医联体总药师制度促进基层医疗机构合理用药的实践与探索

Practice and exploration of improving the rational use of drugs in primary medical institutions by the general pharmacist system of the medical consortium

目的探索建立适合我国国情的医联体总药师制度。方法在广州市天河区卫生健康局领导下,依托区域药学专科联盟建立医联体总药师制度,由总药师负责统筹策划医联体内药学服务工作;设立药学服务联合协作管理办公室,组织医联体内药师培训,建立区域性审方中心,实现医联体内13家社区卫生服务中心的处方审核,开展“互联网+”居家药学服务,面向社区、学校、企事业单位等开展科普宣教。结果经系统性培训和考核,已在医联体内成功组建3个药师队伍,为社区居民提供审方、科普宣教以及家庭药师服务;区域性审方中心成功拦截的不合理处方占比为17.17%,减少不合理用药金额累计656万元;审方系统的干预使得社区卫生服务中心的门诊处方合格率≥95%,合格率平均提高了6%;科普宣教部举办了35次科普及义诊活动,其中71.20%的居民认为该活动提高了其对药物的认知水平;药师团队为111例患者提供了居家药学服务,患者对药师干预的接纳度为91.89%。结论在“新医改”形势下,推行医联体总药师制度切实可行;此举可有效提高医联体内医疗机构的药事管理和药学服务能力以及合理用药水平,降低不合理用药支出,减轻医疗负担。

OBJECTIVE To explore and establish a general pharmacist system suitable for China’s national conditions,and to improve the rational use of drugs in primary medical institutions.METHODS Under the leadership of Tianhe District Health Bureau of Guangzhou,relying on the regional pharmaceutical specialty alliance,general pharmacist system of medical consortium was established,and the general pharmacist was responsible for the overall planning of pharmaceutical care in the medical consortium.The joint management office of pharmaceutical care was established,and the training of the pharmacists in the medical consortium was organized.A regional audit center was established to realize the prescription review of 13 community health service centers in the medical consortium.“Internet plus”home pharmaceutical care was carried out,and science popularization education was provided for communities,schools,enterprises and institutions.RESULTS After systematic training and assessment,three pharmacist teams had been successfully established in the medical consortium to provide prescription review,science popularization and education and family pharmacist services for community residents;the regional audit center successfully intercepted 17.17%of unreasonable prescriptions,reducing the amount of unreasonable drug use by a total of 6.56 million yuan.After the intervention of prescription review system,the qualified rate of outpatient prescriptions in community health service centers was≥95%,and the qualified rate increased by an average of 6%.The department of pharmaceutical science popularization and education held 35 science popularization and free clinic activities,of which 71.20%of the residents believed that the activities had improved their understanding of drugs.In addition,111 cases patients serviced by home pharmaceutical care were carried out successfully by pharmacist team,and the patients’acceptance of pharmacist intervention was 91.89%.CONCLUSIONS Under the new medical reform,it is feasible to implement a regional general pharmacist system within the medical consortium,which improves the pharmaceutical administration and pharmaceutical care capabilities of medical institutions in the medical consortium,as well as the level of rational drug use,and reduces the medical burden.