“双通道”背景下定点零售药店药事管理及药学服务现状质性研究

Qualitative Research on the Current Situation of Pharmaceutical Administration and Pharmaceutical Care in Designated Retail Drugstores Under the Dual-Channel Background

目的提升定点零售药店药事管理水平和药师药学服务能力。方法采用目的抽样法,依据最大差异抽样原则,对山东省2家大型医药销售连锁公司9家定点零售药店15名药师进行“一对一”、半结构式深度访谈,并采用Colaizzi七步分析法分析。结果受访者认为,患者对定点零售药店药师的认知程度不够;患者不了解医保谈判药品报销政策或不熟悉报销流程,医师不熟悉医保政策中药品支付范围,导致报销困难或无法报销;定点零售药店存在药事管理水平较低、药师药学服务能力不足、药品不良反应上报不及时或不报、超药品说明书用药等用药安全隐患;定点零售药店药师继续教育水平参差不齐,继续教育内容与实际应用有偏差,针对性差,缺乏实践技能培养。结论山东省“双通道”管理机制的建立仍处于初级阶段,定点零售药店药事管理水平和药师的药学服务能力亟待加强,管理部门应加强药店药事监管,采取多种方式加强定点零售药店药师专业培训,使其能胜任医保谈判药品院外药学服务。

Objective To improve the pharmaceutical management level and pharmacist′s pharmaceutical care ability in designated retail drugstores.Methods According to the principle of maximum difference sampling,fifteen pharmacists from nine designated retail drugstores of two large pharmaceutical sales chain companies in Shandong Province were selected by the objective sampling method to conduct one-to-one,semi-structured and in-depth interview.The interview content was analyzed by Colaizzi′s seven-step analysis method.Results The interviewees thought that the patients′awareness of pharmacists in designated retail pharmacies was insufficient;the patients were not familiar with the medical insurance negotiation drug reimbursement policy or the reimbursement process,and the doctors were not familiar with the scope of drug payment in the medical insurance policy,which led to the difficulty or inability of reimbursement;there were hidden dangers of medication safety in designated retail pharmacies,such as low pharmaceutical administration level,insufficient pharmacists′pharmaceutical care ability,untimely or unreported adverse drug reactions,and off-label drug use,the pharmacists′continuing education levels in designated retail drugstores were uneven,and the content of continuing education deviated from the actual application,with poor pertinence and lack of practical skills training.Conclusion The establishment of the dual-channel management mechanism in Shandong Province is still at the initial stage,and the pharmaceutical administration level of the designated retail drugstores and the pharmaceutical care ability of the pharmacists need to be strengthened.The administration department should strengthen the pharmaceutical administration of the drugstores,and take various ways to strengthen the professional training of the pharmacists in designated retail drugstores,so that the pharmacists can be competent for the out-of-hospital pharmaceutical care of the medical insurance negotiation drugs.