我国基层医疗机构药学服务现状及问题研究(三):药学服务开展现状分析
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摘要
目的:通过调查分析了解我国基层医疗机构药学服务开展的基本情况,发现其中存在的问题并寻求改进措施。方法:以面对面访谈的形式发放调查表,对全国各地基层医疗机构开展药学服务的内容、医师药师对药学服务的态度、药学服务的需求以及患者的认可与满意度情况等进行统计、分析。结果:发药(91.1%)、患者用药咨询(90.0%)、处方审核(79.6%)和药品管理(78.7%)是基层医疗机构药师开展频率最高的药学服务工作;几乎所有的药师(98.7%)和医师(96.5%)都认为基层医疗机构需要药师提供药学服务,绝大多数医师(85.3%)会对药师的用药建议予以不同程度的采纳;大部分患者服药前会仔细阅读药品说明书(78.6%)和留意药品保质期(82.1%),约一半的患者会主动了解相关药物知识(55.6%);患者在出现药物不良反应时咨询药师(13.7%)以及从药师处获取药物信息(11.0%)的比例偏低,接受药学服务相对不足;患者在医保报销比率(17.6%)、合理用药宣传(9.9%)和购药配药便利性(7.0%)方面的满意度相对欠缺。结论:我国基层医疗机构药学服务已有初步开展,具有一定的社会效益,但仍存在转变药师工作模式、提高药师与药学服务认可度以及满足患者更多服务需求等提升空间。
OBJECTIVE To learn about the basic development situation of pharmaceutical care practice in primary healthcare institutions in China through an investigation, finding out the problems with it and seeking measures to improve them. METHOD A face-to-face interview survey was conducted to collect the data on the development of pharmaceutical care, both physician and pharmacist attitudes to pharmaceutical care, patient demands for pharmaceutical care as well as patient acceptance and satisfaction with pharmaceutical care in the primary healthcare institutions throughout the country. RESULTS Drug dispensing(91.1%), medication consultation(90.0%), prescription review(79.6%) and drug administration(78.7%) awere the most frequently performed pharmaceutical services for pharmacists in primary healthcare institutions. Almost all of the pharmacists(98.7%) and physicians(96.5%) believed that there was a need for pharmacists to provide pharmaceutical care in primary healthcare institutions. The vast majority of physicians(85.3%) would accept pharmacist advice on medication to varying degrees. Most patients would read the drug label carefully(78.6%) and pay attention to the drug expiration date(82.1%) before taking the medicine. About half of the patients would learn some knowledge related to drug consciously(55.6%). Patients who would consult pharmacists when they had adverse drug reactions(13.7%) and that obtained drug information from pharmacists(11.0%) were both in low proportions, which indicated the low coverage of pharmaceutical services. Patients are not so satisfied with the medical insurance reimbursement ratio(17.6%), the promotion of rational drug use(9.9%), and the convenience in drug purchasing and dispensing(7.0%).CONCLUSION There are already some developments for the pharmaceutical care in the primary healthcare institutions of China, which creates certain social benefits. However, pharmacist transformation of working patterns, the improvement of acceptance for pharmacists and the pharmaceutical services provided by them, as well as the-satisfying more needs of patients for pharmaceutical care remains to be fulfilled in the future.
OBJECTIVE To learn about the basic development situation of pharmaceutical care practice in primary healthcare institutions in China through an investigation, finding out the problems with it and seeking measures to improve them. METHOD A face-to-face interview survey was conducted to collect the data on the development of pharmaceutical care, both physician and pharmacist attitudes to pharmaceutical care, patient demands for pharmaceutical care as well as patient acceptance and satisfaction with pharmaceutical care in the primary healthcare institutions throughout the country. RESULTS Drug dispensing(91.1%), medication consultation(90.0%), prescription review(79.6%) and drug administration(78.7%) awere the most frequently performed pharmaceutical services for pharmacists in primary healthcare institutions. Almost all of the pharmacists(98.7%) and physicians(96.5%) believed that there was a need for pharmacists to provide pharmaceutical care in primary healthcare institutions. The vast majority of physicians(85.3%) would accept pharmacist advice on medication to varying degrees. Most patients would read the drug label carefully(78.6%) and pay attention to the drug expiration date(82.1%) before taking the medicine. About half of the patients would learn some knowledge related to drug consciously(55.6%). Patients who would consult pharmacists when they had adverse drug reactions(13.7%) and that obtained drug information from pharmacists(11.0%) were both in low proportions, which indicated the low coverage of pharmaceutical services. Patients are not so satisfied with the medical insurance reimbursement ratio(17.6%), the promotion of rational drug use(9.9%), and the convenience in drug purchasing and dispensing(7.0%).CONCLUSION There are already some developments for the pharmaceutical care in the primary healthcare institutions of China, which creates certain social benefits. However, pharmacist transformation of working patterns, the improvement of acceptance for pharmacists and the pharmaceutical services provided by them, as well as the-satisfying more needs of patients for pharmaceutical care remains to be fulfilled in the future.
引文
[1] Jin F, Zhou LW, Wu JH, et al.A survey of the willingness of chronic patients to participate in community chronic disease management and its influencing factors[J].Modern Medicine J China(中国现代医药杂志),2016, 18(03):67-70.
[2] Wu JK, MaoKC, YinM.Expanding Pharmaceutical Service and Doing Well the Monitoring of Adverse Drug Reactions[J]. Capit Food Med(首都食品与医药),2006(24):16.
[3] Wang RY, GaoW, Yu CP, et al.Division and cooperation mechanism in urban hospitals and grass-roots health care institutions under the circumstances of the new medical reform[J].Chinese Rural Health Service Administration(中国农村卫生事业管理),2014,(11):1323-1326.
[4] Wu WH, He HB, Sheng QY, et al.The definition of the usage of primaryhealthcare institutions[J].Modern Business Trade Industry(现代商贸工业),2017(31):137-138.
[5] Pan LN. Pharmacy services and integrated pharmaceutical services[J].China Health Industry(中国卫生产业)2014 1136 15-16.
[6] Su QH,Guo H'O. Pharmaceutical services of hospital under big data[J].Chin J Hosp Pharm(中国医院药学杂志)2016,36(6):427-431.
[7] Li LL, Gong SW.The Content and Development Trend of Pharmaceutical Research in China[J].Chin J Hosp Phar(中国医院药学杂志),2012, 32(02):147-150.
[8] Hu XX.Exploration of PharmaceuticalCarePattern in Primary Healthcare Institutions[J].Chin Practic Med(中国实用医药),2013,8(27):275-276.
[9] Liu SY, Liu SL, Zhong Y. The Actuality and Development Countermeasures of Pharmaceutical Service in Primary Healthcare Institutions[J].J Clinic Medical Literature(临床医药文献电子杂志),2017,4(58):11481-11482.
[10] Hou FY. Investigation and thinking on the status of pharmaceutical care in primaryhealthcareinstitutions[A].Chinese Pharmaceutical AssociationHospital Pharmacy Committee. 2014 national hospital pharmacy(drug safety and evaluation)conference proceedings[C]. Chinese Pharmaceutical Association Hospital Pharmacy Committee,2014:2.
[11] Qiu X, Wang Y, Sui Y, et al. Investigation and analysis of the pharmaceutical care in primary medicalinstitutions of South of Shandong Province under new medical reform[J].China Modern Medicine(中国当代医药),2016,23(25):159-161.
[12] Sun G. Quantitative study of pharmaceutical care in health facilities in China[D]. Huazhong University of Science and Technology, 2010.
[13] Li X, Ping QN. Review and Prospect of Clinical Pharmaceutical Service Effect Evaluation Research[J].Herald Med(医药导报),2010, 29(5):691-695.
[14] Huang QJ, Ma KF.Evaluation of community pharmacy services in patients with hypertension[J]. China Pharmacist(中国药师),2011,14(02):260-261.
[15] Li Z, Fang ZJ, Ge MJ, et al. Intervention on effects ofintegrated pharmaceutical care for community chronic obstructive pulmonary disease patients[J]. Chin Gen Prac(中国全科医学),2011,14(13):1496-1500.
[16] Horvat N Koder M Kos M. Using the simulated patient methodology to assess paracetamol related counselling for headache[J].PLoS One 2012, 7(12):e52510.
[17] Svarstad BL, Bultman DC, Mount JK Patient counseling provided in community pharmacies:effects of state regulation, pharmacist age, and busyness[J] J Am Pharm Assoc,2004, 44:22-29.
[18] Svarsted BL,Bultman DC,Mount JK,et al Evaluation of written prescription information provided in communitypharmacies:a study in eight states[J]. J Am Pharm Assoc,2003, 43:383-393.
[19] Yu XY.Research on the legislation of Chinese pharmacists[D]. Nanjing University of Chinese Medicine, 2016.
[20]邵宏.美国临床药师培养模式初探[J].中国新药杂志, 2008,17(1):79-82.
[21] WHO. The role of the pharmacist in the health care system.Preparing the future pharmacist:curricular development[R]. Geneva:World Health Organization, 1997.
[22] Fan L. Encourage rural primary health care sector priority essential medicines and practice recommendations[D].Guangxi Medical University, 2015.
[2] Wu JK, MaoKC, YinM.Expanding Pharmaceutical Service and Doing Well the Monitoring of Adverse Drug Reactions[J]. Capit Food Med(首都食品与医药),2006(24):16.
[3] Wang RY, GaoW, Yu CP, et al.Division and cooperation mechanism in urban hospitals and grass-roots health care institutions under the circumstances of the new medical reform[J].Chinese Rural Health Service Administration(中国农村卫生事业管理),2014,(11):1323-1326.
[4] Wu WH, He HB, Sheng QY, et al.The definition of the usage of primaryhealthcare institutions[J].Modern Business Trade Industry(现代商贸工业),2017(31):137-138.
[5] Pan LN. Pharmacy services and integrated pharmaceutical services[J].China Health Industry(中国卫生产业)2014 1136 15-16.
[6] Su QH,Guo H'O. Pharmaceutical services of hospital under big data[J].Chin J Hosp Pharm(中国医院药学杂志)2016,36(6):427-431.
[7] Li LL, Gong SW.The Content and Development Trend of Pharmaceutical Research in China[J].Chin J Hosp Phar(中国医院药学杂志),2012, 32(02):147-150.
[8] Hu XX.Exploration of PharmaceuticalCarePattern in Primary Healthcare Institutions[J].Chin Practic Med(中国实用医药),2013,8(27):275-276.
[9] Liu SY, Liu SL, Zhong Y. The Actuality and Development Countermeasures of Pharmaceutical Service in Primary Healthcare Institutions[J].J Clinic Medical Literature(临床医药文献电子杂志),2017,4(58):11481-11482.
[10] Hou FY. Investigation and thinking on the status of pharmaceutical care in primaryhealthcareinstitutions[A].Chinese Pharmaceutical AssociationHospital Pharmacy Committee. 2014 national hospital pharmacy(drug safety and evaluation)conference proceedings[C]. Chinese Pharmaceutical Association Hospital Pharmacy Committee,2014:2.
[11] Qiu X, Wang Y, Sui Y, et al. Investigation and analysis of the pharmaceutical care in primary medicalinstitutions of South of Shandong Province under new medical reform[J].China Modern Medicine(中国当代医药),2016,23(25):159-161.
[12] Sun G. Quantitative study of pharmaceutical care in health facilities in China[D]. Huazhong University of Science and Technology, 2010.
[13] Li X, Ping QN. Review and Prospect of Clinical Pharmaceutical Service Effect Evaluation Research[J].Herald Med(医药导报),2010, 29(5):691-695.
[14] Huang QJ, Ma KF.Evaluation of community pharmacy services in patients with hypertension[J]. China Pharmacist(中国药师),2011,14(02):260-261.
[15] Li Z, Fang ZJ, Ge MJ, et al. Intervention on effects ofintegrated pharmaceutical care for community chronic obstructive pulmonary disease patients[J]. Chin Gen Prac(中国全科医学),2011,14(13):1496-1500.
[16] Horvat N Koder M Kos M. Using the simulated patient methodology to assess paracetamol related counselling for headache[J].PLoS One 2012, 7(12):e52510.
[17] Svarstad BL, Bultman DC, Mount JK Patient counseling provided in community pharmacies:effects of state regulation, pharmacist age, and busyness[J] J Am Pharm Assoc,2004, 44:22-29.
[18] Svarsted BL,Bultman DC,Mount JK,et al Evaluation of written prescription information provided in communitypharmacies:a study in eight states[J]. J Am Pharm Assoc,2003, 43:383-393.
[19] Yu XY.Research on the legislation of Chinese pharmacists[D]. Nanjing University of Chinese Medicine, 2016.
[20]邵宏.美国临床药师培养模式初探[J].中国新药杂志, 2008,17(1):79-82.
[21] WHO. The role of the pharmacist in the health care system.Preparing the future pharmacist:curricular development[R]. Geneva:World Health Organization, 1997.
[22] Fan L. Encourage rural primary health care sector priority essential medicines and practice recommendations[D].Guangxi Medical University, 2015.