Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

A Study of Cognition and Demand of Pharmacy Services in Hospitals from the Views of Doctors,Pharmacists and Patients

Objective To study the cognition and demand of pharmacy services in hospitals from the views of doctors,pharmacists and patients and to provide references for improving the quality of pharmacy services.Methods 3 level 2 hospitals and 3 level 3 hospitals in Beijing were selected and questionnaires for doctors,pharmacists and patients were distributed and collected.Results and Conclusion Cognitively speaking,69.85% of doctors and 75.36% of pharmacists believe that pharmacy services are necessary,and 81.1% of patients believe it is helpful for pharmacists being involved in the process of treatment plans.Doctors and pharmacists themselves believe that the current pharmacist’s service ability is still insufficient,mainly due to the lack of clinical knowledge and the knowledge of medication combination.In terms of demand,doctors and patients have higher demand for pharmacy services,which is mainly involved in designing patient treatment plans,providing drug information and giving medication advice,and providing medication counseling.Doctors,pharmacists and patients all recognize and support the development of pharmacy services.However,in the understanding of the meaning of pharmacy services,doctors are better than pharmacists.Doctors and patients have greater demand for pharmacy services,but the supply of pharmacy services is still far from enough.It is recommended to strengthen the construction of related systems,incorporate pharmacy service work into hospital performance appraisal;attach importance to pharmacy professional talent training,improve pharmacy service ability,explore new hospital pharmacy service mode and to promote hospital pharmacy development.

Training of clinical pharmacists in psychiatric pharmacy services during the prevention and treatment of COVID-19

A series of pharmacy services of clinical pharmacists at the Wuhan Mental Health Center during the prevention and treatment of Coronavirus disease 2019(COVID-19),such as participation in the formulation of COVID-19 prevention and treatment plans suitable for psychiatric departments,popular science of pharmacy,medical order review,real-time intervention,and medication education are summarized here.Due to the sudden public health incident,the service model of psychiatric clinical pharmacists should be addressed,as clinical pharmacists are an important part of the diagnosis and treatment of psychiatric diseases.Among the majors currently available in the clinical pharmacy training base curriculum,no psychiatry major has been set up in China yet;therefore,in this paper,we provide guidance in psychiatry pharmacy for those who wish to integrate clinical teams.

To Carry out Drug Consultation to Improve the Quality of Pharmacy Service in Outpatient Pharmacy

Objective:to explore the development of drug counseling service,strengthen the quality of pharmacy service in outpatient pharmacy,better service to patients,promote harmonious relations between doctors and patients.Methods:to analyze the necessity of drug consultation in outpatient pharmacy,in order to improve the quality of pharmacology service in outpatient pharmacy,we will discuss how to effectively provide drug counseling to improve the pharmacological service quality of outpatient pharmacy.Results:the implementation of the complete drug consultation process can effectively improve the quality of pharmaceutical work in outpatient pharmacy.Improve the patient's satisfaction with pharmaceutical work.Conclusion:with the perfection of the medical system,improving the quality of pharmaceutical service in outpatient service,and improving the quality of medical consultation,make it more systematic,normalization is important,only improving the quality of outpatient pharmacy service and strengthening the development of drug consultation work,to achieve the common progress of medical services.

Pharmacy Service in Private Hospitals: Problems and Countermeasures

Objective To improve the quality of pharmacy service in private hospitals on the background of the fact that hospital pharmacy service is an important guarantee to promote rational drug use and the government encourages social capital to enter the field of pharmacy and healthcare, therefore, private hospitals are facing a new stage of development. Methods Questionnaire survey was used to sample and analyze 10 representative private hospitals in local area, and comparisons were made with the status of pharmacy service in level 3 public hospitals. Results and Conclusion It can be found that private hospitals have many problems in pharmacy services, such as the low level of professional skills of pharmaceutical personnel, low recognition and trust from patients, and the imperfect pharmaceutical management system. Some countermeasures and suggestions are put forward to promote the level of pharmacy services in private hospitals on the basis of this study.

中药智慧药学服务的实践与技术分析

目的 分析中药智慧药房的发展现状,总结中药智慧药学服务实践经验,概述其技术要求和发展方向。方法 成都中医药大学附属医院自2018年1月启动智慧中药房项目,建立中药智慧药房,承担门诊中药饮片调剂、煎药、配送等药学服务业务。结果 截至2023年5月已完成中药饮片代煎配送557.2万副,2022年度共服务患者23.14万人次。服务环节更简单,无需等候取药,无需二次到院取药,服务效率高,改善了患者就医体验。结论 中药智慧药学服务发展迅速,未来将依托技术进步建立全程化智慧服务体系。

Investigation on the Current Situation of China’s DTP Pharmacy and Suggestions for Its Development

Objective To summarize the main characteristics and development approaches of direct-to-patient(DTP)pharmacies,and to explore its future development trend.Methods Firstly,relevant policies of DTP pharmacies were sorted out based on some documents on the government website,and related articles were studied.Secondly,499 DTP pharmacies were investigated.Finally,the current status of the industry was summarized and analyzed.Results and Conclusion Policies on China’s DTP pharmacy have been constantly improved.According to industry standards,the current compliance rate of DTP pharmacies is about 46.09%.In terms of varieties,the market share concentration rate of biological products is higher than that of chemical drugs.The regional distribution of these drugs is mainly concentrated in the central and eastern provinces.However,63.45%of DTP pharmacies have less than 50 product specifications.DTP pharmacies have an average of 7.3 pharmacy technicians and 2.3 licensed pharmacists,which is higher than that of ordinary pharmacies.Due to the policy promotion,DTP pharmacies will be paid more attention by the public and the government,and the market share will become larger than before.Patients shifting from hospitals to drug-to-pharmacies can make them better layout.Besides,pharmaceutical services will become more specialized,and disease division will be more detailed.With the deepening of medical reform and the continuous improvement of national medical security as well as drug procurement and medical insurance payment methods,DTP pharmacies can play an important role in the national basic medical security system.

呼吸与危重症医学科咳喘药学门诊的建设实践与效果评价

目的 回顾性总结呼吸与危重症医学科(PCCM)咳喘药学门诊实践成果,与综合药学门诊进行成效对比,评估其药学服务价值,为其他医疗机构药学门诊的规划建设提供参考。方法 选取黄石市中心医院药学综合门诊2020年11月至2021年5月及PCCM咳喘药学门诊2021年11月至2022年5月就诊的哮喘病例,通过药学门诊病人用药评估指导单、病人吸入装置操作评定表,对比评价药学综合门诊和PCCM药学门诊的药学服务效果。结果 以药学综合门诊哮喘病人为对照组,PCCM咳喘药学门诊哮喘病人为干预组,病人自我用药情况评估,在知晓用药原因、用法用量、不良反应应对措施、药物相互作用方面,首次就诊:对照组为92例(64.8%)、109例(76.8%)、87例(61.3%)、85例(59.9%),干预组为90例(65.2%)、107例(77.5%)、83例(60.1%)、80例(58.0%),两组差异无统计学意义(P>0.05),复诊或随诊时:对照组为118例(83.1%)、114例(80.3%)、98例(69.0%)、94例(66.2%),干预组为132例(95.7%)、128例(92.8%)、123例(89.1%)、120例(87.0%),干预组改善情况优于对照组(P<0.05);哮喘控制测试(ACT)评分,在良好控制、控制不佳方面,首次就诊:对照组为21例(14.8%)、121例(85.2%),干预组为19例(13.8%)、119例(86.2%),两组差异无统计学意义(P>0.05),复诊或随诊时:对照组为88例(62.0%)、46例(32.4%),干预组为105例(76.1%)、8例(5.8%),干预组改善情况优于对照组(P<0.05);吸入制剂药师指导前后测评,在操作一般、操作不佳方面,药师指导前:对照组为82例(60.3%)、32例(23.5%),干预组为81例(62.3%)、29例(22.3%),两组差异无统计学意义(P>0.05),药师指导后:对照组为76例(55.9%)、18例(13.2%),干预组为30例(23.1%)、2例(1.5%),干预组改善情况优于对照组(P<0.05)。结论 PCCM药学门诊与综合药学门诊相比,在哮喘病人的药物知识教育、吸入装置操作、哮喘控制效果等方面能够发挥出更好的药学服务作用,对其他医疗机构规划建设药学门诊具有一定的借鉴及参考意义。

我国静脉用药调配中心洁净环境相关研究的文献计量学分析

目的检索国内静脉用药调配中心(PIVAS)洁净环境研究的相关文献,分析研究现状及问题,为提升PIVAS洁净环境、促进成品输液质量提升提供参考。方法以主题词、题名、关键词或常用字段检索2010—2022年收录在中国知网、万方数据库、维普中文科技期刊数据库及中国生物医学文献数据库中与PIVAS洁净环境研究相关的文献,运用Excel软件记录文献基本特征,运用CiteSpace 6.2.2软件绘制作者和关键词可视化知识图谱并进行分析。结果中文文献共检索出750篇,纳入分析274篇,其中北大核心期刊文章占比17.52%(48篇)。文献研究方向主要为质量控制、感染管理、洁净环境监测等,发文作者集中于江苏、广东、河南等省份,第一作者多为主管护师(22.86%)。结论近年来PIVAS洁净环境相关研究发文量总体平稳但研究型论文发文量呈上升趋势,先进便捷的环境监测技术是未来重点研究方向。

全程管理模式对临床药师抗感染会诊效果影响的前后对照单臂观察性研究

目的 探讨全程管理模式对医院临床药师抗感染会诊的影响效果。方法 对长沙市第四医院临床药师抗感染会诊实施全程管理模式前(2021年2—7月)的592例会诊病例和实施全程管理模式后(2022年2—7月)的688例会诊病例的抗菌药物使用疗程、抗菌药物使用品种数、抗菌药物使用费用、抗菌药物使用累计DDD(限定日剂量)数、抗菌药物使用强度、病人住院天数、病人住院费用和病人住院药品费用等指标进行对比和分析。结果 实施全程管理模式后,临床药师参与管理的抗感染会诊病例的抗菌药物使用累计DDD数减少3.31(实施前21.16±19.65,实施后17.85±16.09)、抗菌药物使用强度减少6.79(实施前103.22±58.37,实施后96.43±48.80)、病人住院天数减少2.26 d[实施前(20.59±13.13)d,实施后(18.33±11.71)d],抗菌药物使用天数、抗菌药物使用品种数、抗菌药物使用费用、病人住院费用以及病人住院药品费用等指标差异无统计学意义。结论 全程管理模式对临床药师抗感染会诊效果影响显著,对降低临床药师参与抗感染会诊病例的抗菌药物使用强度及减轻病人疾病负担具有重要意义,值得推广应用。

焦点循环管理法在静脉用药调配中心多环节质量控制中的应用

目的探讨焦点循环管理法(FOCUS-PDCA)在静脉用药调配中心多环节质量控制中的应用效果。方法跟踪2016—2022年淄博市中心医院东院静脉药物调配中心各年各类错误发生情况,采用FOCUS-PDCA发现问题,分析原因,制订相应的目标及措施并持续改进,2016年FOCUS-PDCA实施前用药医嘱作为对照组,2017—2019年FOCUS-PDCA实施后用药医嘱作为第一轮干预组,2020—2022年FOCUS-PDCA实施后用药医嘱作为第二轮干预组,分析两轮干预前后不合理医嘱未审核率,排药、贴签、混合调配及复核包装不合格率变化情况。结果第一轮干预组排药、贴签和混合调配不合格率低于对照组,差异有统计学意义(P<0.017);第一轮干预组不合理医嘱未审核率和复核包装不合格率与对照组比较,差异无统计学意义(P>0.05)。第二轮干预组各类质量不合格率低于对照组,差异有统计学意义(P<0.017);第二轮干预组不合理医嘱未审核出率、排药和复核包装不合格率低于第一轮干预组,差异有统计学意义(P<0.017);第二轮干预组贴签和混合调配不合格率与第一轮干预组比较,差异无统计学意义(P>0.05)。结论FOCUS-PDCA能显著降低静脉用药调配中心的错误发生率,为临床合理用药提供保障。

以临床药学服务能力为导向的药物毒理学教学设计探讨

药物毒理学课程在医药学专业本科教育中日益重要。针对不同教学模块采用医学问题前移、刻意训练和切块拼接等教学设计提升学生对知识的掌握程度;通过药学服务实践、学科竞赛等第二课堂促进知识能力融合、技术素养共同进步,最终提升学生临床药学服务能力、为其奠定坚实的从业基础。

某院2019至2021年PIVAS沉降菌检测结果分析

目的分析医院静脉用药调配中心(PIVAS)洁净区沉降菌检测结果,评估洁净区的洁净程度。保证洁净区环境指标达标,便于进行精细化管理。方法统计2019至2021年PIVAS内部不同洁净级别区域沉降菌检测结果,并对检测数据进行对比分析处理。结果操作台3年合格率频数大部分集中在>90%,调配间3年合格率均>90%;操作台合格率两两比较显示合格率呈逐年增高趋势,差异均有统计学意义(P<0.05);操作台检测结果与月份无明显关系(P>0.05)。结论沉降菌检测结果影响因素较复杂,只有按要求规范严格做好各方面工作才能保证检测结果的真实,才能准确评估洁净区的洁净程度。

静脉用药调配中心实施六西格玛管理联合目视管理模式的价值研究

目的探究目视管理联合六西格玛管理模式在静脉用药调配中心的应用价值。方法收集南京中医药大学附属南京医院实施目视管理时1400张药方作为对照组,实施目视管理联合六西格玛管理模式时1400张药方作为观察组,药方按照电脑予以简单随机法进行分配。比较两组的质量控制指标、配药质量、不良事件发生率、临床各科室满意程度。结果观察组总差错率(0.50%)低于对照组(3.43%)(χ^(2)=38.988,P=0.000);对照组配药及时率、配药准确率、成品输液合格率(分别是88.28%、94.35%、89.07%)低于观察组(分别是96.35%、97.72%、93.14%)(χ^(2)=64.330,P=0.000;χ^(2)=20.722,P=0.000;χ^(2)=14.322,P=0.000)。观察组不合理医嘱审出率、药物破损率、配药差错率、不良事件出现概率(分别是0.21%、0.50%、2.28%、1.07%)低于对照组(分别是1.07%、1.64%、5.65%、4.21%)(χ^(2)=8.052,P=0.005;χ^(2)=8.626,P=0.003;χ^(2)=20.722,P=0.002;χ^(2)=26.872,P=0.000)。观察组临床各科室满意度(91.34±6.29)分高于对照组(83.67±5.14)分(t=869.645,P=0.000)。结论在静脉用药调配中心采用六西格玛管理联合目视管理模式可提高配药质量、工作效率,减少不良事件的发生,有利于静脉配药调配中心的运行。

某院静脉用药调配中心抗肿瘤药物不合理医嘱评价结果分析

目的探讨某院静脉用药调配中心抗肿瘤药物不合理医嘱的原因,根据不合理的原因制定个性化的对策,规范患者合理、安全用药。方法收集某院2023年静脉用药调配中心抗肿瘤药物不合理医嘱的记录共258条,统计这些不合理医嘱的药物种类、科室分布,以及记录不合理医嘱的原因,并采取针对性的措施,减少不合理医嘱。结果统计分析显示,某院2023年静脉用药调配中心抗肿瘤药物不合理医嘱共258张,其中放疗科、肿瘤科、胸外科的不合理医嘱比率占前三位,分别为32.17%、21.71%、20.16%;不合理类型中溶媒选择不合理的占比最高,为43.41%,其次分别为溶媒用量、浓度不合理,用药剂量不合理,用药顺序不合理,配伍不当,其他,占比分别为29.07%、15.50%、5.04%、4.26%、2.71%。112张抗肿瘤药物溶媒选择不合理医嘱中,注射用依托泊苷溶媒选择不合理最多,占比为33.04%。75张抗肿瘤药物溶媒用量、浓度不合理医嘱中,注射用吉西他滨溶媒用量、浓度不合理最多,占比为24.00%。40张抗肿瘤药物用药剂量不合理医嘱中,复方苦参注射液超量使用最多,占比为40.00%。结论评价静脉用药调配中心抗肿瘤药物不合理医嘱发生具体原因,加强合理用药管理,采取针对性的措施,可保障抗肿瘤药物合理应用。

医院静脉用药调配中心抗肿瘤药物配置的精益管理

目的研究分析精益管理在医院静脉用药调配中心(Pharmacy Intravenous Admixture Services,PIVAS)抗肿瘤药物配置中的应用效果。方法选取2022年1月—2023年12月滨州市中心医院PIVAS的22名抗肿瘤药物配置工作人员作为研究对象,按照时间的不同,设为对照组(实施常规管理,2022年1—12月)和观察组(实施精益管理,2023年1—12月)。对比分析两组的管理效果。结果观察组的审方、配置、排药时间均短于对照组,差异有统计学意义(P均<0.05)。观察组药物配置环节差错发生率比对照组低,差异有统计学意义(P均<0.05)。观察组的总满意度高于对照组,差异有统计学意义(P<0.05)。结论在PIVAS抗肿瘤药物配置中,采取精益管理能够获取良好效益,可有效提升药物配置质量,同时能够有效减少差错事件发生,为临床抗肿瘤药物的合理用药提供了保障。

品管圈管理在静脉用药调配中心的应用效果

目的:观察品管圈管理在静脉用药调配中心(PIVAS)的应用效果。方法:选取2020年1—12月该院PIVAS的46名护士作为对照组,实施常规管理;另选取2021年1—12月该院PIVAS的46名护士作为观察组,实施品管圈管理。比较两组配药安全知识知晓率、药物配制差错率和药物配送时间延长率。结果:观察组药物配置流程、药物配伍禁忌、药物剂量换算、用药前正确评估患者、药物输注流程、输注时观察要点等配药安全知识知晓率均高于对照组,差异有统计学意义(P<0.05);观察组药物配置差错率为0.48%(12/2500),低于对照组的2.32%(58/2500),差异有统计学意义(P<0.05);观察组药物配送延长率为0.36%(9/2500),低于对照组的2.48%(62/2500),差异有统计学意义(P<0.05)。结论:品管圈管理应用于PIVAS可提高配药安全知识知晓率,以及降低药物配制差错率和药物配送时间延长率的效果优于常规管理效果。

临床药学服务价值评价实践指南(第一版)

目的为评价临床药学服务价值提供较为全面的评估体系,为改进和优化临床药学服务提供指导。方法采用世界卫生组织(WHO)指南制定手册进行指南的研究设计。采用德尔菲法确定临床问题,通过系统检索,秘书组广泛收集相关问题已有的循证证据,完成系统评价、证据分级,撰写证据总结,由写作组根据秘书组的分析报告具体撰写指南。采用澳大利亚Jonana Briggs循证卫生保健中心(JBI)证据级别系统和WHO 2004年推荐分级的评估、制定与评价系统(GRADE)对该指南进行证据质量分级,通过德尔菲法对推荐意见及证据级别达成共识,最终形成《临床药学服务价值评价实践指南》(第一版)。结果通过对100余位专家进行问卷调研,德尔菲法投票,该指南拟纳入临床药学价值评价指标23项。将纳入的指标相关内容按照纳入文献的人群、干预措施、对照和结局原则进行检索,并进行系统评价、Meta分析、网状Meta分析以及相关原始研究。每项检索策略经指南指导委员会审定,确定临床药学价值评价的推荐意见20项。结论该指南提供了一套衡量临床药学服务质量和效益的指标体系,对于改进和提升医疗机构临床药学服务具有重要意义。

FMEA模型和6S管理方法在降低儿童专科医院PIVAS调剂差错中的应用

目的降低儿童专科医院静脉药物配置中心(PIVAS)的调剂差错。方法采用失效模式和效应分析(FMEA)模型,对我院PIVAS调剂流程进行风险识别,找出各环节中可能导致调剂差错的潜在失效模式,分析其失效原因,并对潜在失效模式的严重度、发生率和检测度进行量化评分,计算其风险优先指数,从而筛选需要优先改善的失效模式;应用6S管理方法,从整理(seiri)、整顿(seiton)、清扫(seiso)、清洁(seiketsu)、素养(shitsuke)和安全(safety)6个方面制定相应的改善措施,并对实施前后的干预效果进行评价。结果根据风险优先指数评估筛选出32个潜在失效模式,其中需要优先改善的关键失效模式共18个。根据6S管理方法采取相应措施后,18个关键失效模式的风险优先指数均有所下降,风险优先指数值由497降至142,降幅达71.43%;其中15个关键失效模式的差错率均较实施前显著降低(P<0.05)。结论应用FMEA模式和6S管理方法对PIVAS工作流程的各环节进行风险管控的预测和改进,能有效降低PIVAS调剂差错风险,保障儿童静脉用药安全。

民族地区特色智慧药学服务平台的建设和应用

目的 构建适用于民族地区特色的智慧药学服务平台,以优化药师资源,改善药学服务质量。方法 以四川省凉山彝族地区为例,通过结合多种形式的彝语用药指导,对成熟的药学服务软件进行改进创新。结果 平台经过初步运行,药学部初步建立了彝语用药指导共计150条,平台日均推送461条用药指导内容,其中彝汉用药指导276条,患者可通过微信公众号、手机短信等途径接收,用药指导覆盖率明显提升。结论 通过彝族地区特色药学服务平台提升了彝族地区药学服务质量,满足彝族患者的个性化需求,可为其他民族地区的药学服务提供新的思路和方法。