基于“问药师”平台的用药咨询服务实践
|
摘要
目的:总结在"问药师"平台进行的用药咨询服务实践,为药师参与药学服务提供参考。方法:收集本文作者于2017年10月-2018年7月在"问药师"平台上对502例关于儿童、孕期和哺乳期妇女用药咨询服务的数据,对用药患者的一般情况及主要用药情况、咨询药物的种类、咨询的用药问题类型及其中的不合理用药类型进行统计与分析,并通过典型实例介绍药师基于循证理念指导患者合理用药的服务实践。结果:在502例咨询中,男性、女性分别为147(29.3%)、355(70.7%)例,年龄分布以20～40岁患者为主(291例,58.0%);同时用药1～2种、3～4种、5种及以上占比分别为45.4%、41.4%、13.2%,且同时服用5种及以上药物者均为儿童患者;在用药咨询内容中,儿童用药、哺乳期用药、孕期用药占比分别为42.0%、40.6%、17.4%,咨询药物的种类以抗菌药、中成药和抗病毒药占比最大,分别为25.6%、17.8%、12.1%,咨询的用药问题类型主要是药物适应证、用量与疗程、药物安全性与不良反应,占比分别为31.9%、17.5%、13.6%;不合理用药类型包括选药不合理、重复用药、无适应证用药,占比分别为44.1%、21.0%、14.9%;在典型实例中,药师严格按照循证理念进行系统地证据查询并解答患者的用药咨询,循证的主要流程包括制订检索策略、检索相关文献资料、严格评价证据(真实性、可靠性和适应性)并依据其证据级别从高到低依次筛选、综合评价证据并应用于实践。药师基于循证方法而提出的用药指导信息,不但纠正了患者的不合理用药,且收到了患者良好的反馈评价,满意度评价中5星评分占比为95.5%。结论:在"问药师"平台基于循证方法提供的用药咨询服务,可为药师进行有针对性的药学服务提供参考。
OBJECTIVE: To summarize the practice of medication consultation service based on the platform of "Our Pharmacist",and to provide reference for pharmacists participating in pharmaceutical care. METHODS:The 502 medication consultation service for children,pregnant women and lactating women were collected from the platform of"Our Pharmacist"during Oct. 2017-Jul. 2018. General information,main medication,types of drugs,types of questions,types of irrational drug use were analyzed statistically. The practice of rational drug use patient guidance service based on evidence-based concept was introduced with typical examples. RESULTS:Among 502 cases of consultation,147(29.3%)were males and 355(70.7%)were females,and the age was mainly 20-40 years old(291 case,58.0%). The proportions of patients taking 1-2,3-4,5 types or more drugs were 45.4%,41.4% and 13.2%,respectively,and those who took 5 or more drugs at the same time were all children's patients. In respect of medication consultation content,children medication consultation,pregnant medication consultation and lactating medication consultation accounted for 42.0%,40.6%,17.4%,respectively. Antibiotics,Chinese patent medicines and antivirals accounted for the largest proportion of consulting drugs,being 25.6%,17.8%,12.1%,respectively. The question types of medication consultation included indication,dosage and course of treatment,drug safety and ADR,accounting for 31.9%,17.5%,13.6%,respectively. The types of irrational drug use mainly included improper drug selection,repeated drug use and no indication,accounting for 44.1%,21.0%,14.9%,respectively. In typical cases,pharmacists conducted systematic evidence inquiry and answered patient consultation strictly in accordance with the evidence-based concept. The main evidence-based process included formulating retrieval strategies,retrieving relevant literature,strictly evaluating evidence(authenticity,reliability and adaptability),screening evidence according to its evidence level from high to low,evaluating evidence comprehensively and applying it to practice. Medication guidance information provided by pharmacists based on evidence not only corrected the irrational drug use of patients,but also received good feedback from patients. Five-star score accounts for 95.5% of the satisfaction evaluation. CONCLUSIONS: Based on evidence-based concept, the platform of "Our Pharmacist" provides medication consultation service,which provides references for pharmacists to carry out targeted pharmaceutical care.
OBJECTIVE: To summarize the practice of medication consultation service based on the platform of "Our Pharmacist",and to provide reference for pharmacists participating in pharmaceutical care. METHODS:The 502 medication consultation service for children,pregnant women and lactating women were collected from the platform of"Our Pharmacist"during Oct. 2017-Jul. 2018. General information,main medication,types of drugs,types of questions,types of irrational drug use were analyzed statistically. The practice of rational drug use patient guidance service based on evidence-based concept was introduced with typical examples. RESULTS:Among 502 cases of consultation,147(29.3%)were males and 355(70.7%)were females,and the age was mainly 20-40 years old(291 case,58.0%). The proportions of patients taking 1-2,3-4,5 types or more drugs were 45.4%,41.4% and 13.2%,respectively,and those who took 5 or more drugs at the same time were all children's patients. In respect of medication consultation content,children medication consultation,pregnant medication consultation and lactating medication consultation accounted for 42.0%,40.6%,17.4%,respectively. Antibiotics,Chinese patent medicines and antivirals accounted for the largest proportion of consulting drugs,being 25.6%,17.8%,12.1%,respectively. The question types of medication consultation included indication,dosage and course of treatment,drug safety and ADR,accounting for 31.9%,17.5%,13.6%,respectively. The types of irrational drug use mainly included improper drug selection,repeated drug use and no indication,accounting for 44.1%,21.0%,14.9%,respectively. In typical cases,pharmacists conducted systematic evidence inquiry and answered patient consultation strictly in accordance with the evidence-based concept. The main evidence-based process included formulating retrieval strategies,retrieving relevant literature,strictly evaluating evidence(authenticity,reliability and adaptability),screening evidence according to its evidence level from high to low,evaluating evidence comprehensively and applying it to practice. Medication guidance information provided by pharmacists based on evidence not only corrected the irrational drug use of patients,but also received good feedback from patients. Five-star score accounts for 95.5% of the satisfaction evaluation. CONCLUSIONS: Based on evidence-based concept, the platform of "Our Pharmacist" provides medication consultation service,which provides references for pharmacists to carry out targeted pharmaceutical care.
引文
[1]谢丽平.“互联网+”背景下药师用药咨询服务运作模式的探讨[J].海峡药学,2017,29(11):288-289.
[2]郑造乾,骆瑾瑜,王小军,等.微信用药教育公众平台的构建及应用研究[J].中国现代应用药学,2014,31(12):1520-1522.
[3]US Food and Drug Administration.Ribavirin[EB/OL].(2015-05-21)[2018-03-10].https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020903s053,021546s009lbl.pdf.
[4]SHIELDS MD,BUSH A,EVERARD ML,et al.BTS guidelines:recommendations for the assessment and management of cough in children[J].Throax,2008,63(Suppl 3):iii1-iii15.
[5]KENEALY T,ARROLL B.Antibiotics for the common cold and acute purulent rhinitis[J].Cochrane Database Syst Rev,2013,4(6):247-248.
[6]US Food and Drug Administration,Public Health Advisory.Nonprescription cough and cold medicine use in children:FDA recommends that over-the-counter(OTC)cough and cold products not be used for infants and children under 2 years of age[EB/OL].(2011-08-31)[2018-03-10].http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafety Informationfor Heathcare Professionals/Public HealthAdvisories/UCM051137.
[7]SHARFSTEIN JM,NORTH M,SERWINT JR.Over the counter but no longer under the radar:pediatric cough and cold medications[J].N Engl J Med,2007,357(23):2321-2324.
[8]American Academy of Pediatrics.Withdrawal of cold medicines:addressing parent concerns[EB/OL].(2011-08-23)[2018-03-10].http://practice.aap.org/content.aspx?aid=2254.
[9]冀连梅.一年狂卖40亿的匹多莫德,请放过中国儿童[J].中南药学(用药与健康),2018,3(3):23-27.
[10]国家食品药品监督管理总局.关于修订匹多莫德制剂说明书的公告(2018年第30号)[EB/OL].(2018-03-09)[2018-03-10].http://samr.cfda.gov.cn/WS01/CL1706/226085.html.
[11]PAPPAS DE,HENDLEY JO.The common cold and decongestant therapy[J].Pediatr Rev,2011,32(2):47-54.
[12]STOCKWELL MS,CATALLOZZI M,LARSON E,et al.Effect of a URI-related educational intervention in early head start on ED visits[J].Pediatrics,2014,133(5):1233-1240.
[13]American Academy of Pediatrics,Committee on Drugs.Use of codeine and dextromethorphan containing cough remedies in children[J].Pediatrics,1997,99(6):918-920.
[14]WALTER K,DILGER C.Ibuprofen in human milk[J].Br J Clin Pharmacol,1997,44(2):211-212.
[15]RIGOURD V,DE VILLEPIN B,AMIROUCHE A,et al.Ibuprofen concentrations in human mature milk:first data about pharmacokinetics study in breast milk with AOR-10127“Antalait”study[J].Ther Drug Monit,2014,36(5):590-596.
[16]ITO S,BLAJCHMAN A,STEPHENSON M.Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication[J].Am J Obstet Gynecol,1993,168(5):1393-399.
[17]HALE TW.Medications&mothers’milk:17th[M].New York:Springer Publishing Co Inc,2017:476.
[18]RICHARD KM.Drugs during pregancy and lactation:Treatment options and risk assessment[M].3rd edition.London:Academic Press,2015:655-656.
[19]AAP.The transfer of drugs and other chemicals into human milk[J].Pediatrics,2001,108(3):776-789.
[20]冀连梅.冀连梅谈:中国人应该这样用药(图解母婴版)[M].南京:江苏凤凰科学技术出版社,2016:35-37.
[21]国家食品药品监督管理总局.关于修订利巴韦林颗粒剂说明书的通知[EB/OL].(2006-02-21)[2018-03-10].http://samr.cfda.gov.cn/WS01/CL1706/226085.html.
[22]EICHENBERGER PM,LAMPERT ML,KAHMANN IV,et al.Classification of drug-related problems with new prescriptions using a modified PCNE classification system[J].Pharm World Sci,2010,32(3):362-372.
[23]PAULINO EI,BOUVY ML,GASTELURRUTIA MA,et al.Drug related problems identified by european community pharmacists in patients discharged from hospital[J].Pharm World Sci,2004,26(6):353-360.
[24]GRANAS AG,BERG C,HJELLVIK V,et al.Evaluating categorisation and clinical relevance of drug-related problems in medication reviews[J].Pharm World Sci,2010,32(3):394-403.
[25]STAFFORD AC,TENNI PC,PETERSON GM,et al.Drug-related problems identified in medication reviews by Australian pharmacists[J].Pharm World Sci,2009,31(2):216-223.
[26]苏琼华,秦玉花.浅谈药学服务中的人文关怀[J].中国药房,2010,21(5):470-472.
[2]郑造乾,骆瑾瑜,王小军,等.微信用药教育公众平台的构建及应用研究[J].中国现代应用药学,2014,31(12):1520-1522.
[3]US Food and Drug Administration.Ribavirin[EB/OL].(2015-05-21)[2018-03-10].https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020903s053,021546s009lbl.pdf.
[4]SHIELDS MD,BUSH A,EVERARD ML,et al.BTS guidelines:recommendations for the assessment and management of cough in children[J].Throax,2008,63(Suppl 3):iii1-iii15.
[5]KENEALY T,ARROLL B.Antibiotics for the common cold and acute purulent rhinitis[J].Cochrane Database Syst Rev,2013,4(6):247-248.
[6]US Food and Drug Administration,Public Health Advisory.Nonprescription cough and cold medicine use in children:FDA recommends that over-the-counter(OTC)cough and cold products not be used for infants and children under 2 years of age[EB/OL].(2011-08-31)[2018-03-10].http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafety Informationfor Heathcare Professionals/Public HealthAdvisories/UCM051137.
[7]SHARFSTEIN JM,NORTH M,SERWINT JR.Over the counter but no longer under the radar:pediatric cough and cold medications[J].N Engl J Med,2007,357(23):2321-2324.
[8]American Academy of Pediatrics.Withdrawal of cold medicines:addressing parent concerns[EB/OL].(2011-08-23)[2018-03-10].http://practice.aap.org/content.aspx?aid=2254.
[9]冀连梅.一年狂卖40亿的匹多莫德,请放过中国儿童[J].中南药学(用药与健康),2018,3(3):23-27.
[10]国家食品药品监督管理总局.关于修订匹多莫德制剂说明书的公告(2018年第30号)[EB/OL].(2018-03-09)[2018-03-10].http://samr.cfda.gov.cn/WS01/CL1706/226085.html.
[11]PAPPAS DE,HENDLEY JO.The common cold and decongestant therapy[J].Pediatr Rev,2011,32(2):47-54.
[12]STOCKWELL MS,CATALLOZZI M,LARSON E,et al.Effect of a URI-related educational intervention in early head start on ED visits[J].Pediatrics,2014,133(5):1233-1240.
[13]American Academy of Pediatrics,Committee on Drugs.Use of codeine and dextromethorphan containing cough remedies in children[J].Pediatrics,1997,99(6):918-920.
[14]WALTER K,DILGER C.Ibuprofen in human milk[J].Br J Clin Pharmacol,1997,44(2):211-212.
[15]RIGOURD V,DE VILLEPIN B,AMIROUCHE A,et al.Ibuprofen concentrations in human mature milk:first data about pharmacokinetics study in breast milk with AOR-10127“Antalait”study[J].Ther Drug Monit,2014,36(5):590-596.
[16]ITO S,BLAJCHMAN A,STEPHENSON M.Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication[J].Am J Obstet Gynecol,1993,168(5):1393-399.
[17]HALE TW.Medications&mothers’milk:17th[M].New York:Springer Publishing Co Inc,2017:476.
[18]RICHARD KM.Drugs during pregancy and lactation:Treatment options and risk assessment[M].3rd edition.London:Academic Press,2015:655-656.
[19]AAP.The transfer of drugs and other chemicals into human milk[J].Pediatrics,2001,108(3):776-789.
[20]冀连梅.冀连梅谈:中国人应该这样用药(图解母婴版)[M].南京:江苏凤凰科学技术出版社,2016:35-37.
[21]国家食品药品监督管理总局.关于修订利巴韦林颗粒剂说明书的通知[EB/OL].(2006-02-21)[2018-03-10].http://samr.cfda.gov.cn/WS01/CL1706/226085.html.
[22]EICHENBERGER PM,LAMPERT ML,KAHMANN IV,et al.Classification of drug-related problems with new prescriptions using a modified PCNE classification system[J].Pharm World Sci,2010,32(3):362-372.
[23]PAULINO EI,BOUVY ML,GASTELURRUTIA MA,et al.Drug related problems identified by european community pharmacists in patients discharged from hospital[J].Pharm World Sci,2004,26(6):353-360.
[24]GRANAS AG,BERG C,HJELLVIK V,et al.Evaluating categorisation and clinical relevance of drug-related problems in medication reviews[J].Pharm World Sci,2010,32(3):394-403.
[25]STAFFORD AC,TENNI PC,PETERSON GM,et al.Drug-related problems identified in medication reviews by Australian pharmacists[J].Pharm World Sci,2009,31(2):216-223.
[26]苏琼华,秦玉花.浅谈药学服务中的人文关怀[J].中国药房,2010,21(5):470-472.