展状况,探讨优化我市临床药学服务的方法。方法:采用问卷调查的方式,按照地域、医疗机构级别,兼顾综合与专科医院,选取重庆市50家样本医疗机构(包括15家三级医院、25家二级医院和10家一级医院),对其临床药师队伍及临床药学工作开展状况等进行调查,并对结果进行统计分析,找到共性问题并提出相关建议。结果与结论:共回收45份调查问卷,回收率90%,其中合格问卷39份,合格率86.67%。39家医疗机构中设置临床药学部门的有32家(82.05%)、临床药师培训基地医院有4家(10.26%)。39家医疗机构均配有专职药师,共计239人,平均每家医疗机构6.13人从事临床药学工作,其中专职临床药师4.5人/家,多数医疗机构专职临床药师为2~5人(25家);临床药师主要参与工作的临床科室占比排序前5位依次为呼吸科、心血管科、内分泌科、重症医学科(ICU)、肿瘤科,大部分临床药师(16家,42.11%)在临床的工作时间占比为>50%~≤80%;在开展的临床药学项目方面,以开展药品不良反应监测、合理用药知识宣传、处方医嘱点评、查房、会诊、编辑出版药讯的医疗机构数量较高(28~37家,>70.00%)。28家(78.95%)暂未开展治疗药物监测项目;39家(100%)医疗机构均开展了患者用药教育工作,以宣传栏(30家,78.95%)、科普讲座(28家、73.68%)和用药教育表(28家、73.68%)的形式较多,用药教育内容以注意事项(39家,100%)、用法用量(37家,97.37%)、不良反应(36家、94.74%)为主;29家医院开展了临床药学科研工作(73.68%),以合理用药研究(28家,73.68%)为主;5家(12.82%)医疗机构开设了联合药学门诊、2家(5.12%)开设了独立药学门诊,其余均未开设药学门诊(26家,66.67%)。本次调查发现药学服务存在科室病区床位覆盖不全、药学部门科研基础薄弱等问题。建议国家和地方卫生健康委员会可采取加强多层次临床药学人才梯队建设、探索培养驻科临床药师、评选和建设重庆市临床药学重点专科、建立临床药师激励机制等方式,各级医疗机构可采取多途径加快临床药师培养、增加药师门诊宣传、改变病区工作模式、培养特色专科临床药师、完善继续教育途径及路径、增强科研实力等方式提高临床药学服务水平。

OBJECTIVE:To investigate the present situation of clinical pharmacy in different levels of medical institutions in Chongqing,and to investigate the method for optimizing clinical pharmaceutical care. METHODS:By questionnaire survey,50 sample medical institutions(including 15 third level hospitals,25 second level hospitals and 10 first level hospitals)in Chongqing were selected according to the region,the level of medical institutions,comprehensive and specialized hospitals. The team of clinical pharmacists and the development of clinical pharmacy were investigated,and the results were statistically analyzed to find common problems and put forward relevant suggestions. RESULTS & CONCLUSIONS:Totally 45 questionnaires were collected,with a recovery rate of 90%,of which 39 questionnaires were qualified,with a qualified rate of 86.67%. There were 32 hospitals(82.05%)in 39 medical institutions with clinical pharmacy departments and 4 hospitals(10.26%)with clinical pharmacist training base. There were 239 full-time pharmacists in 39 medical institutions,with an average of 6.13 persons in each medical institution,including 4.5 full-time clinical pharmacists,and 2-5 full-time clinical pharmacists(25 hospitals)in most medical institutions. Top 5 clinical departments that clinical pharmacists mainly participated in were respiratory department, cardiovascular department,endocrinology department,ICU and oncology department. Most of the clinical pharmacists(16 hospitals,42.11%)worked in the clinic for more than 50% to no more than 80%. The number of medical institutions(28-37,>70.00%)carrying out ADR monitoring, rational drug use knowledge publicity,prescription and medical order comment, ward round,consultation, editing and publishing drug information was relatively high. 28 medical institutions(78.95%)did not carry out the test of therapeutic drugs;39(100%)medical institutions had carried out the education of patients’ drug use,in the form of billboards(30 hospitals,78.95%),science lectures(28 hospitals,73.68%)and drug education forms(28 hospitals,73.68%).The contents of drug use education mainly included precautions(39 hospitals,100%),usage and dosage(37 hospitals,97.37%),ADR(36 hospitals,94.74%). 29 hospitals had carried out clinical pharmaceutical research(73.68%),mainly rational drug use research(28 hospitals,73.68%);5 medical institutions(12.82%)had set up joint pharmacy outpatient service,2(5.12%)had set up independent pharmacy outpatient service,the rest had not set up pharmacy outpatient service(26 hospitals,66.67%). In this survey,it is found that there are some problems,such as incomplete coverage of beds in the ward in pharmaceutical care,weak foundation of scientific research in pharmaceutical departments. It is suggested that the national and local health committees should strengthen the construction of multi-level clinical pharmacy talent echelon,explore and train resident clinical pharmacists,select and build key clinical pharmacy specialties in Chongqing,and establish incentive mechanism for clinical pharmacists. Medical institutions at all levels can adopt multiple ways to accelerate the training of clinical pharmacists, increase the publicity of pharmacists’ outpatient service,change the working mode of the ward,cultivate special clinical pharmacists,improve the ways and paths of continuing education,and enhance the strength of scientific research to improve the level of clinical pharmaceutical care.