国内外药师参与整合门诊的文献分析

Literature Analysis of Pharmacists’ Participation in Integrated Outpatient at Home and Abroad

目的:为我国药师参与整合门诊诊疗工作提供参考。方法:以"药师""临床药师""整合门诊""联合门诊""门诊""Pharmacist""Integrated outpatient""Outpatient department""Outpatient"等为中英文检索词,组合检索Embase、PubMed、中国知网、万方、维普等数据库,检索时限均为各数据库建库起至2019年7月24日,就国内外文献的研究方式、药师参与整合门诊的类型、服务内容及服务成效评价指标进行比较。结果:共检索到相关文献848篇,其中有效文献30篇。从研究方式上看,国外文献采用的研究方式主要以回顾性研究为主(42.86%),其次为自身前后对照试验(21.43%)和问卷调查/电话调研(14.29%);而国内文献采用的研究方式以描述性研究为主(37.50%),其次为病例对照(25.00%)和自身前后对照试验(25.00%)。从药师参与整合门诊的类型来看,国外药师参与整合门诊的类型有9种,包括癌症或姑息门诊、老年门诊、脂质管理门诊、艾滋病门诊、高血压门诊等,其中药师参与癌症或姑息门诊的占比较高,达42.86%;国内药师参与整合门诊的类型有11种,包括抗凝门诊、糖尿病门诊、癫痫门诊、帕金森病门诊等。国外药师在癌症或姑息门诊中提供服务内容较为深入,包括治疗建议、对药品相关问题进行分类并解决、提供药物信息与药师干预等;国内药师则在抗凝门诊提供的药学服务内容较为深入,包括抗凝药物剂量调整、药学监护、用药咨询、用药指导及教育等。对于服务成效的评价,国外研究的结局指标涉及13种,包括临床指标的改善、患者就医成本的减少、用药数量的减少等;国内研究的结局指标涉及11种,包括用药依从性、临床指标及不良反应的改善等。结论:国内外药师参与联合门诊均以慢病为主,但侧重点各有不同。国内药师和相关学者可在研究方式、药师参与的整合门诊类型、服务内容及其成效评价指标等方面进一步改进。

OBJECTIVE:To provide reference for pharmacists’ participation in the integrated outpatient treatment in China.METHODS:Using"Pharmacist""Clinical pharmacist""Integrated outpatient""Combined outpatient""Outpatient department"as Chinese and English retrieval words,the related literatures were retrieved from Embase,PubMed,CNKI,Wanfang and VIP,retrieval time limit was from the construction of database to July 24,2019. The type,research method,service content and the evaluation indexes of the service effectiveness of pharmacists’ participation in the integrated outpatient treatment at home and abroad were compared. RESULTS:A total of 848 related literatures were retrieved,including 30 valid ones. From respective of research method,main foreign method was retrospective research(42.86%),followed by self-control trial(21.43%) and questionnaire survey/telephone research(14.29%);main domestic method was descriptive research(37.50%),followed by case control(25.00%)and self-control trial(25.00%). From respective of the types of pharmacists’ participation in the integration of outpatient services,there were 9 types of pharmacists’ participation in the foreign integrated outpatient treatment,including cancer or palliative outpatient department,geriatric outpatient department,lipid management outpatient department,AIDS outpatient department, hypertension outpatient department, etc. Among them, the proportion of pharmacists participating in cancer orpalliativeoutpatient department was the highest,being 42.86%. There were 11 types of pharmacists’ participation in the domestic integrated outpatient treatment, including anticoagulation outpatient department, diabetes outpatient department and epilepsy outpatient department,Parkinson’s disease outpatient department, etc. Foreign pharmacists provided in-depth services in cancer or palliative outpatient department,including treatment suggestions,classification and resolution of drug-related problems,provision of drug information and pharmacist intervention,etc.;the contents of pharmaceutical care provided by domestic pharmacists in anticoagulant outpatient department was more in-depth,including dosage adjustment of anticoagulants,pharmaceutical care,medication consultation,medication guidance and education,etc. For the evaluation of service effect,foreign researches involved 13 kinds of outcome indexes,including the improvement of clinical indexes,the reduction of medical cost,reduction of drug used,etc. Domestic researches involved 11 kinds of outcome indexes,including the improvement of medication compliance, clinical indexes and ADR, etc. CONCLUSIONS: The participation of pharmacists in integrated outpatient at home and abroad are mainly chronic diseases,but also different in their emphasis. The domestic pharmacists and related scholars can improve the research methods,the types of integrated outpatient services,service contents and the evaluation indexes of effectiveness of pharmacists.