Exploring the Contribution of Pharmacists in Addressing the Opioid Crisis through Naloxone Prescriptions and Pharmacist-Led Interventions

The opioid epidemic in the United States continues to take the lives of many individuals, with overdoses continuing to rise every year. Naloxone is an opioid antagonist that is efficacious in temporarily reversing opioid overdoses. Pharmacists play an important role in the accessibility and education of naloxone in both the community and health system settings. Recent efforts, such as co-dispensing naloxone with opioid prescriptions, naloxone training programs, and approval of naloxone to be over-the-counter, have been implemented in hopes to better control the opioid epidemic. Despite the efforts to make naloxone more accessible, there are still some barriers to overcome such as lack of training, cost, stigma, and patient refusal. This review aims to explore the contributions pharmacists have made thus far and define the barriers that still have to be resolved.

Rôles et vécus des pharmaciens d’officine dans les soins palliatifsàdomicile en France Role and Experience ofCommunity Pharmacists in Home Palliative Care in France

The need for home palliative care is increasing in allWestern countries.Community pharmacists are local professionals whose role in end-of-life care at home remains poorly understood.The aim of this study is to understand how community pharmacists see their role in end-of-life home care in France,and to analyze their experiences of this care.An online questionnaire was distributed to community pharmacists working in France between December 2022 and March 2023.Of the 136 respondents to the questionnaire,87%had accompanied at least one patient at the end of life in the 3 months preceding the survey.Therapeutic education(88%of respondents),psychological support for caregivers(85%of respondents),securing treatment(82%of respondents)and monitoring therapeutic compliance(80%of respondents)are the behaviors validated by the greatest number of participants.The majority of professionals surveyed had a positive overall experience of managing patients at the end of life.These results pave the way for pharmacists to better support end-of-life patients at home.

Roles of Community Pharmacists in Screening and Disseminating of Information about Non-Steroidal Anti-Inflammatory Drugs Risks: Implications for Drug Safety Assessment

Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.

A Study of Pharmacist-Patient Communication: Examining Optimal Distance and Angle Using an Eye-Tracking System

This study focuses on seating arrangement and interpersonal distance as important aspects of nonverbal communication and aims to elucidate the optimal distance and angle between pharmacist and patient through an analysis based on the subjective evaluation of the patient and the objective evaluation of eye movements. Seven female simulated patients and one male and one female pharmacist cooperated as patients and pharmacists, respectively. The medication teaching scenes were set up with three pharmacist placements (face-to-face at 50 cm and 70 cm, 90-degree at 70 cm) and three hospital rooms (0-degree, 45-degree, 90-degree). Pupil diameter, blink rate, saccades, and fixation rate of the patient at each of these locations were measured using a Tobii Pro Glass 2. The patient’s subjective evaluation at each placement was also investigated using the conversation scale, which assesses the optimal distance for conversation. The results for the pharmacy setting revealed that pupils were significantly more mydriatic at the 50 cm point than at the other points. The results for the hospital room setting showed the greatest mydriasis at the 0-degree point. The result of the 50 cm point for the pharmacy setting and the 0-degree point for the hospital room setting was similar to that of the subjective evaluation. When the likelihood of saccades occurrence in the hospital room setting was compared, saccades were found to be most likely to occur when medication instructions were given to patients at the 0-degree point. We believe that using pupil diameter for interpersonal distance, and saccades for angle will enable more accurate determinations of the optimal distance and angle between pharmacist and patient. The results of the present study suggest that the 70 cm face-to-face point in the pharmacy and the 45-degree point in the ward may be suitable for medication instruction.

The role of community pharmacists and their perception towards antimicrobial stewardship in Baghdad,Iraq

Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community pharmacy.Methods:A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship.Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad.In total,381 participants have completed the survey.Results:The majority of the participants(85.6%)strongly agreed/agreed that“antimicrobial stewardship programs reduce the problems of antibiotic resistance”;and 85.5%of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use.In addition,high percent of community pharmacists(88.4%)strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system.The total score of perception was significantly influenced by older age groups,postgraduate degrees,and experience of 6–10 years(p<0.001).This study also showed that 65.4%of pharmacists always/often advise patients to continue the full course of antimicrobials,and 64.9%of them reported always/often considering clinical and safety parameters before dispensing antibiotics.The role of pharmacists was significantly influenced by the younger age group,females,higher degree in pharmacy,experience of 3–5 years,and medical complex pharmacy(p<0.001).Conclusion:Community pharmacists have a good perception toward antimicrobial stewardship programs,but their role is still limited.More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.

“1+X”网格化模式在审方药师药学服务胜任力培养中的应用和实践

目的通过建立规范、系统、可行的培训方法和课程体系,探索以临床药师为核心的审方药师培养与实践新模式,为各级医疗机构处方审核药师培训考核机制建设提供参考。方法从专业、团队、工作三个层面构建“1+X”网格化处方审核药师培养模式,利用合理用药分析软件,分析评价中国科学技术大学附属第一医院2022年1—10月“1+X”处方审核模式应用效果;并采用李克特量表,设定审方药师自我评价满意度水平,据此设计问卷调查表,进行审方药师培训前后药学服务胜任力的自我评定。结果经过“1+X”网格化模式培训后,审方药师已成功优化审方规则225条,药师每月审核处方比例从5.24%降至2.56%,药师每月干预处方比例从19.32%降至11.17%,医师修改处方数、药师干预有效的处方数、整体用药错误上报率等明显下降,审方工作效率提升;审方药师在个人素养、基本知识和技能、专业知识和技能、内驱力方面均得到了不同程度的提升(P<0.05)。结论“1+X”工作模式应用效果显著、易推广,可提高药师核心胜任力,保障用药安全,契合当前政策和实际工作的需要。

医联体下新社区药学服务模式建立实践

目的分析某医疗联合体(简称医联体)下新社区药学服务模式(以人民健康为核心)的建立经验。方法总结该新模式的亮点,包括建立集团特色质控标准,信息化助力构建智能药学服务模式,结合移动查房系统与社区药学照护系统提供全程化社区药学服务,开展系统基层药师授权培训等。通过问卷调查和随访分析新模式开展效果。结果共回收有效问卷973份,有效回收率97.30%。其中糖尿病患者332例。与干预前比较,干预后患者依从性好的比例显著升高(P<0.01),对临床药师的认知度显著改善,对药师的满意度显著改善(P<0.05);且糖尿病患者用药问题(涉及4个维度、7个类型)发生率均不同程度降低(最高降幅72.28%),其中5类问题显著降低(P<0.05)。结论医联体下新药学服务模式的开展,强化了医联体内部同质化管理,促进了药学服务下沉,加强了信息化建设,有助于不断推进医联体内部药事管理同质化发展,充分发挥基层药学人员专业特长,从而提升基层医疗机构的医疗质量和优质药学服务水平,促进我国药学事业的同步发展。

基于审方中心信息化和药师同质化促进门急诊处方合理性的效果分析

目的探讨审方中心信息化和药师同质化对提高门急诊处方合理性的效果。方法基于合理用药管理系统的系统规则和人工设置的自定义规则,经过信息化和流程规范化管理,比较审方中心成立前(2023年2—7月)和成立后(2023年8月—2024年1月),药师审方质量、效率同质化和处方合理率的变化情况。结果与审方中心成立前比较,审方中心成立后审方药师审核通过率显著提高(P<0.05),平均耗时均延长(P<0.01):平均耗时、通过平均耗时和打回平均耗时分别由(4.50±0.58)、(4.50±0.58)、(4.75±0.96)s延长至(11.67±1.03)、(8.50±0.55)和(13.17±0.98)s。门急诊处方不合理率由2023年8月6.27%逐月下降至2024年1月0.93%(P<0.01)。审方中心成立以来干预系统规则数和门急诊处方不合理率具有显著相关性(P=0.0044)。结论利用审方中心平台,成立专职审方药师和信息药师团队,通过信息化和规范化管理流程,可助力提升审方质量与效率,提高处方合格率,提高医院管理水平和医疗质量。

1例肺血栓栓塞症伴多种合并症乳腺癌患者的抗凝治疗分析与药学监护

目的 为肺血栓栓塞症(PTE)伴多种合并症乳腺癌患者的抗凝治疗和药学监护提供参考。方法 临床药师参与1例PTE合并继发于系统性红斑狼疮的可疑抗磷脂综合征伴血小板重度减少的乳腺癌患者的诊疗过程,并提供制订个体化抗凝方案、监测患者出血情况等药学监护。针对患者出现的PTE,临床药师建议停用所有乳腺癌治疗药物;针对初始抗凝方案,临床药师在明确血小板重度减少并非抗凝治疗的绝对禁忌证后,建议予磺达肝癸钠注射液抗凝治疗;针对长期抗凝方案和疗程,临床药师建议优选华法林,推荐疗程至少3~6个月,并根据12周后的抗磷脂抗体谱复查结果结合肿瘤治疗方案决定是否进行无限期抗凝治疗。结果 医师采纳临床药师建议。经治疗后,患者血丝痰及气促消失,血小板恢复正常,准予带药出院。结论 临床药师以“抗凝-出血”为切入点,通过分析乳腺癌治疗相关药物与PTE的因果关系、充分评估患者的出血和血栓复发风险、监测患者出血症状和体征及凝血指标等药学服务,为患者制定了个体化用药方案,保障了患者用药的安全有效。

临床药师通过不同切入点参与肾移植受者围妊娠期药学服务的案例分析

临床药师从不同切入点为处于不同妊娠阶段的肾移植受者提供药学服务,包括妊娠早期药物对胎儿的安全性影响评估、妊娠晚期基于药物相互作用及不良反应的治疗方案优化、围术期镇痛方案的个性化选择以及哺乳期药物的安全性评估。医师或患者接受并采纳临床药师的建议,母体疾病得到有效控制,胎儿健康分娩。临床药师对肾移植受者提供的围妊娠期药学服务有助于提升该特殊群体的用药安全性、合理性。

临床药师参与一例妊娠合并胆囊炎的药学实践和体会

目的探讨临床药师在妊娠合并急性胆囊炎治疗中促进合理用药的作用,为临床类似病例治疗的药学实践提供参考。方法以某院收治的1例妊娠合并急性胆囊炎患者为例,根据患者的特殊生理状况与疾病用药特点,从药物选择、疗效、并发症以及不良反应等方面进行分析,为患者制定有效的治疗方案。结果临床药师协助临床医生制定个体化治疗方案并提供药学服务,使疾病得到良好控制,改善了围生期母婴结局。结论临床药师是治疗团队的一员,应该与医生、护士共同组成救治团队,参与临床救治,并可在妊娠合并胆囊炎的药物使用方面发挥专业优势。

临床药师参与1例婴儿难治性重症沙眼衣原体肺炎治疗的药学实践

目的探讨临床药师在婴儿难治性重症沙眼衣原体肺炎治疗过程中的作用。方法临床药师查阅国内外文献,对婴儿沙眼衣原体肺炎的流行病学、临床特征、微生物检测及抗感染治疗方案进行分析和讨论,并结合患儿实际病情提出个体化用药建议。结果临床医师采纳临床药师建议,采用呼吸道病原体靶向测序技术检测出沙眼衣原体。在考虑婴儿用药安全性、有效性及依从性的基础上,加用阿奇霉素静脉给药抗沙眼衣原体感染,并成功治愈出院。结论临床药师参与婴儿沙眼衣原体肺炎抗感染用药方案的制订,确保了用药的安全性和有效性,并提出相关建议,为临床治疗婴儿沙眼衣原体肺炎提供了依据和方向。

家庭医生签约制度下临床药师对痛风患者的管理实践

目的探讨家庭医生签约制度下临床药师对痛风患者的管理模式和管理效果。方法选取某社区卫生服务中心2021年11月至2022年10月收治的签约痛风患者200例,随机分为对照组和干预组,各100例,管理期间失访脱落6例,最终对照组纳入98例、干预组纳入96例。两组患者均由签约医师根据病情制订治疗方案,对照组患者予常规治疗,干预组患者在对照组治疗基础上增加临床药师管理,临床药师加入签约团队进行为期1年的管理与随访,为患者提供个体化用药方案调整、用药指导、痛风相关知识宣教和不良反应监测。两组患者均于签约后2个月、4个月、6个月、8个月、10个月、12个月进行随访,并对比两组患者的血尿酸达标率、用药依从性、不良反应发生率和痛风发作率。结果随着随访时间的延长,两组患者的血尿酸达标率均呈上升趋势,随访至12个月时,干预组的达标率显著高于对照组(75.00%比46.94%,P<0.05);干预组患者干预6个月、8个月、10个月、12个月的依从率分别为84.38%,79.17%,77.08%,73.96%,显著高于对照组的72.45%,63.27%,54.08%,45.92%(P<0.05);随访期间,对照组发生2例不良反应,干预组发生1例不良反应,其分级均为轻度,且两组无显著差异(P>0.05);干预12个月时,干预组患者痛风发作17例次,显著低于对照组的32例次(P<0.05)。结论临床药师加入家庭医生签约团队,参与痛风患者的管理,可有效提高血尿酸达标率和用药依从性,降低痛风发作率,为痛风患者的家庭医生团队管理提供了参考,也为其他慢性病的基层药学服务和家庭医生签约制度实施提供了借鉴。

药师如何参与医保合理用药及医保控费工作的探讨

目的 探讨医疗机构药师如何利用自身职能参与医保合理用药及医保控费工作。方法 药师通过医保局反馈的医保违规数据,梳理目前医保用药存在的问题,根据文献、指南等,分析医保违规用药存在的问题,结合药师参与医保控费实际工作,探讨药师如何通过药学路径合理控费,规范医保用药。结果 药师可以通过药学管理多个路径参与医保合理控费工作,减少医保基金浪费。结论 药师作为医院用药的重要把关人,可以在医保控费中发挥职能作用,合理控制药品费用、住院费用,保障患者合理用药,从而实现医保、医院、患者共同受益。

临床药师与护师协同合作在提高血栓性疾病患者用药合理性中的作用

本文介绍抗凝治疗专业临床药师针对专科护理人员开展的以提升护理团队对于抗血栓药物的使用和管理水平为主要目的的药学实践工作内容,同时结合国内外文献,探索临床药师与护师协同合作模式。通过调查护师对临床药师工作的认可程度,表明临床药师定期对护师进行抗血栓药物知识培训并给予药学支持工作有助于提升护理质量。临床药师应充分发挥其药学专业特长,探索药师与护师优势互补的药护协同合作模式,增加血栓性疾病患者药物治疗的有效性和安全性。

临床药师参与的综合用药干预在精神分裂症患者中的应用效果分析

目的:分析临床药师参与的综合用药干预在精神分裂症(SZ)患者中的应用效果。方法:选取2023年8月—2024年7月于徐州市铜山区济复医院接受治疗的SZ患者84例作为研究对象,采用随机数字表法分为对照组(n=42)与试验组(n=42)。对照组实施常规用药指导,试验组实施临床药师参与的综合用药干预。比较两组用药规范性、用药依从性、精神症状、不良反应发生情况。结果:干预后,两组用药规范性、用药依从性评分高于干预前,且与对照组比较,试验组更高(P<0.05)。干预后,两组阳性症状、阴性症状、一般精神病理评分及总分低于干预前,且与对照组比较,试验组更低(P<0.05)。与对照组比较,试验组不良反应总发生率更低(P=0.048)。结论:临床药师参与的综合用药干预SE患者中的应用效果显著,可提高患者的用药规范性及依从性,减轻精神症状,保障患者用药安全性。

1例免疫缺陷患儿播散性马尔尼菲篮状菌感染的药学监护

目的为临床安全、合理治疗免疫缺陷患儿播散性马尔尼菲篮状菌(TM)感染提供参考。方法临床药师通过参与1例免疫缺陷患儿播散性TM感染的治疗,结合相关指南、专家共识、患儿检查结果对其抗真菌用药的选择、药品不良反应(ADR)等实施药学监护。结果基于患儿的血培养结果为TM,临床药师建议予两性霉素B脱氧胆酸盐抗真菌;但患儿仍反复高热,痰培养结果仍为TM,考虑为播散性TM,建议加用注射用伏立康唑联合抗真菌;患儿病情稳定后,调整为伏立康唑片单药口服治疗。同时建议行基因检测,结果提示X连锁高免疫球蛋白M综合征,出院继续口服伊曲康唑口服液维持治疗。随访6个月,患儿预后良好,无复发。结论目前,尚无关于预防及治疗免疫缺陷患儿播散性TM感染的标准或指南,临床药师参与免疫缺陷患儿播散性TM感染的药学监护,可提高合理用药水平,保障用药安全。

门诊处方适宜性审核的难点内容回顾性分析

目的通过对医院门诊处方适宜性审核,提高药师审核处方能力。方法对2019年~2023年门诊处方采取系统审核后药师再次审核,选取难点内容进行分析,去掉重复案例。结果难点内容233例,不合理70处,不合理处占30.04%,主要表现在用药与临床诊断(14处),剂量与给药频次(19处),重复用药(8处),剂型与给药途径(6处)和联合用药(6处)等方面,审方药师提供专业修改建议给处方医师,保障处方合理。结论药师挖掘出了很多的假阳性处方和假阴性处方,提高了审方能力和效率,保障了处方合理,保障了患者用药安全。

临床药师干预对Ⅱ类切口围手术期预防用抗菌药物使用的影响分析

目的分析临床药师干预对Ⅱ类切口患者围手术期预防用抗菌药物情况的影响。方法利用霍邱县第二人民医院信息系统随机检索2023年1—12月行Ⅱ类切口手术的住院患者440例,按照临床药师干预时间节点(2023年7月1日)分为对照组(220例)与观察组(220例),收集并统计两组围手术期预防用抗菌药物相关信息,如预防用抗菌药物时机、预防用抗菌药物遴选、预防用抗菌药物时长等,以《抗菌药物临床应用指导原则(2015年版)》作为点评标准,比较两组围手术期预防用抗菌药物的使用情况。结果观察组围手术期未预防用抗菌药物比例高于对照组,头孢唑肟/噻肟、联合甲硝唑用药比例低于对照组,≤24 h用药占比高于对照组,>48 h用药占比低于对照组,平均用药时长短于对照组,预防性抗菌药物合理用药率高于对照组,差异有统计学意义(P<0.05)。结论临床药师干预能有效促进围手术期预防用抗菌药物的规范使用,提高预防用抗菌药物合理用药率,同时减少非必要用药及非必要联合用药等不合理用药现象。

临床药师参与1例神经外科术后难治性耐药铜绿假单胞菌感染患儿的治疗实践

目的:分析临床药师参与治疗神经外科术后难治性耐药铜绿假单胞菌感染患儿的实践经验。方法:回顾性分析1例临床药师全程参与神经外科术后难治性耐药铜绿假单胞菌感染患儿的治疗过程。结果:临床药师结合患儿病情、病原菌特点及抗菌药物特性,协助临床医师进行治疗方案的制定并提供药学监护,最终患儿感染得以控制。结论:在神经外科术后难治性耐药铜绿假单胞菌感染患儿的治疗过程中,临床药师结合自身专业知识,及时协助医师进行抗感染方案的制定、调整和药学监护,保障了治疗的安全性与有效性,发挥了临床药师在治疗团队中的重要作用。