超越pharmaceutical care,呼唤中国特色的药学实践规范

本文将各种药学实践模式及中国药学实践规范加以阐述。药学实践在美国可分为 5个阶段 ,Pharmaceuticalcare (PC)是美国药学发展的一个新阶段 ,此概念已进入国内药学。虽然国外药学已走上规范化发展 ,但国内药学存在许多问题 ,药学工作离规范化发展相距甚远 ,因而建立中国药学实践规范极有必要。为此 ,我们提出了中国药学实践规范的初步建议。

The effect of pharmaceutical care in the elderly patients with type 2 diabetes mellitus

Pharmaceutical care plays a crucial role in reducing mortality and morbidities of the patients.A hospital based quasiexperimental study was conducted with elderly patients with type 2 diabetes who attended at the diabetes clinic of No.(2)Military Hospital(500-Bedded)in Myanmar from April 2013 to February 2014.The aim of this study was to evaluate the effect of pharmaceutical care in elderly patients with type 2 diabetes mellitus.A total of 52 respondents enrolled in this study.The clinical outcomes and quality of life of patients before and eight months after intervention were assessed.Pharmaceutical care program was implemented as intervention.Of the total number of respondents,52 drug related problems were identified.

A Literature Review: Pharmaceutical Care an Evolving Role at Community Pharmacies in Pakistan

The aim of this paper is to highlight the role of pharmaceutical care at community pharmacies in Pakistan. The paper draws on the literature related to current dispensing practices at community pharmacies in developing countries as well as in Pakistan. There are approximately 63,000 community pharmacies in Pakistan, and according to an estimate, 80% of the medicines are being distributed through this channel to majority of the population. They often lack adequate facilities, staffing and equipments. Absence of pharmacists and their roles being performed by the non-qualified personnel working at community pharmacies are a common practice. There are 8102 pharmacists who are categorized as a category, 31,000 pharmacy technicians categorized in B & C category in the country. There is a shortage of pharmacists who could be engaged for ensuring good pharmacy practices. There are only ten percent of the total pharmacists who work at community pharmacies in the country according to the Pharmacy Council of Pakistan. All kind of medicines are freely available irrespective of their status as prescription or over the counter drugs. The paper highlights that the professional role of pharmacist in hospitals and community pharmacies is switching from dispensing and sale of drugs, to patient counselling. But, the concept of pharmaceutical care at community pharmacies has not been acknowledged yet in Pakistan. The process of prescription handling is poor and patients are often treated without a proper prescription. Prescription validation, drug labeling and patient counseling are the missing components in effective patient management at the community pharmacies. The paper concludes that although laws exist, but due to lack of accountability and weak regulatory framework their proper implementation is not witnessed. Moreover, due to lack of research and evidence related to problems in dispensing practices in healthcare system of Pakistan, the counteractive actions for resolving these problems are limited.

Experience of clinical pharmaceutical care carried out in pediatric respiratory department

Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department.Methods Supply pharmaceutical information,participate in clinical rounds,provide the rationalization proposal,help doctors to formulate correctly dose regimen,enhance medication efficiency;establish medicine record for the patient,record the drugs which were used,provide pharmaceutical care for the patient such as disease propaganda,medicine-use education,medicine consultation and so on.Results Promote rational administration,enhance the security of medical practice,the clinical pharmacists' work obtains the doctors' approval;improve the medication compliance,reduce patients' economy and spiritual burden,and obtain the patients' trust.Conclusions The pharmaceutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors,cut down the medication cost,shorten the time of patients to be hospitalized,raise the medication efficiency,and promote the doctor-patient relationship harmoniously.In a word the clinical pharmacists are indispensable.

Qualitative and semi-quantitative analysis of health-care pharmaceutical products using laser-induced breakdown spectroscopy

Laser-induced breakdown spectroscopy(LIBS) is a sensitive optical technique that is capable of rapid multi-elemental analysis. The development of this technique for elemental analysis of pharmaceutical products may eventually revolutionize the field of human health. Under normal circumstances, the elemental analysis of pharmaceutical products based on chemical methods is time-consuming and complicated. In this investigation, the principal aim is to develop an LIBS-based methodology for elemental analysis of pharmaceutical products. This LIBS technique was utilized for qualitative as well as quantitative analysis of the elements present in Ca-based tablets. All the elements present in the tablets were detected and their percentage compositions were verified in a single shot, using the proposed instrument. These elements(e.g., Ca, Mg, Fe, Zn, and others) were identified by the wavelengths of their spectral lines, which were verified using the NIST database. The approximate amount of each element was determined based on their observed peaks and the result was in exact agreement with the content specification. The determination of the composition of prescription drug for patients is highly important in numerous circumstances. For example, the exploitation of LIBS may facilitate elemental decomposition of medicines to determine the accuracy of the stated composition information. Moreover, the approach can provide element-specific, meaningful, and accurate information related to pharmaceutical products.

Pharmacist Role in Pharmaceutical Care during Ramadan

Introduction: Ramadan is the ninth month in the Islamic Hijri calendar where Muslims are ex-pected to fast every day from dawn to sunset. The eating behavior changes during Ramadan and the abstinence of food affects the oral drugs administration and other convenience dosage forms. There is a need to highlight and illustrate the role of the pharmacists in medication adjustment challenges that the patients conquer in the Holy month of Ramadan. Objectives: To estimate the awareness of pharmacists’ role in providing pharmaceutical care during Ramadan;moreover, to explore pharmacists’ perspective on the importance of medication regimen adjustment along with the proper counseling required to optimize patients’ health throughout fasting. Method: This is an observational study that was done through dissemination of a cross-sectional survey among 130 pharmacists covering Abu Dhabi, Dubai, Sharjah, Ajman, and Northern Emirates regions. The targeted population consisted of practicing community pharmacists and hospital pharmacists across UAE. Results: Among pharmacists participated in the study 115 pharmacists (88.5%) were Muslims and 79 pharmacists (60.8%) were Arabs. 126 pharmacists (97%) reported performing one or more kinds of medication regimen adjustment around Ramadan for at least one patient. Changing the frequency had the highest percentage by the pharmacist compared to other methods of regimen adjustment (39%). Moreover, the results revealed that 46.9% of the pharmacists chose not to change the medication itself. Nineteen percent of Muslim pharmacists initiated the conversation about medication regimen adjustment (P = 0.0448) compared to non-Muslims, while14% of pharmacists were Arabs who showed no statistically significant difference. Conclusion: In conclusion, pharmacists are more qualified to adjust and manage medication regimens than what they are presently performing. Utilization of such skill is required to adjust patients’ medication regimen during fasting the Holy month of Ramadan and to ensure safe transition for fasting patients into and out of Ramadan.

Impact of Pharmaceutical Care on Self-Administration of Outpatient Low-Molecular-Weight Heparin Therapy

Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatment of different diseases. The effectiveness of community-pharmacy-based interventions in preventing problems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown. Our objective was to provide a standard operating procedure (SOP) for community pharmacists and to compare pharmaceutical vs. standard care in both clinical and daily life settings. We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction, and in fewer complications;the interventions used are feasible in daily life;and the results achieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlled trial), patients were recruited sequentially in hospital wards;in the daily life setting (quasi-experimental design with a comparison group), recruitment took place in community pharmacies by pharmacists and trained master students during their internship. Interventions were offered according to patient needs. Data were collected by means of a monitored self-injection at home and structured questionnaire-based telephone interviews at the beginning and the end of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills;syringe count to assess adherence;and frequency, effectiveness, and patient’s assessment of received interventions. The results show a median age of the 139 patients of 54 years. Interventions resulted in improved application quality (p p = 0.03). Oral instructions were pivotal for improving patients’ application quality. We found no significant score differences between the intervention groups in the clinical and daily life settings. Patients’ baseline skills were high, with the lowest score being 0.86 (score range ?2.00 to +2.00). Adherence rate was high (95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, appreciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies if adequate assistance is provided.

Pharmaceutical Care:An Additional and Personalized Service in Health Care

The Pharmaceutical Care(PC)service is a growing sector.The continuous development of the role of the professional pharmacist in the sector of health services within the pharmacy leads to having an active role in the primary care.The PC service has been in operation for years in other western countries such as Spain,the United Kingdom and the United States.Several studies have been carried out,which confirm the benefits of the service in reducing morbidity,hospital admissions and the cost of the health care system.This article sets out the concept of PC and the financial benefit to health expenditure.It also analyzes the Drug Therapy Problem(DTP)and the Patient Care Process.To conclude,a patient case is presented to understand the practical implementation of the theory of the PC and to show how the professional pharmacist reports the pharmacotherapeutic case.

The Introduction of Pharmaceutical Care in Psychiatric Outpatients in Community Pharmacy of the Northeast Region of Argentina

The purpose of this paper is to implement a pharmaceutical care program in psychiatric outpatients in a community pharmacy. Outpatients （536） with psychiatric treatment requiring the dispensing of medication prescribed by a psychiatrist were followed up in a community pharmacy, where different medicines were prescribed as PS （pharmaceutical specialties）, PC （pharmaceutical compounding） or both PS and PC. Each prescription was registered with details on a patient level. Also, three reporting sheets were designed： patients profile, patients monitoring and patients counseling. The total study population in the community pharmacy consisted of 536 outpatients： 357 （66.6%） females and 179 （33.4%） males. Most of the outpatients （78.5%） have health insurance, 50% correspond to public and 28.5% to private institution. The other patients （21.5%） do not have medical insurance. We also observed that the education level of these patients was： primary school 19.1%; high school 45.9%; college 15.3% and university 20.7%. Many patients had more than one psychiatric diagnosis, to whom were prescribed different medicines. All the medication studies on the charts were screened for prescriptions with antidepressants and other psychotropic drugs, starting on the date of first diagnosis made by a psychiatrist. The counseling to the patients was also registered. The possibility of the follow-up of these outpatients in the community pharmacy promoted the development of the psychiatric pharmacy and all advances in care for patients with mental health needs, working in closer collaboration with psychiatrists.

Pharmaceutical Care in Homeopathic Treatment

Homeopathy is a therapy based on the principle of similarity. This therapy was proposed by the father of medicine, Hippocrates for almost 3000 years, thus developing the principle ＂Similia similibus curantur＂. Therapy with homeopathic medicines is widely used in therapeutics, but the patient often has difficulty in understanding how the treatment should be conducted. The Pharmaceutical Care, one pact relationship between patient and pharmacist, presents itself as an appropriate tool to assist in obtaining positive results in homeopathic therapy. Objectives： to demonstrate how the pharmacotherapeutic follow--AFT assists in detecting and solving problems related to homeopathic medicine and promotes improvements in response to treatment. Methodology： we performed literature review of the portals： SCIELO, MEDLINE and Google academics. Patients were interviewed by pharmacotherapeutic monitoring that was conducted--AFT employing the Dader method adapted to pharmaceutical care in homeopathic medicines in a pharmacy, this place was located in Rio de Janeiro, from November-December 2010 and January 2011. The research was previously approved by the Research Ethics Committee of the Unigranrio （CAAE： 4531.0.000.317-10）. Results： the first of three interviews were identified DRM （drug related problem）, having been required to apply IF--pharmaceutical intervention to adjust the behavior of the patient regarding the treatment and improvement of the results. Conclusions： the pharmacotherapeutic follow--AFT--introduced himself as appropriate methodology for managing patients on therapy with homeopathic medicines, and an improvement factor in the outcome of treatment of the patients.

A Study of Attitudes toward Pharmaceutical Care during COVID-19 Pandemic in Tbilisi(Georgia)

Background:After the outbreak of COVID-19 in Georgia,the number of patients visiting pharmacies has increased.It became relevant to research the importance of Pharmaceutical Care inprevention of COVID-19.The aim of the study was to understand the attitudes of patients and physicians regarding the involvement of pharmacists in prevention of COVID-19,after the spring and autumn waves of pandemic;also,what role can pharmacists take in the future and whether they can transfer Good Pharmaceutical Practice(GPP)to Georgia.Study also tried to capture overall attitudes towards involving pharmacists in healthcare projects such as population rapid testing and vaccinations.Methods:522 patients,1289 pharmacists,and 200 physicians were surveyed regarding their attitudes toward pharmaceutical care during COVID-19 pandemic.Results:The study found that 82.2%of surveyed patients who visited pharmacy during pandemic bought medication and COVID-19 preventive items(face mask,disinfectants,etc.).Out of the surveyed participants,66.9%of patients and 77.1%of pharmacists believe that recommendations given by pharmacists play an important role in the prevention of COVID-19.Study also revealed that 76.6%of pharmacists and 79.3%of patients agree with the statement,the pharmacist should be able to decide whether to choose over-the-counter medications for a patient or refer the patient to a physician.91.8%of patients and 78.3%of pharmacists believe that during a pandemic pharmacist should provide patients who visit pharmacies with complaints of flu,cold,and fever with Pharmaceutical Care;which is agreed by 41.7%of physicians.63.1%of patients,52%of pharmacists,and 45%of physicians have a positive attitude towards administering rapid testing of COVID-19 by pharmacists.The desire for pharmacists to be involved in vaccination was expressed most in patients(43.6%),followed by pharmacists(38.7%),and physicians(36.7%).Conclusions:The study showed similar attitudes of patients and pharmacists-Pharmaceutical Care plays an important role in pandemic prevention.The attitude of patients and pharmacists is positive regarding administering Pharmaceutical Care for patients who come in pharmacies with symptoms of flu and cold.Physicians had more cautious attitude towards the issue,indicating that they may see risks of spreading the virus and aggravating patients’conditions.Most patients who participated in the study believe that pharmacists should be involved in pandemic prevention activities-COVID-19 tests and vaccinations.It is recommended that Georgian healthcare system develops projects that support collaboration of medical professionals and bring us closer to Good Pharmacy Practice(GPP).Training of pharmacists along with physicians in scope of pandemic prevention projects should be planned.

The Guiding Role of Pharmaceutical Care in the Rational Drug Use of Bronchial Asthma

Objective:To investigate the guiding role of pharmaceutical care in the treatment of bronchial asthma.Methods:Eighty patients with bronchial disease admitted to our hospital from November 2008 to December 1818 were enrolled in this research.The computer program was used to generate random numbers.The method was divided into two groups:control group and observation group,40 cases respectively.40 patients in the control group were treated with normal medication according to the doctor’s advice;40 patients in the observation group were enrolled in the pharmacological care on the basis of the control group,and the rational drug use was compared between the two groups.Results:The incidence of adverse reactions in the observation group and the control group were 5.00%and 17.50%,respectively,and the difference was statistically significant(P<0.05);the incidence of medication error events in the observation group was 7.50%,which was significantly lower than that of the control group,which was 25.00%,and the difference was statistically significant(P<0.05).The medication errors mainly include improper administration,incorrect dosage,and unscientific administration.Conclusion:The guiding role of pharmaceutical care in bronchial asthma rational drug use can reduce medication error events and ensure rational drug use,which is worthy of popularization in clinical practice.

Pharmaceutical care of a patient with antibiotic-associated encephalopathy

Objective:To provide reference of pharmaceutical care for the clinical treatment of a severe patient with antibiotic-associated encephalopathy.Methods:Clinical pharmacists participated in the clinical treatment of the patient with antibiotic-associated encephalopathy,provided pharmaceutical care for clinicians,including the evaluation of adverse drug events and the prevention of adverse drug interaction and development of anti-infection programs by using Pharmacokinetics/pharmacodynamics theory and therapeutic drug monitoring technique.Results:Through active clinical treatment and pharmaceutical care,the symptoms of patients with encephalopathy were relieved,and the infection was effectively controlled.Conclusion:Clinical pharmacists play a positive role in the treatment for the case with antibiotic associated encephalopathy.

Pharmaceutical Care of the Patients Suffering from Depression

Depression is the most present mental disorders with a very expensive treatment costs. Due to the high prevalence of depression in Bosnia and Herzegovina and high work load of psychiatrists, patients that suffer from depression are often marginalised, stigmatised and inadequately treated. Therefore, a pharmacist can influence an adequate selection of a therapy through an interdisciplinary approach and pharmaceutical care and alos provide patient monitoring, counselling about side effects and interactions of the prescribed drugs, which will in the end improve the quality of life for patients that suffer from depression. The aim of this work was to establish the influence of pharmaceutical care on the outcome of the quality of life and the pharmacological treatment of patients suffering from depression. Results showed that the involvement of pharmacist in a multidisciplinary approach to the treatment of depression lead to improvement of the effect of therapy and increased quality of life.

Study on the Management Effect of Pharmaceutical Care on Adverse Reactions of Traditional Chinese Medicines in Joint Surgery and Neurology

Objective:In general hospitals,pharmaceutical care was carried out to reduce the incidence of adverse drug reactions(ADR),and this effect was significant.It can significantly reduce the incidence of adverse drug reactions and improve the safety of drug therapy.The Joint Surgery Department and the Department of Neurology of Changle County People's Hospital in Shandong province were investigated for the effect of pharmaceutical care on reducing adverse drug reactions.Methods:120 patients were selected from the Department of Joint Surgery and Neurology,Changle County People's Hospital,Shandong Province from May 2015 to May 2020.According to the random table method,the patients were divided into experimental group(60 cases)and control group(60 cases).Control group:routine drug therapy.Experimental group:pharmaceutical care treatment was carried out jointly,and the incidence of adverse reactions was compared between the two groups.Results:The incidence of adverse reactions in experimental group was lower than that in control group.Conclusion:In general hospitals,pharmaceutical care is effective in reducing adverse drug reactions,which can significantly reduce the incidence of adverse drug reactions.At the same time,this improves the safety of drug treatment,which is worthy of clinical promotion.

Design of Pharmaceutical Care Process for Retail Pharmacies Based on Pareto Analysis

Objective To study the problems of pharmaceutical care in retail pharmacies and provide reference for the standardized development of pharmaceutical care in China.Methods Based on the literature of CNKI database,Pareto analysis was used to study the present situation of pharmaceutical care in retail pharmacies.Then the following problems in pharmaceutical care were found such as low personnel professional quality,inadequate attention,imperfect laws and regulations,and lack of standard service process.As to the first three problems,there were more research references.But there was less literature on the standard care process.Results and Conclusion Focusing on the customer demand,taking drug sales process as the basic framework of pharmaceutical care standardized process,and combining with the collaboration,the service process including prescription drugs review and OTC drugs purchase consultation is established.This process elaborates the division of staff services as well as the service standards in pre-sale,on-sale,and after-sale stages.Besides,it also puts forward some advice for the previous three problems,which will ensure the smooth implementation of pharmaceutical care in drugstores.

Importance of the Pharmaceutical Council in the Dispensation of Laxants and Probiotics

The goal of pharmaceutical care is to improve the patient’s quality of life, and it must do so by maximising its effectiveness and reducing the risks of the treatment. Therapeutic protocols are an important tool for encouraging the correct use of drugs. The aims of this work are： to analyse the type of patients who visit the pharmacies in the study; to determine the importance of pharmaceutical advice in dispensing; and to identify the most commonly used strains of probiotics and laxatives. A transversal descriptive and observational study was conducted with 500 patients in five pharmacies. The population taking part in the study is predominantly female, aged over 61, of Spanish nationality, actively employed and with middle or higher educational studies. Over 90% of the patients followed the advice of the pharmacist over the advice of their doctors. The most widely used probiotics were Lactobacillus acidophillus and Saccharomyces boulardii for gastrointestinal protection and treatment of diarrhoea. The most commonly used laxatives are bulk-forming and contact laxatives. The pharmacist’s opinion is increasingly important in the treatment of pathologies that may be considered as minor. Therapeutic protocols are an aid to correct dispensing.

Research on the Construction of Pharmacy Organization and the Development of Pharmaceutical Services in China’s Primary Medical and Health Institutions—Based on the Survey of 5 Provinces

Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.

Occurrence and risks of pharmaceuticals,personal care products,and endocrine-disrupting compounds in Chinese surface waters

The continuous and rapid increase of chemical pollution in surface waters has become a pressing and widely recognized global concern.As emerging contaminants(ECs)in surface waters,pharmaceutical and personal care products(PPCPs),and endocrine-disrupting compounds(EDCs)have attracted considerable attention due to their wide occurrence and potential threat to human health.Therefore,a comprehensive understanding of the occurrence and risks of ECs in Chinese surface waters is urgently required.This study summarizes and assesses the environmental occurrence concentrations and ecological risks of 42 pharmaceuticals,15 personal care products(PCPs),and 20 EDCs frequently detected in Chinese surface waters.The ECs were primarily detected in China’s densely populated and highly industrialized regions.Most detected PPCPs and EDCs had concentrations between ng/L toμg/L,whereas norfloxacin,caffeine,and erythromycin had relatively high contamination levels,even exceeding 2000 ng/L.Risk evaluation based on the risk quotient method revealed that 34 PPCPs and EDCs in Chinese surface waters did not pose a significant risk,whereas 4-nonylphenol,4-tert-octylphenol,17α-ethinyl estradiol,17β-estradiol,and triclocarban did.This review provides a comprehensive summary of the occurrence and associated hazards of typical PPCPs and EDCs in Chinese surface waters over the past decade,and will aid in the regulation and control of these ECs in Chinese surface waters。