上海市社区药学服务需求现状

Needs of Pharmaceutical Care in the Community of Shanghai

背景随着患者就诊下沉明显,联合家庭医生团队开展社区药学服务日益重要,但如何发挥家庭医生团队作用以满足患者社区药学服务需求仍有待进一步探索。目的了解上海市社区药学服务需求现状,为改进社区药学人员参与家庭医生团队开展服务的方式提供参考建议。方法于2020年9—12月,采用多阶段抽样法抽取349例老年慢性病患者和855例家庭医生团队主要成员〔全科医生(n=481)、护士(n=234)、公共卫生医生(n=140)〕进行问卷调查。针对老年慢性病患者的调查问卷主要内容包括基本情况、患病情况、用药情况、社区药学服务需求情况和社区药学服务利用情况。针对家庭医生团队成员的调查问卷主要内容包括基本情况、社区药学服务认知情况和社区药学服务需求情况。结果349例老年慢性病患者中,125例(35.8%)同时患有≥3种慢性病,305例(87.4%)每日需多次用药。用药管理类药学服务方面,“用药重整及随访”需求人数最多,为52例(14.9%),“用药随访”利用人数最多,为49例(14.0%)。用药教育类药学服务方面,“慢性病用药特殊性的普及教育”需求人数最多,为247例(70.8%),“宣传健康生活方式”利用人数最多,为33例(9.4%)。家庭医生团队成员中,全科医生、护士、公共卫生医生对药学服务的了解程度方面,分别有440例(91.5%)、202例(86.3%)、112例(80.0%)表示了解;对药师的信任程度方面,分别有302例(62.8%)、183例(78.2%)、103例(73.6%)表示非常信任;“协同医师做好药物使用遴选”服务项目的需求人数分别有359例(74.6%)、112例(47.9%)、81例(57.8%);“指导护士使用与管理药品”服务项目的需求人数分别有190例(39.5%)、153例(65.4%)、57例(40.7%)。结论一方面患者实际迫切需要用药管理类药学服务,另一方面患者的用药教育类药学服务需求远未得到满足。鉴于社区药学人员队伍薄弱及家庭医生团队对社区药学服务认知局限的现状,社区药学人员应通过培训团队成员,提升团队的社区药学服务认知水平及服务能力,借助团队力量及成员特性,更广泛高效地开展社区药学服务。

Background To satisfy the pharmaceutical care needs of a growing number of patients seeking healthcare in primary care,it is increasingly important to integrate family doctor teams as providers of such care services,while the way bringing the strength of the teams into full play needs to be further explored.Objective To understand the needs of pharmaceutical care services in the community of Shanghai,providing a reference for improving the way of integrating community pharmacists into a family doctor team for delivering such services.Methods This study was conducted from September to December in 2020.Multistage sampling was used to select 349 elderly patients with chronic diseases in the community and 855 main members of family doctor teams〔general practitioners(n=481),nurses(n=234),and public health doctors(n=140)〕for questionnaire survey.The questionnaire for the patients mainly includes demographics,chronic condition,use of medications,needs and utilization of community-based pharmaceutical care.And the questionnaire for family doctor team members mainly contains demographics,understanding of community-based pharmaceutical care,and pharmaceutical services preferred to be involved in as a provider.Results According to the survey results,the prevalence of three or more chronic diseases,and needing to take medications two or more times a day was 35.8%(125/349),and 87.4%(305/349),respectively.Among medication management services,"medication re-prescribing and follow-up"was the most needed〔14.9%(52/349)〕,and"medication follow-up"was the most used〔14.0%(49/349)〕.Among medication education services,"universal education on medication cautions for chronic conditions"was the most needed〔70.8%(247/349)〕,and"healthy lifestyle promotion"was the most used〔9.4%(33/349)〕.Among family doctor team members,440(91.5%)general practitioners,202(86.3%)nurses and 112(80.0%)public health doctors expressed that they had an understanding of pharmaceutical care.In terms of the level of trust in pharmacists,the self-reported level of 302(62.8%)general practitioners,183(78.2%)nurses,and 103(73.6%)public health doctors was high.The number of general practitioners,nurses,and public health doctors wanting to be involved in"assisting physicians in providing medication selection and use services"was 359(74.6%),112(47.9%),and 81(57.8%),respectively.The number of general practitioners,nurses,and public health doctors wanting to be involved in"providing nurses with guidance on medication use and management"was 190(39.5%),153(65.4%)and 57(40.7%),respectively.Conclusion Elderly patients with chronic diseases were in urgent need of medication management services,and more medication education services.However,the strength of pharmaceutical professional workforce in the community was weak,and family doctor team members had limited understanding of community-based pharmaceutical services.To efficiently provide residents with such services,it is suggested to train family doctor team members with relevant trainings by pharmaceutical professionals to improve their understanding level and service capability regarding pharmaceutical services at the individual and team levels.