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.

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.

It’s Not Just the Money: Why Consumers Do Not Purchase Pharmacist-Provided Services

The reimbursement model for pharmaceutical care remains a barrier to successful widespread implementation of pharmacist-provided services. In some instances, community pharmacists have been successful in obtaining direct compensation for services from patients;however, evidence suggests that lack of patient demand for pharmacist-services may ultimately undermine the campaign for widespread third-party payment. The purpose of this study is to conduct a secondary analysis of data indicating consumer/patients’ rationale for not purchasing pharmacist-provided disease management services when offered the opportunity to do so in community pharmacies. Our review of the data indicates that while financial concerns are clearly important in consumer demand for pharmacist-provided services, other considerations exist. The consumer/patient belief that pharmacist-provided services are duplicative or that these services are not needed are significant barriers to overcome. Intensive education and marketing campaigns are needed to sway consumer opinion on the value of pharmacist-provided services.

Pharmaceutical practice and value of pharmacists under the new medical reform situation

Zero addition of drugs is an important aspect of medication reformation in the whole country, which is the end of the era of medicine. The role of pharmacists is changing from being medication dispensers to outcome-oriented and patient-focused care providers. However, it is still unclear how to play the role of pharmacists and carry out the related work in the new situation. Here, literature for relevant evidence was searched and summarized. Analysis results showed that there was a significant gap between pharmacy practice in China and developed countries. Evidence has supported pharmacists in their emerging role as care providers, that is available to improve the efficacy and quality of pharmaceutical care and ensure the safety of medicines for patients, but still more efforts are needed to promote new attitude toward more professional career, such as paying attention to the examination of outpatient prescription and medical orders, deeply clinical practice and individualized treatment, self-enhancement and public awareness of pharmacists. Collectively, the safety of patients can be ensured only by improving profession of pharmacists and showing the value of pharmacists. In doing so, pharmacy can develop rapidly, and pharmaceutical care with rational drug use can be realized.

Assessment of the quality of randomized controlled trials on pharmaceutical care for asthmatic patients in journals of China's Mainland

The objective of this study was to assess the quality of randomized controlled trials（RCTs） on pharmaceutical care for asthma tic patients conducted by pharmacists in China's Mainland, to identify the problems in current studies, and to provide some references for further studies. The China National Knowledge Infrastructure（CNKI）, Wanfang Database, and VIP Database were searched for randomized controlled trials on pharmaceutical care for asthma tic patients, and only those studies undertaken by pharmacists were included. Information about the study design and reporting of selected studies was extracted and collected to systematically analyze these studies. Meanwhile, the Cochrane Collaboration＇s tool for assessing risk of bias was used to assess potential biases related to these studies. Ultimately, 14 articles were included in this study. No study determined the sample size in a scientific way. No article reported a scientific and detailed method of random sequence generation or allocation concealment. Two（14.3%） studies claimed to have implemented a double-blinding and a single-blinding respectively, but neither of them reported any details about how they performed the blinding. No study employed a blinding of outcome assessment. Five（35.7%） studies either stated statistical methods incompletely or used them incorrectly. One（7.1%） study reported an attrition without employing an intention-to-treat analysis. All studies reported eligibility criteria for participants to some extent, and all these criteria involved diagnosis of asthma, but only four（28.6%） of them reported patients＇ ages and three（21.4%） described the severity and the stage of asthma. Nine（64.3%） reported baseline data in the text rather than in a table, and 13（92.9%） involved comparisons between groups with significance tests either explicitly or implicitly. No report made a distinction between primary and secondary outcomes. Two（14.3%） mentioned informed consent of subjects, while no article reported ethical approval. ＂Unclear risk＂ made up the highest percentage of the studies analyzed according to the risk of bias assessment by the Cochrane Collaboration＇s tool. Our study demonstrates that the quality of RCTs on pharmaceutical care for asthma tic patients conducted by Chinese pharmacists is suboptimal, especially with regards to study design and reporti ng.

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.

视频和节点提醒用于结肠镜检查肠道准备患者药学服务效果分析

目的探讨临床药师利用视频和节点提醒的药学服务对结肠镜检查肠道准备质量、不良反应发生情况、健康教育指导满意度的影响。方法选取医院消化内科2021年1月至12月接受结肠镜检查的住院患者216例,按肠道准备指导方式分为干预组和对照组,各108例。对照组患者给予肠道准备方案及复方聚乙二醇电解质散,以及传统纸质肠道准备指导单进行健康教育指导;干预组患者在对照组基础上由临床药师利用视频和节点提醒进行肠道准备健康教育。比较两组患者肠道准备质量的合格率和不良反应发生率,并同时调查患者对临床药师健康教育指导的满意度。结果干预组肠道准备质量合格率为87.96%,显著高于对照组的67.59%(P<0.05);干预组患者波士顿肠道准备评分量表(BBPS)评分显著高于对照组(P<0.05);干预组患者呕吐、腹胀不良反应发生率分别为5.56%和7.41%,均显著低于对照组的12.96%和13.89%(P<0.05)。干预组患者对临床药师健康教育指导的满意率为90.82%。结论临床药师利用视频和节点提醒的药学服务可显著提高结肠镜检查患者的肠道准备质量,减少呕吐、腹胀等不良反应,且患者满意度高。

医院合理用药信息化建设创新实践

目的提高医院药事管理效能,促进临床合理用药。方法医院药学部以原有合理用药信息化系统知识库为基础,建立了以问题为导向的双联合工作机制,主要表现为信息药师针对临床药师事后点评发现的用药问题建立管控方案,编写管控规则,不断完善知识库,通过信息化在处方和医嘱前置审核环节进行管控。在此基础上,对重点项目(如门诊适应证、围术期抗菌药物、抗肿瘤药物管理等)建立系统管控方案。结果2020年至2022年,共改进、优化基础知识库规则5266项,建立了具备564项自定义规则的自定义知识库;实现合理用药信息化系统版本升级4次,系统创新与改进32项;门诊/住院次均药品费用增幅、门诊处方合理率、住院医嘱合理率、抗菌药物使用强度等药事管理指标改善明显。结论构建全面的合理用药监管体系,能有效提升医院药事管理水平与药学服务能力,促进临床合理用药水平的提升。

临床药师对1例骨肉瘤患者进行围化疗期药学监护

目的探讨抗肿瘤药物专业临床药师参与肿瘤患者治疗的药学实践。方法通过对1例骨肉瘤患者进行围化疗期药学监护,阐述临床药师在肿瘤患者治疗中的作用。结果临床药师参与了肿瘤患者的全程治疗,医师和护理人员采纳临床药师的建议,患者顺利完成了第1周期化疗。结论围化疗期药学监护注重监护的时间和内容,可对患者进行有针对性和计划性的药学监护,是临床药师参与肿瘤患者治疗的重要切入点,有助于临床药师将自身专业知识转变成专业能力,从而更好地开展药学服务工作。

我院中医师与中药临床药师联合会诊工作模式建立及实践

目的为医疗机构选择和建立适用于自身临床特色的中药临床药学服务模式提供参考。方法结合临床案例,介绍我院中医师与中药临床药师联合会诊模式的工作流程、服务内容,并进行成效分析。结果我院联合会诊药学服务模式的工作流程分为评估患者用药情况,会诊查房、制定给药方案,床旁教育,药学监护,药学查房和药学延伸服务6个环节。该模式的服务内容主要包括会诊前充分收集临床信息,评估患者药物治疗方案;会诊中针对患者个体化情况,中药临床药师与中医师一起制定给药方案;会诊后开展床旁用药教育,保障患者正确用药;会诊后制定并执行药学监护计划;会诊后监测患者病情变化,及时反馈至会诊中医师以调整给药方案;会诊后提供药学延伸服务,开展药物咨询、药学门诊、联合门诊。该模式建立后,每年服务住院患者近1000人次,服用中药饮片患者的医嘱审核率为100%;个体化用药教育占比达到78.80%,患者满意度为100%;病区中药饮片处方合格率由联合会诊工作开展前的89.33%提高至开展后的97.08%;每年为1000余例患者提供中药相关咨询,为医护人员整理、提供药学资料近百份。结论通过建立中医师与中药临床药师联合会诊工作模式,开展中药临床药学服务,提高了中药饮片的合理使用水平,体现了中药临床药师价值。

临床药师参与1例大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染治疗的药学实践

目的为大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染患者的抗菌药物方案调整、不良反应识别和个体化药学监护提供参考。方法临床药师参与1例大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染患者的治疗全过程,结合循证证据协助临床遴选初期抗皮疽诺卡菌感染的联合治疗方案,并及时沟通微生物室以提供早期药敏数据;在患者出现癫痫时甄别可疑药物,并提醒临床亚胺培南西司他丁钠会影响丙戊酸钠疗效,建议将丙戊酸钠换为左乙拉西坦抗癫痫治疗,并停用亚胺培南西司他丁钠;治疗期间,建议临床对伏立康唑、利奈唑胺进行血药浓度监测,并根据监测结果协助临床及时调整用药剂量。结果医生采纳临床药师建议。患者病情好转,带药出院。结论临床药师基于循证医学证据、药敏试验结果和血药浓度监测数据,协助临床为患者选择敏感的抗感染方案;及时识别不良反应并调整治疗方案,并为患者提供全程用药监护,保证了临床药物治疗的安全性和有效性。

我国医疗机构药学会诊工作模式分析:一项范围综述

目的系统总结我国药学会诊的工作模式,为药学会诊的流程标准化、内容规范化与服务同质化提供参考。方法系统检索中英文文献数据库,纳入我国医疗机构发表的药学会诊工作模式文献,由2名研究者筛选与提取关键信息,最终进行定性总结与描述性分析。结果基于纳入的11篇文献,我国临床药师探索的药学会诊工作模式中,会诊内容主要涉及抗感染、肠外营养、癌性疼痛等。药学会诊的总体思路应参考已构建的流程图,具体的会诊问题可参考路径、思维导图或决策树等框架性指导开展工作,最后可根据会诊系统或专科会诊模板撰写会诊意见,采用新型的工作模式(如药师主动会诊)也可促进药学会诊数量和接受率的提升。结论我国医疗机构已初步探索出一系列药学会诊的工作模式,但尚未完善,缺乏统一的质控与评价体系,未来的研究与实践应重点予以关注。

基于人工智能+多元化教学法在肿瘤药学培训中的应用

目的探讨人工智能+多元化教学法在肿瘤药学服务能力提升培训中的应用效果。方法选取2023年第一、二期参加湖南省肿瘤药学服务能力培训班的175名学员作为研究对象,其中第一期学员(n=76)采取授课教学法(LBL+CBL教学法),第二期学员(n=99)采取人工智能+多元化教学法(AI+LBL+CBL结合情景模拟教学法),采用满意度调查问卷,从培训效果满意度、学习体验满意度和教学计划满意度三个维度进行教学效果评价。结果第二期培训效果满意度评价(99.0%vs 90.8%,P<0.05)以及教学计划满意度评价(99.0%vs 78.9%,P<0.05)优于第一期。人工智能+多元化教学方法在开拓临床思维和提高药学实践水平方面优于传统授课教学法(P<0.05)。提高科研工作能力方面,授课教学法表现更优(P<0.05)。学员培训方式的选择由多到少依次是情景模拟教学(97.0%)、结合案例教学(90.0%)、常规多媒体教学(53.5%)。结论人工智能+多元化教学方法满意度更高,更有利于肿瘤临床药师综合能力的提升,其中情景模拟实践教学更受学员欢迎,研究构建的肿瘤临床药学服务能力模式可为其他相关的培训与教学提供参考。

1例未足月胎膜早破青霉素过敏患者抗菌药物应用的药学监护

1例29岁有青霉素过敏史的妊娠女性,因“停经31+周,阴道流液5 h”入院。患者诊断为胎膜早破,有预防性应用抗菌药物指征。临床药师了解患者过敏史后,考虑发生青霉素速发型过敏反应风险较低,建议试行青霉素皮试或使用头孢呋辛。患者拒绝青霉素皮试,头孢呋辛皮试阳性。调整为万古霉素(1 g,每8 h 1次,静脉滴注)联合阿奇霉素(首次500 mg口服,第2天250 mg 1次·d^(-1),口服,疗程4 d),行B族链球菌(GBS)筛查及宫腔细菌培养。GBS筛查阴性,建议停用万古霉素。宫腔细菌培养报大肠埃希菌,结合患者症状体征、检验指标考虑污染可能性大,继续使用阿奇霉素。患者羊水较少,予引产后分娩,母儿情况可。阿奇霉素使用5d后停用,患者出院。产后2周随访母儿情况良好。

《药房自动化与信息技术标准》制订与解析

医疗机构药学部门以患者为中心的药事管理与药学服务能力的提升,离不开自动化与信息化。《医疗机构药事管理与药学服务》第4-4部分:药房自动化与信息技术标准是中国医院协会团体标准之一,对医疗机构自动化建设的基本要求、自动化硬件设备建设、智慧化信息平台建设、质量管理与持续改进4个方面32个关键要素进行了规范,可用于指导各级各类医疗机构对药房自动化设备与信息平台的选型与优化。该文介绍了《药房自动化与信息技术标准》的构建方法和内容,以加深同行对该标准的理解,促进该标准的落地执行。进一步推动医疗机构药学服务现代化、信息化与智慧化,提高整体医疗药事管理与服务的质量和效率。

营养支持药师参与居家肠内营养管理的药学服务与价值体现

居家肠内营养(HEN)可以提升患者生活质量、降低医疗费用,在美国、欧洲等地广泛普及。由于HEN制剂特点、药物相互作用以及患者营养状况存在个体差异,患者使用HEN期间需要营养支持药师(NSP)进行药学监护。中国的HEN尚处于起步阶段,NSP参与HEN缺乏相应的规范、指南及具体的运行标准。该文分析和探讨NSP参与HEN的管理现状、药学监护内容、药学服务价值体现,旨在为HEN的进一步实践及研究提供参考。

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。

利用临床药师工作站解读药敏试验结果的工作模式探讨

目的 探讨利用临床药师工作站解读药敏试验结果工作模式的意义。方法 介绍利用临床药师工作站解读药敏试验的工作流程、工作开展情况。结果 我院将常规药敏试验解读工作形成标准化系统板块嵌入临床药师工作站中,医生站以及检验科LIS系统与其智能化链接,使得报告的查收、发送以及接收均在线上完成,减少了中间环节,医生可在查收药敏试验结果的同时,更清晰地查看临床药师的用药建议。结论 利用临床药师工作站解读药敏试验结果的工作模式充分利用了信息化优势,提高了临床药师的临床参与度。该工作模式可量化,且覆盖科室范围较广,获得了临床的认可。

药学干预对某儿童医院国家基本药物使用情况的效果评价

目的:评价药学干预对某儿童医院国家基本药物使用情况的效果。方法:从医院信息系统分别抽取2021年(干预前)和2022年(干预后)某儿童医院国家基本药物使用数据,包括基本药物采购品种比、基本药物配备使用金额占比、门诊患者基本药物处方占比、门诊患者基本药物处方使用占比、住院患者基本药物使用率和住院患者基本药物使用占比,比较2021年与2022年各指标的全院增长率和不同临床科室的增长率。结果:与2021年相比,2022年我院基本药物采购品种比降低了1.32%,基本药物配备使用金额占比增长率为2.26%,门诊患者基本药物处方占比增加了13.82%,门诊患者基本药物处方使用占比增加了11.69%,住院患者基本药物使用率持平,住院患者基本药物使用占比增加了1.30%。基本药物各项考核指标明显改善的科室包括心内科、新生儿科、综合内科、神经外科、感染性疾病科、新生儿重症监护室、耳鼻喉科、血液科1、外科监护室和血液科2。结论:我院基本药物使用情况经临床药师干预后有一定的改进成效,但基本药物配备使用金额占比和住院基本药物使用率仍未达到省考要求,需要药师与医师积极配合对患儿家属进行基本药物宣教,增加其对基本药物的信赖程度,同时呼吁国家能够增加国家基本药物目录中儿童专科用药品种,提高儿童用药的经济性和可及性。